E Merck’s Cult of Sight

Can a drug company commit itself to sell free its patented drug to the society as long as it is needed? Yes. E-Merck did it and succeeded in eradicating a dreaded disease that blinded millions in the third world!

River blindness is one of the leading causes of preventable blindness worldwide. Transmitted through the bite of black flies — which live and breed near fast-flowing streams and rivers — and can cause intense itching, permanent skin and eye lesions and, over time, blindness. It has historically been prevalent in remote rural areas of 36 countries (in Africa, Latin America, and in Yemen.) for centuries… This is called river blindness. For centuries, River blindness has no solution and it was on WHO’s list of neglected tropical diseases targeted for elimination globally.

This all began to change in the mid-to-late 1970s when Dr. William Campbell of Merck Research Laboratories suggested the use of ivermectin (later named Mectizan) for river blindness in humans. Following the breakthrough lab work by Dr. Campbell, another Merck researcher, Dr. Mohammed Aziz, championed the clinical development of Mectizan. Dr. Aziz led the collaboration with the World Health Organization (WHO) in the early 1980s to design and implement field studies in West Africa that, ultimately, proved the effectiveness of the drug against river blindness.

In 1987, Merck committed to eliminate this blindness from the third world countries decided to donate Mectizan – note not sell – “as much as needed, for as long as needed” – with the goal to help eliminate river blindness. It is at least a twelve year regimen to an adult!

More than thirty years later, the results of this pioneering program speak for themselves. Several countries in Africa are making significant progress towards eliminating both diseases. In Latin America, four countries – Colombia, Ecuador, Mexico and Guatemala – have received WHO verification of river blindness elimination.

There are good samiritans in pharmaceutical industry and not all are just profiteering as the sole motive on the suffering of humanity!! All businesses make profits to sustain but a few earn goodwill by handholding the suffering poor!

Is the motif in E-Merck’s office, the ‘cult of sight’ or ‘lead by example’? What does the motif of this blind man led by a youth, convey? Science leads the world by ‘example’!

Tryst with Death

How would you like to die?

Does the word ‘death’ not send tremors to most of us? Since time immemorial, man would strive to do anything to ward off death – be it ‘a magic potion – elixir of life’ or religious rites to please the god of death. Rig Veda advocates a prayer to Lord Shiva – mrithyanjaya mantra, that can protect one from death. It is believed to stop premature deaths, or at best ward off the fear of death! There are citations in epics where Lord Shiva himself revealed this mantra to his disciples: Markandeya, sukrachaya and Rishi Vasishta. One who does not die is called a Chiranjeevi. There are six more Chiranjeevis as per Hindu mythology: Hanuman, Parashurama, Vibhushan, Aswathama, Mahabali and Kripacharya. Though ‘chranjeevi’, lives for ever, one can consider himself so, after having lived for over a hundred years in the present day of evolutionary autonomy coupled with progress in various facets of medical field. The life expectancy otherwise being a little over 70 years in most of the developed societies of the world.

Is living that long a boon or bane?

As people age, they are much more likely to develop degenerative conditions that could lead to a lower quality of life. Crucially, strategies to promote healthy ageing may not only ease the burdens on society, but help to ensure that our longer lives are better lives – even in a philosophical sense. As the population continues to age, we will need to make important and potentially difficult choices about how we want to care for the elderly. Sometimes it might be better for us to die earlier than we otherwise might have, if doing so is more consistent with the “life story” we wanted for ourselves – for example, being active and independent throughout our lives. Else life then becomes a pain rather than pleasurable. But even then, the very thought of Death is scaring – as dying is not easy.

But terminally ill also may dwell on such thoughts!

Though the impact of sudden death is terrible, it is extremely painful to watch the sufferings of terminal ills. More so to the kith and kin. Even the philosophically balanced person would be extremely disturbed if the ‘expiry date’ is known! For example those who are terminally ill, their days are counted but not sure whether it is months or years. In such cases, the life expectancy statistics are just numbers that are not useful to those suffering. Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. Those are really blessed who do not know the ‘secret’ – ignorance is bliss!

Though there were several writers who wrote about the mental tribulations of the kith and kins when the ‘death’ was at the doorstep, the recent one by Dr Paul Kalanidhi, ‘while breath becomes air’ depicts the resolution to face the reality with determination and grace! After years of hard work, when he was about to reach his cherished goal of qualified neurosurgeon, he was struck with lung cancer. In this book, written in his twilight years of less than two years from the knowledge of his impending death, he beautifully depicts the mental tribulations of all close to him, most of them doctors in their own right. With so much of plans to accomplish in life, when death suddenly stares at him, he and his wife settle down to face the reality and plan for the small ‘left over’ life. It needs immense guts to live the ‘remnant’ life with grit.

On the other hand, sudden death, say due to massive heart attack or by an accident, though is extremely painful, is on an entirely different plane, compared to the slow death.

Coming to the life of ‘non-Chiranjeevis’, the normal mortals – most of them age ‘gracefully’. As one ages the expectations of ‘left over’ remnant life depends on the quality of life or the their present status of health. The wish reduces – accordingly one plans ‘the future’ – in sixties it may be for a decade at best, while in nineties, even if you wake up healthy, you should be happy – you live for the day! One should be aware of fragility of life, though! I am not talking of life of ‘real chiranjeevis’ living after scoring a century.

Think of the plight of terminally ill patients, when the doctor first pronounces the prognosis. They invariably utter – ‘God, why me? What have I done for the hell to befall on me?’. But the fact of life is, if such thing can happen to anybody, then why not you. There are diseases with extremely rare even in productive age group who are commonly with robust health – But it is not absolute zero occurrence. How many can simply accept that as one’s fate? Yes, it is a fact that all are mortals, but knowing when you are going to die or the death is not far away, is extremely sickening! The fateful day being a secret to many, is indeed a blessing in disguise!

Even if you have not sinned, you may not be totally risk free! The oft quoted adages like வினை விதைத்தவன் வினை அறுப்பான், as you sow so you reap, is to keep the morally weak not to sin. But in day to day life, do you really see its happening that way? No. One sows for others to reap! The adage is pronounced only to heal your afflicted wounds – to curse others who are harming – to vent out your helplessness!

I am amazed at our elders often putting a prefix while pronouncing any plans – ‘பொழைச்சுக்கிடந்தா நாளைக்கு ஊருக்கு போகலாம்’! This roughly translates to ‘will go to town, if at all we are alive’ – what a prophetic statement? They have understood that life is uncertain. If at all one plans, be certain that there would be ‘uncertainty that can’t be planned’!

In the Indian epic ‘Mahabharata’, there comes an encounter with ‘yaksha’. The eldest of the Pandavas is asked by the yaksha several questions and one of them is on this present topic – ‘who is the most ignorant fool?’ Dharmaraj answers ‘those who think they would not be dying even after being witness to many of the deaths around’! This phenomenon called ‘death’ could not have been philosophically explained better!

But taking the life as it is even while being terminally ill and suffer in silence, require moral strength which only a few possess. King Parikshit on knowing he is left with only a week to live, listened to ‘Bhagavatham’ for a blissful demise!

தேர்ந்த ஆன்மீகவாதிகள் நாளையும் நேரத்தையும் குறித்து கொடுத்துவிட்டு அந்த நாளில் சமாதி அடைவதாக கேள்விப்படுகிறோம். அது அவர்கள் தவத்தினால் கிடைத்த வரம். அது போல் எதுவும் அறியாதவர்களுக்கு மரணகாலத்தை மறைத்து வைப்பது இறைவன் கொடுப்பினை.
அதுவும் இருக்கும்வரை (ஓரளவுக்காவது) பிறருக்கு துன்பம் தராமல் இருப்பதும் கொடுப்பினை. அது இயற்கையாக நிகழ்வதும் கொடுப்பினை. நோய் என்று வந்து வாழ்கையே சுமை என்னும்போது மரணமே கொடுப்பினை. அனைத்துக்கும் ஆண்டவன் அருள் வேண்டும்.

Is there any other way to get mental peace for ‘agnostics’ in this predicament?

Could Scientists ever become mightier than the Almighty?

Genes evolve over eons by natural selection. If one starts manipulating them, would nature not rebel? Is there a limit to exploit the knowledge of genes to suit the goals by those superior in the nature’s hierarchical ladder, the homosapens?

The major beneficial impact of genetic research was realised when Genentech announced the production of genetically engineered human insulin in 1978. The insulin produced by bacteria was approved for release by the Food and Drug Administration of USA in 1982. The prices of this life saving drug drastically reduced since then. Another breakthrough was in the drug research: Genetically modified mice are not aware opthe defacto standard for the study and modelling of cancer, obesity, heart disease, diabetes, arthritis, substance abuse, anxiety, aging and Parkinson disease. Also genetically modified pigs have been bred with the aim of increasing the success of pig to human organ transplantation.

Genetic research entered paradigm shift when Gene editing became a reality. The gene editing tool known as CRISPR catapulted into scientific laboratories and headlines only a few years ago. Clustered regularly interspaced short palindromic repeat (CRISPR)-Cas systems are well-known acquired immunity systems that are widespread in archaea and bacteria. The RNA-guided nucleases from CRISPR-Cas systems are currently regarded as the most reliable tools for genome editing and engineering. The first hint of their existence came in 1987, when an unusual repetitive DNA sequence, which subsequently was defined as a CRISPR, was discovered in the Escherichia coli genome during an analysis of genes involved in phosphate metabolism.

This year’s chemistry Nobel was awarded to Emmanuelle Charpentier and Jennifer Doudna for their work on CRISPR, a method that can cut up DNA in an organism’s genome and edit its sequence, the genetic “instructions” that determine how an organism will develop. CRISPR is currently making a huge impact in health: There are clinical trials on its use for blood disorders such as sickle cell disease or beta-thalassemia, for the treatment of the most common cause of inherited childhood blindness and for cancer immunotherapy. It is literally a ‘cutting edge’ technology today.

The Regeneron cocktail that was recently administered to president Trump, has fully-human antibodies produced by the mice, which have been genetically modified to have a human immune system, as well as antibodies identified from humans who have recovered from COVID-19.

Fast on its heels of gene editing came the reemergence of a profoundly consequential controversy: Should these new techniques be used to engineer the traits of future children, who would pass their altered genes to all the generations that follow? This is not an entirely new question. The prospect of creating genetically modified humans was openly debated back in the late 1990s, more than a decade and a half before CRISPR came on the scene and several years before the human genome had been fully mapped.

The use of gene-editing in human cases following the first use by Chinese scientist He Jiankui, who made the first genome-edited human babies in 2018. He Jiankui and his colleagues were targeting a gene called CCR5, which is necessary for the HIV virus to enter into white blood cells (lymphocytes) and infect our body. The team wanted to recreate this mutation using CRISPR on human embryos, in a bid to render them resistant to HIV infection, the father being HIV positive. But this did not go as planned and they generated different mutations, of which the effects are unknown. The twin girls were delivered by the mother, may or may not have been conferred HIV resistance, and may or may not have other consequences.

Editing the genes of an embryo is not enough to create a designer baby. The embryo would need to be viable, and working with viable embryos — one that can actually develop into babies — is a whole new step that many countries would not allow. But if someone were to do this work on viable embryos, implant them in a hospitable womb in a fertility clinic, and let them be carried to term, that would effectively create a person with genetically modified DNA that they’d then be able to pass on.

During the same millennial shift, policymakers in dozens of countries came to a very different conclusion about the genetic possibilities on the horizon. They wholeheartedly supported gene therapies that scientists hoped (and are still hoping) can safely, effectively, and affordably target a wide a range of diseases. But they rejected human germline modification—using genetically altered embryos or gametes to produce a child—and in some 40 countries, passed laws against it. There are 29 countries had an outright legal ban on genetic editing. In China, India, Japan, and Ireland, bans existed but didn’t necessarily have legal enforcement mechanisms behind them. In the case of China, the group who announced their famous results in April was able to get permission to work with non-viable embryos that could never have been brought to term; that’s how they worked within China’s guidelines. The US a special case, where the NIH has a moratorium on this research. Other countries have ambiguous rules.

Direct genetic engineering in the food industry has been controversial ever since its introduction. The successful completion of two decades of commercial GM crop production (1996–2015) is underscored by the increasing rate of adoption of genetic engineering technology by farmers worldwide. With the advent of introduction of multiple traits stacked together in GM crops for combined herbicide tolerance, insect resistance, drought tolerance or disease resistance, the requirement of reliable and sensitive detection methods for tracing and labeling genetically modified organisms in the food/feed chain has become increasingly important. The most widely accepted genetically modified traits in GM crops are herbicide tolerance and insect resistance. GM soybean, maize, canola, and cotton are the most common examples of these crops in the market. Developing countries like India and China are the largest producers of genetically modified Bt cotton. The development of a newer dicamba and 2,4-D tolerant crops as an update of older version, exposes that despite contradicting the warnings of environmentalists, corporations were actively preparing for the emergence of superweeds. The introduction of these new herbicide tolerant crops is an admission of failure. It also represents a colossal failure of imagination in dealing with the cycle of problems in chemical-GM farming. The biotech industry is committed to addressing the problems that GM creates with new GM products rather than with actual solutions.

For 10 years, the company Oxitec has been testing whether genetically modified mosquitoes can suppress populations of their natural brethren, which carry devastating viruses such as Zika and dengue. Its strategy: Deploy (nonbiting) male Aedes aegypti mosquitoes bearing a gene that should doom most of their offspring before adulthood. Now, a team of independent researchers analyzing an early trial of Oxitec’s technology is raising alarm—and drawing fire from the firm—with a report that some offspring of the GM mosquitoes survived and produced offspring that also made it to sexual maturity. As a result, local mosquitoes inherited pieces of the genomes of the GM mosquitoes. There’s no evidence that these hybrids endanger humans more than the wild mosquitoes or that they’ll render Oxitec’s strategy ineffective. “The important thing is something unanticipated happened,” says population geneticist Jeffrey Powell of Yale University, who did the study with Brazilian researchers. “When people develop transgenic lines or anything to release, almost all of their information comes from laboratory studies. … Things don’t always work out the way you expect.”

Should the scientific pursuits and new knowledge frontiers not allow their exploitation for healthier life? Could the present day fertility clinics produce ‘designer babies’ in the future? Should it serve to increase the food production? Or Would it be construed as interfering with the God’s nature by the society?

So far this Million dollar question has not been answered yet, right?

Credits:

1. History of CRISPR-Cas from Encounter with a Mysterious Repeated Sequence to Genome Editing Technology: Yoshizumi Ishino, Mart Krupovic, Patrick Forterre

https://jb.asm.org/content/200/7/e00580-17

Is India generously over reporting covid numbers?

Should all the covid patients be isolated? Are they all infectious? No. Only those with sufficient viral loads would infect. If so, why not judiciously detect the high viral load patients?

There is a growing concern among the epidemiologists that the widely used, RT-PCR, a gold standard test, is so sensitive that it is not that useful in the present phase of pandemic. In RT-PCR, the number of amplification cycles needed to find the virus, called the cycle threshold, Ct, is set in most of the machines by the manufacturers at 40, a few at 37. This sensitivity is set from the point of view of not to miss the RNA at ‘any cost’.

Would this high sensitivity be counter productive now?

A major drawback of PCR and other diagnostic approaches (including RAT) is that they all fail to determine virus infectivity; PCR sensitivity is excellent but specificity for detecting replicative virus is poor. A typical study (3), involving symptomatic individuals, utilising a cross-sectional approach to correlate COVID-19 symptom onset to specimen collection with SARS-CoV-2 E gene RT-PCR and virus viability as determined by cell culture was conducted. These results demonstrate that infectivity (as defined by growth in cell culture) is significantly reduced when RT-PCR Ct values are > 24. For every 1-unit increase in Ct, the odds ratio for infectivity decreased by 32%. The high specificity of Ct and STT (Symptoms To Test) suggests that Ct values > 24, along with duration of symptoms > 8 days, may be used in combination to determine duration of infectivity in patients.

In another study (2) of three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, it was found that up to 90 percent of people testing positive carried barely any virus. They had Ct values set between 37-40.

Any test with a cycle threshold above 35 is too sensitive. Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left.

People infected with the virus are most infectious from a day or two to about five to eight days after getting infected irrespective of appearance of symptoms. But with a low Ct threshold, the start phase might give a negative result. But in a few days, the viral load would increase sufficient enough to get a ‘positive’ and again it will taper out to give a ‘negative’. Only a delayed, repeat test (with a gap of 4 or 5 days) could confirm the phase! But at the current testing rates, it is impossible to do frequent testing to capture somebody in that window. It is more so if the person is asymptomatic with potential viral loads. Repeat tests, while only some can afford, may be a heavy burden on the health infra if adopted as a policy by the state.

From these analysis, there appears a strong case for lowering the threshold which is set very conservatively in India at 40. But, it is discounted by many, including the ICMR. Why ICMR is not inclined to take these suggestions and update their advisories, which are now followed in the west? The concern is from the fact that the amount of viral loads collected in swabs is not quantitative. Hence detection could differ even with same Ct values? Hence it would not give a reliable guidance. But, a conservative cutoff could be 30 to 35, may be at 30 could be a solution.

Alternatively, if Ct in RT-PCR could not give a dependable conclusion, then why not adopt RAT, that would only qualitatively give positives based on the ‘infectability’. The usual blame of ‘false negatives‘ that is missing out some positives (5%) may be due to low viral loads.

The latest protocol and advisory of ICMR on this strategy encompasses most of the concerns. It is now for the implementing states to follow. Higher dependence on RT-PCR by some states could delay the end of the ‘war’.

There is yet another dimension to the high sensitivity of RT-PCR: one may not get a negative test after the standard two weeks isolation. Only an anti body test could confirm the absence of infection. In some states, negative tests are demanded for removing the quarantine requirement. RT-PCR may be a gold standard since it detects even a fragment of dead virus! But would it not mislead the less informed health authorities?This could also be a reason for ‘alarming‘ reports of ‘reinfection‘!

Presently, the strategy of isolation of the infected is until 2 negative NP RT-PCR results 48 hours apart after 14 days of symptoms. Since, RT-PCR positivity persists significantly beyond infectivity is It is appropriate to adopt the Clinical criteria of 14 days from symptom onset or 72 hours symptom free (whichever is longer), to avoid any unnecessary isolation, and use of personal protective equipment and testing resources. And avoidable restrictions to the infected and their near and dear.

For asymptomatics, a 14 day quarantine without retesting would be sufficient.

The RT PCR with the present protocols would not at all miss a positive case but, some ‘false positives‘ can’t be ruled out. On the other hand, why not accept certain missed cases with Rapid Antigen Test that gives some ‘false negatives‘. If RAT is adopted to test only for asymptomatics, the error would not be damaging from infection control point of view: The missed cases would not spread the infection as RAT misses them only due to low viral loads. The error is manageable and acceptable in such demographically large and economically challenging country like India.

But, for heaven’s sake let us not report unnecessarily high case numbers with very sensitive RT-PCR, and frighten the general public.

Credits:

1. https://in.dental-tribune.com/news/cycle-threshold-ct-value-of-rt-pcr-can-tell-us-if-a-sars-cov-2-infected-person-can-spread-disease/

2. https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html?referringSource=articleShare

3. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

Safety Protocols for Sanjeevini

Would Lakshman have survived had the safety protocols, now insisted for Covid vaccine, were in vogue during the Ram-Ravan war? Ram would have resisted Jambavan’s impromptu prescription of ‘sanjeevini’ brought through Maruti’s ‘himalayan’ journey! Luckily, there was no drug controllers around then. Why the present day ‘drug control’ regime not take inspiration from Ramayana? Could a vaccine under development become a Sanjeevini?

Vaccines are approved for mass deployment only after thorough phased protocols. Many vaccines are in pipeline but only a few are closer to the winning mark. Some have reached the final stage 2 and 3 phases. Since a vaccine is cleared for mass immunisation only after the stage 3 trials, with quite a few in stage 2, it is pertinent to understand the significance of the trial stages.

Stage 1 is animal experiment while 2 & 3 are human trials. Stage 2 trials are designed to establish safety, that is whether the vaccine gives any adverse or side reaction. Volunteers selected are to be healthy otherwise and the number should be small may be a few hundreds with close follow ups.

Stage 3 is to establish the effectiveness. The Volunteers from all segments are identified for reliable statistical analysis. The thumb rule for crossing the winning post in this trial, is that the number of people infected subsequently, should be less than the control group, that is given placebos. Under normal circumstances, a vaccine will be accepted as effective and considered for approval if the number affected in the control group is 50% more. The number of recorded infections is set at 150 by many regulators. Independent panels of experts called data and safety monitoring boards (DSMB) will review trial data at pre-specified points in both the stages. These boards can recommend companies stop the trials if the evidence is overwhelmingly positive or negative.

Presently vaccines from Astra Zeneca, Pfizer and Moderna are in stage 3 trials. These vaccine trials which have enrolled thousands of people, say they may have proof of effectiveness of the vaccine, after just a few dozen subjects become infected. Would it be considered too low or adequate for emergency approval? With the infection in waning phase, would there be any fertile ground for statistically sufficient number of infections? Or Would one country accept a finding of infection data in any other country? The vaccine trial is at its controversial crossroads for approval and commercial deployment .

Should one have to wait till all the safety tests are completed in Phase-3 or deploy vaccines based on risk-benefit analysis? Especially in ‘pandemics‘? Would it not be possible to build adequate ’fine prints’ to absolve all the parties involved in the immunisation chain, if it all it statistically misfires later? No doubt compensation claims have to be contended with, whatever may be the well meaning ‘shortcuts’ are! Should the manufacturers set aside a part of the ‘booty’ while costing the ‘magic portion’? Regulators also can charge hefty levies for such ‘emergency approvals’ should there be any need to compensate the victims on a later date! It would also keep all the parties, those who follow the lengthy protocols and who bypass them through shortcuts, on a level playing field! Otherwise they will be accused of ‘kickbacks‘!

UK and USA would lead the list of liberal nations in wriggling a way out of the conundrum! UK is already rewriting its laws to allow emergency use of any effective coronavirus vaccine well before it is fully licensed; The proposed regulations would permit emergency approval, allowing people to be immunized while the full licensing process is sill being finished! Wouldn’t rewriting such protocols raise the eyebrows? Proverbially, if law makers who frame the laws themselves can not rewrite their own guidelines, who else has the rights?

It is trumpeted that the United States may have four Covid-19 vaccines would be in large-scale clinical trials by the middle of September, so that the programme of approval of tens of millions of (doses of) safe and effective vaccines be available by calendar year-end. Would CDC match the pace of frustrated Trump whose earnest wish is not only to save his dear citizens, but also his chair as well! China and a Russia have already started their immunisation programmes while their vaccines are still in Stage 3 phase!

If the vaccine’s safety is assured with phase 2 clearance, would it be ethically wrong to shortcut the stage 3 or to be more precise, is it not unethical to delay the inoculation of front line workers and possibly save precious lives! Would it not be a good idea for healthcare workers and vulnerable subjects to enrol in the COVID-19 vaccine Phase 3 trials at least in India where the pandemic is raging? If this is to be done quickly, professional organisations, civil society, regulatory agency, the Indian Council of Medical Research and vaccine manufacturers should act immediately and allow and encourage enrolment of healthcare workers and vulnerable people in Phase 3 trials. It would enable to quicken a ‘meaningful’ phase-3 trial in India without much risk! They are also the appropriate cohorts to report side reactions with adequate knowledge in the field. This deviation in the enrolment process of Volanteers for phase-3 would go a long way in overriding the virus for ever!

While it is easy to immunise the mass and save the valuable lives in communist Russia or the draconian China, where there is only a little dignity left for human life, it is not so in vibrant liberal democratic republics such as USA, Europe or India for example? Strange, that a ‘sanjeevini’ could be denied in countries that prefer to make noise! Otherwise would we not end up with ‘operation success – patient didn’t survive paradox’?

Credits:

1. https://zeenews.india.com/world/uk-moves-to-fast-track-coronavirus-vaccine-if-safety-tests-passed-2306022.html

2. https://www.thehindu.com/opinion/lead/the-participants-we-need-in-phase-3-trials/article32459266.ece

Facts and Myths of COVID-19

New Corona (COVID-19), a Flu virus: The monster virus, COVID-19, that has taken the world by storm since the dawn of this year, is yet another type of flu infection. The flu, or influenza, in general, is a highly contagious viral infection, that mainly affects the respiratory system. It is usually a seasonal illness, with yearly outbreaks killing hundreds of thousands of people around the world. Though rare, completely new versions of the virus may infect people and spread quickly, resulting in pandemics (an infection that spreads throughout the world) with death tolls in the millions, just like in 1918 for example! Symptoms of the flu include sudden onset fever, coughing, sneezing, a runny nose, and severe malaise, though it can also include vomiting, diarrhea and nausea. Influenza has plagued humankind for centuries and, given its highly variable nature, may continue to do so for centuries to come. There were only four major flu- epidemics in the last 100 years, is a fact for comforting the pessimists!

The “flu season” typically lasts from late fall to spring. One may be surprised to know that each year, flu epidemics cause a mind boggling 3 to 5 million cases of severe illness and about 290,000 to 650,000 deaths around the globe, (generally the elder ones are the victims) according to the World Health Organisation.

Evolution of COVID-19 virus: Not all coronaviruses are deadly – the ones endemic to like the common cold, are often considered inconsequential. like the common cold, are often considered inconsequential. Humans are not (presently) immune to this new virus as the human system has not yet evolved for this new infection, which is the evolutionary consequence of mutations in animals. Both the recent outbreaks, previously SARS in 2003 and COVID-19 now, have origins in the wet market of China!

Bats have been known to carry Ebola and Marburg viruses, passing them on to humans. Researchers have been looking at bats ever since the SARS outbreak because bats are the real reservoir, not civets, that was originally thought. They may also be hosting henipaviruses and strains of rabies.

Chinese menu is known for delicacies with fruit bats. in the communities in Yunnan Province in rural southwest China, who live near bat colonies, it is found that there is some 3% prevalence of exposure to bat viruses, This Suggests that all the time across the region, bat viruses are getting into people, either infecting them with a mild infection with no clinical signs, or causing respiratory illness that never gets diagnosed properly. May be they have developed immunity. So this outbreak is probably just one of a number of spillover events that have happened in south China.

Researchers initially suspected that intermediate species were necessary for coronaviruses to move from the primary reservoir species into humans. Perhaps the virus evolved and adapted to the intermediate species, making it more efficient at binding to human cells. However, recent studies have shown that some bat coronaviruses can infect human cells without passing through an intermediate host — meaning a significant reservoir of undiscovered coronaviruses may lurk out there. In some places in the world, eating bats is illegal due to the danger of zoonotic diseases.

Similarly, it was once believed pigs might serve as a “mixing vessel” where avian influenza strains would become better adapted to mammals, since pigs seem to have both α2,3- and α2,6-linked sialic acids on the cells of their trachea, allowing human and bird strains to mix and produce novel human-adapted viruses. But while pigs may serve this function, it is now known that such mixing is not required, and that avian viruses can infect humans without a pig intermediate.

Some researchers also claim that the deadly virus was passed to humans from bats – via snakes, which are sold at the open-air market in Wuhan. Results derived from evolutionary analysis suggest for the first time that snake is the most probable wildlife animal reservoir for the 2019-nCoV.

The sequencing of Stimulator of interferon genes (STING), isolated from the Chinese rufous horseshoe bat which plays an important role in innate immunity, revealed a striking abnormality in the bat version: a mutation that was universal across 30 bat species. This mutation originally provided an evolutionary advantage to bats by preventing their immune systems from boiling over every time the animals fly. But this mutation triggers an uncontrollable storm of interferons and other inflammation-inducing molecules, overwhelming the human immune system while infecting them.

Spread mechanism: The principal mode of transmission is still thought to be respiratory droplets, which may travel up to six feet from someone who is sneezing or coughing. The new coronavirus isn’t believed to be an airborne virus, like measles or smallpox, that can circulate through the air. Close contact with an infectious person, such as shaking hands, or touching a doorknob, tabletop or other surfaces touched by an infectious person, and then touching your nose, eyes, or mouth can also transmit the virus. So wearing a face mask might not actually prevent the droplets of infected person contaminating you while sneezing from getting deposited on your face which may enter your respiratory system. Instead, a face mask worn by the other person might help in preventing the spread effectively.

It is advisable, especially on returning home after day’s work, especially travelling in crowded public transport, to remove the clothing for washing and take a shower with soap; insist on this regimen especially if there are toddlers and elders (who are vulnerable) at home;

Is the COVID-19 virus infection deadlier than other epidemics? The true death rate could turn out to be similar to that of severe seasonal flu, below 1 percent. But even a disease with a relatively low death rate can take a huge toll if enormous number of people catch it.

Each person with the COVID-19 virus appears to infect 2.2 compared 1.3 for the seasonal flu. But the figure is skewed by the fact that the epidemic was not managed well in the beginning, and infections soared in Wuhan and the surrounding province. As an epidemic comes under control, the reproduction number, as it’s called, will fall. The reproduction number for the flu of 1918 was about the same as that of the COVID-19, perhaps higher, but that was before modern treatments and vaccines were available.

Symptoms: it is more like a common flu; infact much less in severity in the initial phase; Once a person is exposed and becomes infected, the incubation period before the onset of symptoms is about five days, although this can vary from two to 11 days. Flu-like symptoms are often mild at first and some patients recover without the symptoms becoming more serious. But for a subset who get worse, day four after the onset of symptoms is usually when they seek medical care because they develop shortness of breath and early pneumonia, and they may become critically ill by day seven. After day 11, most patients who survive are on their way to recovery.

Management:

Corona virus is large in size where the cell diameter is 400-500 micro and for this reason any mask prevents its entry directly.

The virus does not settle in the air but is grounded, so it is not transmitted by air.

Coronavirus when it falls on a metal surface, it will live 12 hours, so washing hands with soap and water well enough.

Corona virus when it falls on the fabric remains 9 hours, so washing clothes or being exposed to the sun for two hours meets the purpose of killing it.

The virus lives on the hands for 10 minutes, so putting an alcohol sterilizer in the pocket meets the purpose of prevention.

If the virus is exposed to a temperature of 26-27 ° C. it will be killed, as it does not live in hot regions. Also drinking hot water and sun exposure will do the trick

And stay away from ice cream and eating cold is important.

Gargle with warm and salt water kills the tonsils germs and prevents them from leaking into the lungs.

It is suggested if there are flu like symptoms, sneezing, stuffy nose, sore throat, fever for beyond three days, be under expert medical care (no self medication please). manage the patient based on symptoms with body fluids; antibiotics to counter secondary infections;

Immunity: Influenza is a constantly evolving virus. It quickly goes through mutations that slightly alter the properties of antigens. Due to these changes, acquiring immunity (either by getting sick or vaccinated with a flu shot) to an influenza subtype one year will not necessarily mean a person is immune to a slightly different virus circulating in subsequent years. But since the strain produced by this “antigenic drift” is still similar to older strains, the immune systems of some people will still recognize and properly respond to the virus. In other cases, however, the virus can undergo major changes to the antigens such that most people don’t have an immunity to the new virus, resulting in pandemics rather than epidemics. This “antigenic shift” can occur if an influenza subtype in an animal jumps directly into humans. It can also occur if an intermediate host such as a pig—which is susceptible to avian, human, and swine influenza—becomes simultaneously infected by influenza viruses from two different species and the viruses exchange genetic information to acquire completely new antigens, a process called genetic reassortment. Even those who recover from COVID-19 might not be immune forever. It is known that exposure to the four seasonal human coronaviruses (that cause the common cold) does produce immunity to those particular viruses: the immunity lasts longer than that of seasonal influenza, but is probably not permanent.

Has the last word been delivered? No; till now no vaccines for this virus; no known results of successful management with alternative therapies such as siddha or homeopathy, so far. To contain the mortality, it is necessary to quarantine the affected persons; it is also necessary to advice/force people who are prone to sneezing and coughing to cover their mouth and nose with face masks (even primitive) or at least cover with their hand kerchief! Use of disinfectants in public rest rooms would aid in restricting the spread.

Though the mortality rate might turn out to be closer than ‘common flu’, the death toll can be kept under check only by total number of infected population – presently the rate of infection is more than that encountered in common flu season! Also, once the weather warms up, the infection would definitely come down!

The spectacle of survival race between the microbiological world and the kingdom of homosapiens, is an ongoing melodrama ever since the life appeared in this universe: one evolving to out beat the other – may be, gloating in momentary ascendancy! Having terrorised almost quarter of the world, today, it is for this tiny organism – COVID-19; tomorrow?

Is there panacea to thwart ‘sudden heart attacks’?

Who is not afraid of sudden heart attacks especially after having heard of a recent event involving a friend or colleague? Would consulting a heart specialist mitigate such episodes?

It is natural to assume that the degree of narrowing is the most important predictor of a heart attack, but a study of close to 700 patients who underwent invasive coronary angiogram and advanced imaging showed that the degree of narrowing does not predict whether a heart attack will occur. Heart attacks can occur suddenly even in areas of mild narrowing due to blood clots forming in unhealthy arteries!

Following are a few Expert international guidelines to reduce the risks of heart attacks:

For patients with no symptoms, the recommendation is testing for risk factors such as high cholesterol and diabetes.

For patients with a low (less than 10 per cent) likelihood of heart disease (for example, non-anginal chest pain), some guidelines favour treadmill ECG testing.

For patients with a known history of heart disease (for example, previous heart attack), stress imaging is recommended for evaluating new symptoms. The Computed Tomography Angiogram (CTA) is one of these assessments that has recently garnered great interest. It is a non-invasive test using X-ray dye to look for narrowing in the heart arteries. For patients with an intermediate likelihood of heart disease, some guidelines favour using CTA, while others recommend exercise testing with imaging, especially if patients are able to exercise. Routine testing for heart disease with tests such as CTA is not recommended for asymptomatic individuals.

A normal test result can indicate a low risk, but not zero risk. A local review of over 10,000 asymptomatic individuals who took the treadmill ECG test showed that a normal test had an annual less than 0.1 per cent risk of developing a heart attack. In the study, patients with chest pain but a normal CTA result had a low but not zero risk of occurrence (0.9 per cent) over two years. Since low risk does not mean no risk, it is important to manage risk factors such as high cholesterol, smoking and lifestyle choices, rather than relying on testing alone to prevent heart attacks.

Heart attacks can occur suddenly even in areas of mild narrowing due to blood clots forming in unhealthy arteries. While tests cannot totally thwart episodes, you can certainly reduce the risk by being aware of symptoms such as exercise-induced chest discomfort, controlling blood sugar and cholesterol levels, as well as other risk factors.

So the Damocles sword ‘Heart attack’ is here to stay! May be this imminent threat is the one that makes the mortals realise uncertainty of the human life, in spite of the understanding of the anatomy and physiology of the human body, and obliges one to be philosophical!

Credits:

https://www.businesstimes.com.sg/life-culture/choosing-the-right-test-for-heart-disease

Cholesterols and Statins

The medical history’s biggest money spinning hoax is coming to an end: both the statin business and the ‘cholesterol-free modern oils market of FMCG’ is busted with the official pronouncement that there will be no longer be any warning against eating high-cholesterol foods.

Cholesterol is being officially removed from Naughty List. The US government has finally accepted that cholesterol is not a nutrient of concern doing a U-turn on their warnings to stay away from high-cholesterol foods since the 1970s to avoid heart disease and clogged arteries.

Cholesterol is the basis for the creation of all the steroid hormones, including estrogen, testosterone, and corticosteroids. Brain is primarily made up from cholesterol. It is essential for nerve cells to function.There is no such thing as bad Cholesterol. Experts say that there is nothing like LDL or HDL.

This means eggs, butter, full-fat dairy products, nuts, coconut oil and meat have now been classified as safe and have been officially removed from the nutrients of concern list.

When we eat more foods rich in this compound, our bodies make less. If we deprive ourselves of foods high in cholesterol, our body revs up. The majority of the cholesterol is produced by liver.

High cholesterol in the body is a clear indication which shows the liver of the individual is in good health.

Dr. George V. Mann M.D. associate director of the Framingham study for the incidence and prevalence of cardiovascular disease (CVD) and its risk factors states:

Saturated fats and cholesterol in the diet are not the cause of coronary heart disease. Cholesterol is not found to create block any where in human body That myth is the greatest deception of the century, perhaps of any century.

Studies prove beyond doubt, cholesterol doesn’t cause heart disease and it won’t stop a heart attack.The majority of people that have heart attacks have normal cholesterol levels!

The story does not end there: Brainwashing on the ill health effects of the traditional coconut oil, ghee, butter etc., for marketing non-native oils have immensely helped filling the coffers of multi-nationals at the expense of the health of at least three generations!

Is this the benefit of science?

Family Doctors – bygone era?

Recent upsurge of revolt in the medical industry(?) in different parts of the country, pains one who is traditionally brought up in a different culture of doctor-patient relationship. The invasion of western culture has brought immense distortion in our social fabric including Guru-Sishya; these were considered holy professions for centuries but with the advent of modernisation, unethical practices ushered in; the cost of health and education have skyrocketed, thanks to their management by those driven by so called technology, business motives under the guise of charity.

The unfortunate gullible common man believes that ‘the one that is costlier must be better’; the industry exploits this falsehood and calls for clinical investigations that are unnecessary; insurance companies make hay while there is shine…mass screening programmes bring in new patients with many false positives…. once life saving drugs get enlisted under banned list years later… anti cholesterol statins increase the diabetes population…. traditional food habits are butchered by senseless media(anti coconut oil);

It’s time to set the clock back… bring in the culture of family doctor as against specialists; use less Medicine as reckless dispensation of even life saving medicines are injurious; use traditional medicines for common ailment which can even be included in the curriculum; motivate the sense of service as the symbol of social status in the curriculum as against the economic prosperity; profess simple living;

Hope many of you would know what lord McCauley stated long time back: ‘ unless you destroy the cultural values of india and make it western, india can’t be conquered’…..

Herbal remedy for Alzheimer?

Can there be a herbal remedy for dimentia/Alzheimer? it appears the answer is ‘yes’ from the following study: it is ‘coconut oil’ surprisingly. One would not have forgotten the advices of the much learned, scientifically bent western researchers and doctors, who pronounced not long ago, to desist from this dreaded oil!!

Dr Mary, a Dr of newborn, found that her husband is affected by Alzheimer, thus: When the doctor inspected her husband at the hospital, the doctor asked Steve to paint a clock. Instead, he drew a few circles and then drew a few figures without any logic. It was not like a clock at all.

The doctor pulled her aside and said: “Your husband is already on the verge of severe Alzheimer’s disease!”

It turned out that it was a test of whether a person had Alzheimer’s disease. Dr. Mary was very hit at the time, but as a doctor, she would not just give up. She began to study the disease.

Her research says: “The dementia of the elderly is like having diabetes in my head. Before one has the symptoms of diabetes or Alzheimer’s disease, the body has had problems for 10 to 20 years.”

According to Dr. Mary’s study, Alzheimer’s disease is very similar to Type 1 or Type 2 diabetes. The cause is insulin imbalance.

Because insulin has a problem, it prevents the brain cells from absorbing glucose. Glucose is the nutrition of brain cells. Without glucose, brain cells die.

As it turns out, high-quality proteins are the cells that feed our body.

But nutrition is our brain cell is glucose, as long as we have mastered the source of these two kinds of food, we are the masters of their own health!

The next question is, where to find glucose? It must not be the ready-made glucose that we buy from the store. It is not a grape. We are looking for alternatives.

The alternative nutrients for brain cells are ketones. Ketones are popular in brain cells. Ketones cannot be found in vitamins. Coconut oil contains triglicerides.

After the triglyceride in coconut oil is eaten into the body, it is metabolized into ketones in the liver. This is an alternative nutrient for brain cells!

After this scientific verification, Dr. Mary added coconut oil to his husband’s food. It only took two weeks. When he went to the hospital again to do painting and clock tests, the progress was amazing.

Dr. Mary said: “At the time, I thought, it might just be a dog. Will God hear my prayers? Wouldn’t it be coconut oil? But there is no other way. It’s better to continue taking coconut oil.”

Dr. Mary is part of the traditional medical practice base. She clearly knows the capabilities of traditional medicine. After all, traditional medicine can do very little.

Three weeks later, the third time she went to do a smart clock test, the performance was better than the last time. This progress was not only intellectual but also emotional and physical.

Dr. Mary said: “He could not have been running and he can now run. He could not read for a year and a half, but he can read it again after taking coconut oil for two or three months.”

Her husband’s actions had already begun to be inflexible and she did not speak in the morning. Now she has made a lot of changes: “After he got up, he was spirited, talking and laughing. He would drink water and take utensils.”

On the surface, these are very simple daily tasks, but only those who have come and only have demented relatives in their homes can experience the joy: It is not easy to have such progress!

After frying the green onion oil cake with coconut, 2 to 3 months later, after taking 3 to 4 tablespoons of coconut oil per meal, the eye can focus and prove that coconut oil can really improve the problem of dementia in the elderly.

Apply coconut oil to the bread. When the cream is used, the taste is unexpectedly good.

Young people can also use it for maintenance and prevention, and can improve if they have symptoms of dementia.

Dementia is because nutrients cannot be transmitted to brain cells, and nutrients must be passed from the body to insulin to reach the brain.

Especially diabetic patients are not easy to get insulin secretion. “Nutrition cannot get to the brain. When brain cells are starved to death, they are deprived of intelligence.”

Coconut oil contains medium-chain triglyceride, which can supply nutrients to the brain without using insulin. It can improve Alzheimer’s disease and Parkinson’s disease.