Thursday, October 31, 2013

A New Hope….The “Wow” Of Stem Cell Treatments

A New Hope….The “Wow” Of Stem Cell Treatments

Stem Cells under High Magnification

 There I was sitting in the audience of the darkened convention center staring at the slides running on the screen feeling a slight tinge of envy and an odd sense of disappointment thinking that it could have been me there presenting these results, if only. Ah, that "if only" plays a major part of all our lives doesn’t it?

Anyway to start from the beginning I had spent the last three days at a specialty national conference as part of my commitment for annual medical education to learn what’s new in the field of regeneration. Too many times we get caught up in the everyday worries of clinical practice and forget that there is a whole lot of innovation taking place out there in science some of which may be a game changer to how we practice medicine in the near future.

Take for example stem cells. Those who follow this blog regularly know that i have in the past been dismissive of what I have thought was the highly inflated claims of the stem cell propagandists in touting it as a cure for all diseases (read here and here). Well I am happy to confess that i have now changed my mind. I too believe in stem cells now. I believe that soon, very soon we might have actually workable stem cell therapies at hand- something which i would have argued against a few months ago.

There is a thin line separating skepticism and cynicism- what with all the false stuff floating around in the name of miracle cures - science needs us to be ever vigilant and skeptic and believe any claim only if it is proved or disproved with reliable evidence. But to reject the hypothesis without examining the evidence at all is a sign of a closed mind and cynical in the extreme. Thankfully I am not a cynic and if you show me the evidence and it stands rigorous examination then I am happy to change my mind and jump onto the bandwagon too. That’s the advantage of having an open mind.

As I said earlier, I sat there (for three days) in the darkened auditorium staring rapt in attention watching slide after slide of before and after treatment photographs and micro-photographs (histological slides under high magnification) of various diseases where stem cells had been used and I came away impressed. I could see jaws which had been amputated halfway- hemi-mandibulectomy done- grow back into normal jaws with stem cells. And i saw unhealed diabetic ulcers and amputation wounds close down normally with no sweat at all and I couldn’t help thinking that this stem cell therapy thing is definitely a breakthrough in medicine.

Best of all these were all mesenchymal stem cells harvested from routine menstrual blood and not embryonic stem cells with all its hassles (complicated procedures) of cord blood collection and storing even as the child is being born. That old adage of women being life givers is once again being reinforced with even their menstrual blood which is usually discarded as unsanitary -being put to life giving use. And it made me think of that quaint old Indian habit of women being considered as untouchables during their three days of menses and often set apart from the pooja rooms and other religious ceremonies. Science is now providing a fitting reply to religious obscurantism isn’t it?

If you think I am painting too rosy a picture i would be the first to agree that there are still a lot of steps to go through- there are unresolved issues in collecting the stem cells, culturing them (growing them) in the lab and making use of them in the proper way for the proper disease to get the proper result - for the cure should not be worse than the disease, right? There are also worries about stem cells helping cancer cells to grow faster along with normal cells and their cessation of growth by contact inhibition is yet to be elucidated- that is how does the stem cell know that your kidney is only this big and it stops growing further once your size is reached? What if it decides to keep on growing in size till you have the mother of all kidneys? What stops it actually? Food for thought right?

But anyway all these are technical issues and once the proof-of-concept is validated then these can be tackled by multiple people working simultaneously everywhere. Its like somebody inventing the first car and showing that it can indeed run on the road and then people everywhere get in to solve the practical issues- like one person inventing the accelerator, someone else somewhere inventing the brake and someone else inventing the gear box- none of which was possible till people believed that a car could actually run as said.

And as the researchers stressed again and again they were still only dipping their toes in using stem cells  for treatment, exploring the possibilities of its application in a blind "let’s try this and see what does happen" way and it was still in the experimental stage with no long term results available YET. But if the initial results are anything to go by then we are just that nearer to growing back lost or damaged organs- like a kidney, liver or even an amputated limb. We can hopefully cure diabetes, restore lost memory in dementia cases and even make sure that those with spinal cord injuries and paralyzed in bed can take up their beddings and walk again- as the bible says

It might take us another ten years or fifteen for the treatment to go through all the approved regulatory agencies and for all the working mechanisms involved to be studied fully - for we still don’t know much about how/why it works - just that it works but eventually we are going to be able to get commercially mass produced stem cells which can be injected in a wound site and the damaged part is going to heal over nicely without any sign of the original injury or scar.

I even got offers from one or two companies which are early pioneers in this business (start-ups) offering to supply me with stem cells for competitive rates at RS------for a million cells- the total dosage to be determined by the wound size and disease. Of course if I did buy them and use them on my patients it would have to be an experimental trial (clinical study) only and i would have to go through all the prescribed procedures for conducting such a trial prior to doing the treatment. Or I could wait till it becomes mainstream in a few more years and then start using it on my patients along with every other doctor.

As I said right at the beginning of this post, over the three days I was there at the conference I did feel slightly (well, a lot) envious of all the cutting edge advances taking place, more so from the fact that i too could have been one of those up on the podium getting the applause from the audience if only i had not been chased away from all research by the memory of my bitter experiences during college days.

For those readers who have been with this blog for some time I have in some of my past posts mentioned how when I was a promising young researcher working on my thesis some of my results were stolen in the pre-publication stage by a trusted mentor and I had to practice a scorched earth policy in making sure that no one, including me, could ever use that research anywhere. Not the wisest of options I guess- wasting two years of my hard work in the bargain but I simply wasn’t willing to sit back and allow myself to be cheated without fighting it to the bitter end.

Come to think of it now when i have a far more mature head on my shoulders I feel that I overreacted and let the shock of betrayal lead me to burn down the entire house to deal with a backstabbing rat but for good or bad I swore off research forever and decided to stick to clinical practice (and making money) for the rest of my life. So for years and years i have been happily practicing my cutting and sewing working with real patients instead of petri dishes and microscopes and making me a comfortable living in the bargain- but there is always a tiny bit of regret buried somewhere in my heart that i did not follow through with my research ambitions, especially when i attend conferences like these and see such cutting edge scientific advances.

I know it’s just presumptuous to assume that I might have been a success as a researcher but who knows? The future is a closed book to us and if destiny guides me to a path of research again I might even chuck my scalpel away and start ogling at microscopes. Even if I have to sacrifice some/lot of my current income and get accustomed to a lower standard of living just so future generations can benefit from my research findings. Besides there is a hidden thrill in research - that moment when you see the first evidence of your hunch being proven right- a sense of winning against your own doubts which is almost an orgiastic experience and it pays off for all the sacrifices you made till then.

So that’s all about the stem cell therapies i learned about recently which might provide a far more brighter and enriching life (disease-free) to future generations of humanity- so much so that I am tempted to label it "A New Hope" - a phrase familiar to all Star Wars fans. The future, ladies and gentlemen, looks far, far bright than the present. God bless us all.

Wednesday, October 30, 2013

சென்னையில் ஒரு ஆட்டோ ட்ரிப்........

சென்னையில் ஒரு ஆட்டோ ட்ரிப்........

An Auto-Rickshaw in Chennai

 சென்னையின் ஆட்டோ ஓட்டுனர்களை பற்றி முகநூலில் பல பாராட்டுகளைப் படித்து விட்டு என்னோட அனுபவங்களையும் எழுத தோணியது. 

அன்மையில் கொச்சியில் இருந்து திருவனந்தபுரம் மெயிலில் சென்னை சென்ட்ரல் ரயில் நிலையத்தில் அதிகாலையில் வந்து இறங்கிய நான் அண்ணா நகரில் உள்ள என் வீட்டுக்கு செல்ல முற்பட்ட போது ஒரு உன்மையை கண்டறிந்தேன். அது- நாயை குளிப்பாட்டி நடுவீட்டில் வயத்தார் போல எவ்வளவு தான் மீட்டர் ரேட்டை அரசு ஏற்றினாலும் ஆட்டோ ஓட்டுனர்கள் திருந்தும் வாய்பேயில்லை என்பது தான்.

“அண்ணா நகர் போகனுமா? ரூபாய் ஏறநூற்று ஐயம்பது {Rs.250 } குடுங்க” யென்று கேட்ட ஆடோகரர் இடம் “என்னது? நான் எப்பவும் என்பது இல்லை நூறு மேலே குடுத்ததில்லையே” யென்று சொல்ல அவர் என்னை முறைக்க டென்ஷன் ஆனா நான் “ஏதோ Rs.150 என்றல் பரவாயில்லை எடுத்து எடுப்பில் ஒரேயடியா Rs.250 கேட்கறீங்க” யென்று நான் கேட்டதுக்கு அங்கு இருந்த ஆட்டோ ஓட்டுனர்கள் என்னை அதிர்ச்சியுடன் பார்த்து “Rs.150 இப்பல்லாம் மீட்டர் ரேட்டு தெரீயுமா?” என்று கேட்டனர்.

ஏதோ மீட்டர் ரேட்டுக்கு சவாரி சென்றால் அவமானத்தில் அவர் குடும்பத்துடன் தற்கொலை செய்துகொள்ள வேண்டியதுதான் போல பேசினார்கள். இது தான் உண்மை நிலை இன்றும் சென்னை ஆட்டோகளை பொறுத்தமட்டில். நம்பவில்லையென்றால் சென்ட்ரல்லுக்கோ இல்லை எக்மோர்ருக்கோ சென்று பார்க்கவும்.

இதில் வேடிக்கை என்னவென்றால் முன்தினம் கொச்சியில் அதே அண்ணா நகர் தொலைவிற்கு ஆட்டோவில் சென்றடைய மீட்டர்  Rs.26  ரூபாய் தான் வந்தது. நான் Rs. 30 ரூபாய் குடுத்ததும் ஆட்டோ ஓட்டுனர் எனக்கு சில்லறை நான்கு ரூபாய் திருப்பிக் கொடுத்தார். என் கண்ணில் ஆனந்த் கண்ணீர் வராத குறை.

ஆக ஆட்டோ ஓட்டுனர்களில் சில நல்லவர்களும் இருக்கிறர்கள். ஆனால் அவர்கள் சென்னையில் தான் இல்லை.

Thursday, October 24, 2013

Who Gets The Credit? The Creator Or The Creation?

Who Gets The Credit? The Creator Or The Creation?

Arthur Conan Doyle the author of the Sherlock Holmes books once killed his fictional detective Sherlock Holmes by throwing him off the Reichenbach Falls in Switzerland. That he had to resurrect him later on because of public clamor is a different story. But right then, after the abrupt ending to the story The Final Problem, when asked why he had killed his most popular character Doyle reportedly said that the character was strangling him and preventing him from expanding his repertoire as a writer. After the Reichenbach falls story Doyle stopped witting detective fiction for a while and went on to write science fiction -the professor challenger series of books like the lost world etc.

 When Thomas Harris wrote the Hannibal Lecter series of books he was widely reviled in the popular media (of USA) as the inventor of the vilest character in fiction- a psychiatrist turned serial killer, Hannibal the Cannibal. This media crucification of Harris was further reinforced by Anthony Hopkins playing the role of Dr.Hannibal with such chilling intensity in the movie version of the book "The Silence of the Lambs". But despite all the hoopla Thomas Harris did not give a damn to the media crusade against him but went on to write more of the Hannibal Lecter series of books rounding up the stories with sequels and prequels. 

Anthony Hopkins in the role of a lifetime

 Finally the creator of the most famous fictional character of this century Harry Potter's writer Ms.J.K.Rowling has tried hard to publish her new books under different pseudonyms to avoid being judged on the harry Potter success scale. But she has not yet succeeded in avoiding comparisons between her earlier books which were in the children's fiction/fantasy category and her later books involving hard-boiled adult characters. Her widespread earlier success has meant that even years later she is constantly being beseeched by ardent fans to revive the Harry Potter character.

The above incidents perfectly illustrate what I want to discus in this particular post - the moment when a creator is superseded by his creation and its popularity. It’s the dream of every creator or artistic person to create something which makes history and reminds the world of its creator even after death. But very few are actually prepared for such enduring popularity. The popularity they want is more for themselves than for their creation as such. They want the public to recognize their talent, their hard work, their vision in making such a creation possible. Some achieve it - like Shakespeare's enduring popularity along with his books, Leonardo Da Vincis popularity with the Mona Lisa painting etc.

But other creators crave the recognition which their creation achieves and they resent the popularity of what in essence is their own creative offspring. This problem becomes acute when it involves a real life character, like say, just for example - a director of movie becoming jealous of the popularity of the hero of his hit movie or an even more common example- a photographer fazed by the popularity of the model who posed for his picture. If credit is divided equally between the natural beauty of the person who posed for the picture and the technical skills of the photographer than the equation between the two is balanced.

On the other hand the problem becomes stark when the picture is a candid and un-posed one captured suddenly by the photographer and the picture becomes so famous that the photographer himself becomes anonymous - like the famous "National Geographic" cover photograph of the Afghan girl with green eyes shot by ace photographer Steve McCurry. In such cases even if the credit goes to the photographer for capturing that candid shot, it’s ultimately the subjects themselves who are responsible for the popularity of the picture. There is something there, some indefinable quality in those people which attracts not just the eye of the photographer who frames it perfectly but also the audience who views it with the photographer’s eye. Credit to be given where credit due- especially in such candid photos for unless the subject is riveting in their beauty or their pose- the photo would not have garnered such universal praise.

The iconic "Afghan Girl" cover

As a cosmetic surgeon who works mostly with beautiful women who come to me to make them more beautiful if possible I get to hang out with a lot of celebrities - models and actresses who talk to me about how they are always being judged as just a beautiful face. And I always keep reminding them that there are millions of us (including yours truly) who would kill to be in their place and they should be thankful to their genes for their beauty and never regret it - critics be damned. But it’s human nature never to be satisfied with what we have, right? So I get to pull out my hair in frustration (two handfuls at a time) trying to make impossibly perfect profiles even better because they are feeling insecure and driving me to early baldness in the process.

Anyway after we finish the treatment part (the surgery) and then when we take the post-operative pictures to compare the before/after treatment pictures there is always a bit of a controversy over how much processing (Photoshop) is required for the photograph. I, for one always prefer the candid natural shot and most of the time I get to have my own way- for the subjects themselves are naturally beautiful and it doesn’t need much to highlight their pretty faces- especially after they have benefited from my skills (pat/pat on my own back). But we almost always have someone or the other who thinks he can improve on what’s natural using artificial software.

The problem becomes acute when I have to convince the photographer that given my surgical skills and the native beauty of the patient, the technical aspects of the photo should be kept to a bare minimum. For after all if the photograph turns out well the credit is divided equally between the beautiful subject and the talented photographer for as a surgeon the only credit I look for is for people to mistake my work for a natural look. And as an involved bystander I understand both sides of the equation when credit for a job (or a photo) well done turns into a bit of tug-of-war between the subject and the creator.

As a creator of sorts (ok, ok don’t curse) - I believe that unlike a writer or a sculptor or a painter who creates something out of just his imagination we people (ha-ha, I am adding myself to this list) like directors, cameramen, photographers or cosmetic surgeons merely improve on what’s already there. We don’t work on a blank canvas; we trim and tailor the existing canvas to showcase its beauty. As such the creator (the photographer) should be happy that his picture has garnered such widespread appreciation. Any other feeling other than appreciation is not worthy of his talent. Let the girl in the photo bask in the fame of the picture for as a creator you have an equal share in it.  Your attitude should be- You happy, She happy, ALL Happy – Ok, boss?

Disclaimer: This post is no way related to a recent Facebook status message about a photograph of a girl in my friends list.

Wednesday, October 23, 2013

The Bliss Of Life

The Bliss Of Life

I had a talk with two contrasting characters today. The first one was a lady in her mid to late eighties. She popped in to my room at the free clinic and with an apology to start with she said that she was feeling feverish and wanted something for it and she couldn’t wait to see the general medicine specialist (who was the one supposed to see ordinary fevers) as the queues were long there while mine were comparatively shorter (fewer patients) that day. Even though I wasn’t supposed to be seeing the general physicians cases for him (too many ego problems might evolve from even such a harmless act), I thought of making an exception this one time- after all a mild fever was well within my treatment skills and so I wrote the necessary prescription for her, handed it to her and gestured to the next patient in line to come forward and take her seat.

But strangely she looked to be in no hurry to get up and leave to the pharmacy. As i watched and waited for her to leave she hemmed and hawed and made a strange request "Can you prescribe some vitamin tablets too for me doc?" she asked. That surprised me for I don’t usually allow my patients to dictate their treatments to me, for I am after all finally responsible if anything untoward happens. When I looked over at her in a puzzled sort of way she explained that she  was a spinster, had lived with and slaved for her sisters family all her life but recently her sister (much younger) had died and her nephews and nieces had considered their elderly aunt an extra burden and thrown her out of the house. She had tried to survive by doing odd jobs at a few houses and sleeping before a Vishnu temple in Triplicane but one night as she slept with a small bundle containing nothing but a couple of changes of dress under her head, even that had been stolen deftly in the night without waking her up and come morning she was left destitute in front of the temple with nothing on her.

After struggling with her pride for a few days she had turned to begging at the temple entrance for survival. But she still harbored hopes of getting some small job or the other to survive on so she could stop begging for alms. And she reasoned that to work she needed strength and to get strength she needed vitamins. I could have given her a long lecture about how just taking vitamin supplements in the absence of proper food would not be of much use but I desisted because it was no use- such advice would be wasted on people who believed vitamins were magic pills. Hence I did the only other thing I could think of at that time- took some money out of my pocket and gave it to her (despite the disapproving looks of all my staff) and told her to go have a hearty meal. And oh, i did give her a bunch of vitamin supplements as she desired.

The other person I talked to later that day was a girl in her mid twenties and who had gone through a relationship crisis and was spouting suicidal stuff. This was her second relationship and second break up in the short time- a very few months I had know her- so I couldn’t decide who really was in fault. Anyway after I gave her the standard lines i use for relationship advice- about how everyone gets their hearts broken kissing a few frogs before finding their true prince I switched off the chat window and sat there thinking over the contrast between the two characters- the old and young ladies - I had talked to that day.

The old lady had unknowingly showed the way to survive life- by trying to think her way out of her troubles while the young one was merely content to wallow in her misery. The old lady had lived a long and lonely life and she had been betrayed by all her relatives at the very end of it but still she wanted to make sure she had strength enough to work and stand on her own two feet. But like a warrior she was willing to keep on fighting till the very end. Contrast that with the young woman who had everything to go on but was ready to give up her prestigious job at a big firm because an in-office romance had gone bad and she couldn’t face her colleague’s gossips. I felt exasperated at the young woman, so much so that I wanted to give her a crack on the head and tell her to wake up and see the reality of life.

As the first lady showed us- life, all life is precious. It’s not handed over to us in a platter- even though we behave as if it was. Life is a struggle for every creature on earth but it’s only we humans who make too much of this struggle. In doing so we forget that life is also a joy, bliss of great intensity. Worries are forever with us; we are born with them and die with them. But that is no reason to forget to live life while we take a breath. Merely worrying on things we cannot change is going to get us nowhere and suddenly we would find ourselves old and feeble and not able to do anything about it even if we so desire to.

The trick is in finding the balance- to try to push our impossible worries away to a dark corner of our minds to deal with later and to continue to live daily life with awareness and joy. I know that many of you reading this will be thinking- go on, we don’t believe you, it’s easier said than done- but do, do believe me, i never preach what I haven’t practiced first. So rest assured it’s eminently do-able. Worrying changes nothing except hastening us to an early grave and to an eternity filled with regrets for things not done. Isn’t it far better to disregard it all and embrace life? To live life as fully as if we had no worries at all? The human mind is a fascinating creature- it feeds on what you tell it. So long as you keep thinking that your life is all joy- you can end up having a blissful life even if the end of the world is near. The choice as always - is yours. Make it with wisdom.