Sunday, June 3, 2012

ALL IZZ WELL….


My erstwhile colleague Anand called after a long time and asked me “how it was going”. When I asked him back the same thing he started off on a long rant unmindful of the mounting call charges “the economy was going south” he started off “what were the bloody Europeans thinking off when they gave those loans to the Greeks?, first the Americans and now the Europeans, everyone seems to be playing with the world economy..And now look at us..The rupee has gone zooming up to the dollar, how can we buy anything at all? petrol prices are sky high, can’t even switch on the a/c on in the car for fear of fuel consumption, the govt doesn’t care, no one cares” he stopped for breath and I got in a word edgewise when I finally got the chance “How are your kids?” he continued from where he left off  “oh, fine, fine, they are all well, I say, you should come see them now, they are all grown up since you last saw them, the little one is going to start play school this year. And by the way” he added almost casually “I have shifted my house, you should come see the new house, its right behind DAV school”. “What?' I asked in a shocked voice and then the more important “but why?” he hesitated for the first time before saying “well you know the usual family thing - my mother and my wife had some problems, my wife was complaining that there was no privacy in the house for even talk between husband and wife and to make things easier on everyone, I decided to move away from my parents house to a rented flat- its small but it’s very private- no one to disturb us”..I chewed over this for a few seconds, for when I had known him, he had been a very attached and affectionate son, who had listened like the gospel truth to whatever his parents proposed and ultimately marrying a girl he didn’t even like, just because his mother felt she was the right family type..Well, these things come to bite you back, don’t they? Anyhow I asked him the one thing which felt incongruous in the whole logic “so who takes care of the kids now?” for his wife was a lecturer at an engineering college and had to do a long commute everyday outside the city. He replied happily “my mother-in-law has made a big sacrifice by consenting to come and stay with us to take care of the kids till they grow up a bit”. Ha! So this was his idea of privacy.


Anyway the point of this post is not about anand's marital problems but about the culture of negativity and pessimism some people spread about as if it were perfume. I have never actually believed in the glass is half empty philosophy for I thought that any fool can look in the glass and see that it is half full and until it drains to the very dregs tat the bottom it is not time to start worrying. But there are people around who perfectly epitomize JK Rowling’s description of Dementors – those who spread negativity and suck the fun out of everyone around. These people are a walking talking miasma of misery.

I have met quite a few of these oh my god, my life is so depressing, types. The worst among them are the ones who try to psyche you into a “Oh my god, your life is depressing too”, by enumerating what are all the things going wrong in your life which you are not giving a damn about right now. They seem to know a lot of things about you and your troubles, things which you dont know yourself. In the guise of admiration they say “I really don’t know how you can be this happy with so many problems, if I were you I would fall into a deep depression and never get out of the bed. You are soo brave”. Well hold on, I seem to think when confronted by specimens of this kind – buddy, what seems to be insurmountable problems to you are merely specks in my eyes. To the man who has control over his emotions nothing seems to be unsalvageable- there is always some chink somewhere you can find and solve the problem with. Every problem has its own solution they say- so give me a problem and I don’t look at it - I look at solving it

Lots of people around me, look like they are - always boiling cauldrons of emotions. Me? I am a pool of cool (ahem! Ahem!) But seriously I do take my own sweet time in expressing anger, outrage or even getting depressed. I have never been the violently emotional drama queen type which more and more people nowadays aspire to be, as I stay cool without meaning to or making an obvious effort to be so.



My mother has this proverb which she oft repeats to me “aluvara kozhandaiku dhan sorru kedaikum”...in simple English...The crying child gets fed first. That people like me who wait patiently for their turn, get neglected. Is being patient such a drawback then in reality? Do the fussers and tantrum throwers get everything to the exclusivity of others? Maybe at first – but not always I feel.

The longest I have ever been depressed (as far as I can remember ) is three hours – and that's when the bloody result is stuck on the notice board and some bloody girl scores more marks than you in an exam you swore you had aced. Other than that, I don’t have long lasting depressions which last for days and days. Something or the other always tickles my sense of humour or I find funny and once you start smiling or laughing it’s pretty hard to stay depressed. If I can find humour in even the most depressing of circumstances, it’s a good thing, Right? 

Wrong- according to some people. Those people find it strangely eerie that I am not depressed like them, that I don’t have the necessary gravitas for the situation and I am blamed for being an unfeeling type. Hold on, I want to say, being basically happy is also a feeling – you can’t say that being sad is the only worthwhile emotion. Even our films have this bias - heroes who cry a lot (in strange heinous tones) are called thespians and great actors while stars who take things light are not afforded any respect.

So what should I tell people who look at me and tell me my life is so sad and I should be depressed and I should grow a beard or hit the booze? That I only grow a beard during study holidays, to prevent wasting time on unnecessary bodily comforts, time better spent studying? Or that drinking alcohol, will give me the shivers, make my fingers shake and make me professionally useless. And as someone who handles connective tissue grafts the thickness of human hair every day, I cannot afford to have the minutest tremor or vibrations in my fingers and on entering this profession I knew and accepted wholeheartedly that I had to deny myself all indulgences that may produce such adverse results?


 What do I tell these oceans of negativity, these Cassandra’s of gloom and doom..Get lost you evil ones...I may stay hungry, I may stay foolish, but I will stay happy? That nothing’s wrong with India, a falling rupee doesn’t matter, that we have a robust economy and a talented population who will see us through tough times? That petrol prices are simply going to make solar power more interesting and viable and that’s the way we should have already gone if not for the addiction of cheap petrol? That the world economy will balance itself out, that science will find a way, innovations will happen, evolution will advance and the human race as a whole is always moving forward incrementally, one small step after another and we will beat all this gloom and doom and one day successfully straddle the entire galaxy as one civilization? If I tell them all this will they believe me or at least listen? You tell me...

My Favorite Tamil films


I was deep in sleep, dog tired after a hard day’s work and the power had just been restored (after the daily scheduled power cut), so I was off to noddy land to freshen up a bit before evening duty and my mom was shaking me awake “your favorite movie is no Raj TV….” I slowly came awake and murmured “how far is the movie gone?” she said “it’s just got to the interesting part” and I woke up completely to head to the TV in the hall. The movie playing on the screen was Vedala Ulagam. And the hero had just about reached the Vedala Ulagam after singing a dozen songs along the way and the story was about to get interesting.

So started the idea for this post. Which were the movies I loved watching again and again- every time they showed on TV?. Which ones I even had cd’s off at home to watch when the mood struck me?  Being an absolute movie buff- there were literally dozens of films which fill these criteria and I had to whittle it down to manageable limits. So here goes.


Vedala Ulagam:

Lets start with this huge favorite of me- from my childhood days. An absolute cracker of an adventure movie for one made in 1948…it contains an iconic song..and one of my ever green favorite- Ayyo Ayyo Pakka Kannu Koosudhe…..sung by the comedian Sarangapani at the Demons or Vedalams. Another favorite from this movie is the mantra “Rajeevi” as uttered by the Hero T.R.Mahalingam whenever he runs into trouble……got a problem? Call Rajeevi- is now a standing joke in our family. The movie is even scientific for its times- the hero threatens the villain the demon king- with Anu Gundu or Atom bomb….think nuclear weapons in 1948? But more than the other hero its Sarangapani, a now forgotten comic actor who plays the hero’s sidekick who gets away with the best gags and lines always starting with “ada mada vedalangaley”…..and one scene in the movie is vaguely reminiscent of the Micheal Crichton Book/Movie- Sphere- where a Sphere from outer space manifests as actual whatever you desire. The same is shown as part of Indian Mythology- the Sanjeevani Tree below which Sarangapani sits and asks for food and drink which he gets immediately and while enjoying them suddenly gets fearful and thinks about Vedalams and they turn up in droves. This one is a must watch for all Tamil film aficionados.



Anbe Vaa….

I actually almost ate a whole finger nail, chewing over the decision to include this movie on the list beating out my other MGR favorites like Guleb-Bakavalli, Alibaba and 40 thieves and Ragasiya Police 115. Guleb-Bakavalli has a great story line, Aliababa has outstanding music – remember Masilla Unmail Kadale? And Ragasiya Police- was a typical MGR action thriller. But Anbe Vaa beats all this…story, humour, music and action. MGR’s fight with Sitting Bull would have the theatre erupting in claps (I watched this movie in Select Theatre, George Town in the company of my mother and aunts- as the mandatory male escort – at an age of 7/8 years) when MGR bodily lifts the huge villain – Sitting Bull -over his head with absolutely no graphics. And the music- Once a Papa, Met a Mummy is so ingrained in our family’s subconscious that even my 6 year old neice can hum it. And to top it all the outstanding Nagesh-Manorama comedy duo took this movie a notch above everything else. Punnaku Puniyakodi, anyone? Every scene, every dialogue of this movie rocks and remember this was not a typical MGR movie..he was not typecast as the usual do-gooder character he always played but as someone who almost loses his girl to his best friend Asokan, before everything comes right at the end. This movie was  the ultimate romance film of the olden days.


Thunive Thunai…..

If there is one tamil movie which can be said to be of Hollywood standard this is the one- made in 1976 the movie deals with the busting of superstitions-a Vampire film before Twilight became famous. The opening sequence before the credits is one of the best horror sequences in tamil films ever. And the movie has the mother of all punch dialogues- way before Rajnikanth- “Maapla, alavedukkava maapla?” uttered in his inimitable style by SA Asokan….when he wants to measure Jaishankar for his coffin. Let me confess that I am crazy about Jaishankars “Bond” films and I had a tough time choosing between Nilagiri Express, Yaar Nee and Thunive Thunai….but this wins out for the sheer gripping screenplay. Jaishankar’s bold replies on the cart journey to the haunted village has to stand out for the sheer brilliance of dialogue writing. And SA Asokan absolutely rocks among the whole host of villains – as does CID Shakuntala.

There are lots of other movies I enjoy greatly too- Adhe Kangal of Ravichandran, Edhir Neechal of Nagesh- a sadly underrated actor compared to the more hyped NSKrishnan/ChandraBabu, and Pattinathil Bootham of Jaishankar and Nagesh combo with the incomparable Javert Seetharaman of Andha Naal as the eponymous ghost….but those have to be for another day. 

Now tell me which are your favorites?

(Pics: courtesy Google Images )


Friday, June 1, 2012

Evidence Based Medicine Vs. Intuition



Evidence Based Medicine Vs. Intuition

I happened to read this interesting article here (Evidence-Based Medicine: What's the Evidence? http://onlinelibrary.wiley.com/doi/10.1002/clc.21968/full) on Evidence based medicine and re-appraisal of its evolution and growth to becoming the centrality of medical practice. Medicine has always depended on empirical evidence (as has science- despite what the creation science/intelligent design supporters say) but only recently has the concept of evidence based medicine become absolutely indispensable to the everyday practice of medicine beating out clinical acumen, clinical experience and that most elusive of holies- gut feel.

Don’t get me wrong…I love evidence based medicine- despite the fact that my professors in my PG years made me learn by heart the top 100 authors/ researchers (of best articles) in my specialty and their areas of current research and any paradigm altering scientific evidence they produced….you could have woken me up in my sleep and I would have told you what Dr’s Beverly Dale, Kolebrander, Isao Ishikawa were up to till the previous week…but that didn’t make me an expert on evidence based medicine- it was purely exam oriented training. 

But as I started my research works for my master’s thesis and I came into contact with research methodology and those twin towers of medical research- “p” value and odds ratio- I felt the first twinges of disquiet. As the eminent researcher K.A.Fisher pointed out – statistics are just probabilities – they are not certainties and the whole edifice of medicine was based on these research papers as if they were the infallible truth. With the advent of internet medicine and patients armed with reams of printouts from dubious medical websites, we are often forced to practice safe medicine- go for the most defensible prescription- always keeping in mind a potential lawsuit in the future  (years later -when we have forgotten all about it).

It wasn’t always like this. When I was young and getting my usual quota of childhood diseases- we alternated between two doctors to treat my childhood ailments.  One was a famous General Physician called Dr.Venkatesh Pai of George Town, Madras, a schoolmate of my grandfather (in the 1930’s)– who had treated my grandfather, my father and when he finally came down to me- he was the very definition of a family doctor- old, wizened, wise and absolutely authoritative. Patients used to wait in droves outside his palatial bungalow cum clinic and he used to dispense his own compositions- the compounder at the attached pharmacy handed out colored bottles and powders of unknown provenance which used to work wonders- mainly because patients believed that he had the special “gift of the hand”- the Rashi of curing any patient he saw….a placebo belief which was more powerful than any medicine he dispensed.

The other doctor my parents used to take me to was for emergencies- a brash young Paediatrician just starting to make a name for himself in the profession, a Dr.Vishwanath of Nungambakkam, Chennai who was a great believer in symptomatic treatment, in reducing high-fevers in no time, with anti-pyretic injections and corticosteroids. When I started my own clinical practice I begun to understand his line of treatment better- as parents insist on and expect nothing less than immediate success when it comes to children- they don’t appreciate the take this medicine and wait for it to work line. Like every recently graduated doc, he plied me with all the latest drugs on the market- stuff which my other physician would never ever consider. Between these two extremes of treatment, I somehow survived unscathed and lived to write this post.

My next brush with the (un)certainties of modern medicine came when I was in Tanjore Medical College. I used to hang out with a bunch of Oto-Rhino-Laryngologist’s, better known as ENT Surgeons (in fact, I was dating one of them – a PG student which gave me privileged access to the inner sanctum) and I used to hear a lot of gossip about current advances in their specialty. The ENT docs considered Adenoids/tonsils and all accessory lymphoid tissues as purely vestigial and were forever recommending their removal...So much so, that a standing joke among the other doctors was that ENT docs don’t do surgery for tonsillitis (the disease) but for tonsils (normal). This was purely based on current Evidence Based Medicine which said that you don’t need your tonsils for normal, everyday life (along with appendix/wisdom teeth etc)- which gave a fillip to the cut it and throw it out group. This again prompted me to have vague doubts about the vagaries in interpretation of evidence based medicine.

The point I am trying to make is if the practice of medicine was just about writing out a prescription- based on current available best evidence - given a set of symptoms…then any robotic interface can do a better job than even the best trained human. It’s that intangible something called clinical experience, acumen or gut feels which separates robotic medicine from human medicine. For example antibiotics like Co-trimoxazole or Erythromycin have never gone out of circulation, but is there any recent prescription where you have seen them? I have not. The bad reputation these drugs have acquired as becoming ineffective or susceptible to resistant organisms is purely word of mouth gossip over conference lunches and canteen coffees. And practioners have moved onto newer generations of antibiotics for even simpler infections precisely because they have faith on them based on the grapevine rather than any hard evidence or double-blind, gold-plated RCT studies. And of course, when compelling evidence shows us clearly what works or not- we do accept it and change promptly.

So, tell me all, is your practice based solely on best evidence or do you give credence to your inner voice? Your experience, your acumen, your gut-feel when it comes to deciding what works or maybe will work better for that particular patient?

(P.S. this post is based on personal beliefs and is being published on a personal blog in my personal capacity- and not in a peer-reviewed, indexed journal- hence I don’t have to produce voluminous, hard data, to substantiate my beliefs which I stated here…feel free to comment and I will reply..If you feel the need to debate-please excuse)