Popping Pills

Mondays are always crazy busy days in a govt hospital. It’s as if a rash of people get sick over the weekend and can’t wait to get to the doctor early on Monday morning. That leads to a lot of chaos and confusion and fights over who came first and who has the more serious disease and should be seen on a priority basis. All this leads to not only heartburn for the patients’ waiting in the long queues but also poses quite a challenge to the doctors (who are just recovering after a weekend well spent) every Monday morning. And amidst all this serious and very sick patients there comes one who inadvertently lightens up the whole day with an accidental joke. But believe me; the patient is usually ignorant that what he/she says is absurdly humorous. But it’s enjoyable all the same. A complete stress-buster in the midst of all that tension.

Like today, when I was in the midst of a roller-coaster ride of patients (too many sick people/too few doctors, as usual) there walked in a patient, a middle aged lady who told me something bizarre and comical at the same time. When I had prescribed to her a drug which needed to be taken along with food and was explaining the necessity to not to take it on an empty stomach, she exclaimed enthusiastically that she had a method of her own to take drugs. And even before I asked she volunteered the information that she usually took all her medicines between the first and second course of her meal. Flabbergasted I asked her to elaborate, as I had personally never heard of such a thing before and she went on to say that she first took Sambar Rice and then stopping her meal there, she proceeded to take her medicines and then she again went back to eating Rasam rice. She said proudly that this ensured that the pills were not acting on an empty stomach and that there was food in her stomach before and food in her stomach after the medicines thus protecting her from the medicines effects. I had difficulty keeping my face straight and breaking into laughter as I nodded my head sagely at her, praised her intelligence at discovering such a fantastic system to take medicines and sent her away well pleased with her own cleverness. There was absolutely nothing objectionable about her technique in taking medicines. But neither was it necessary.

And that made me think that most often our patients do things blindly, trusting to us doctors without really reasoning out why they do the things they are asked to do by the doctors. And we doctors with our superior attitudes of I know best and also due to a lack of time fail to explain properly to our patients why we tell them to do certain things. Now I cannot go around explaining to each and every patient the intricacies of drug absorption and why certain medicines have to be taken on an empty stomach and why certain medicines should never be taken on an empty stomach. But I can actually do it in detail on a blog post and hopefully those who read it will understand a bit more about medicine and pharmacology and the do’s and don’ts of popping pills. So here goes.

The first and foremost thing to say is that the method the lady I mentioned above follows is completely unnecessary. When we say take a medicine with food, we don’t mean it literally. A medicine can be taken half an hour before or after food. As long as the stomach is not empty for a long time with just the medicine in it. This is done for two reasons. A starving stomach has usually a high acid content already inside it and some medicines can increase the acids produced by the stomach leading to the formation of an ulcer or at least stomach ache in the immediate aftermath of taking the medicine. This can be prevented by taking food along with the medicine as the food absorbs the acid, dampens the medicines effects and protects the stomachs lining from being eaten up by our own stomach acids. If you already have acidity or ulcers you can ask your doctor for a safe drug; for there are many alternative forms of the same medicine with the active -disease fighting ingredient being the same, but the salt with which it is made (like sodium replaced by potassium) can be changed, a small change which has the big effect of changing where the medicine is absorbed from- either the stomach or the intestine.

For example everyone knows the painkiller Diclofenac, also known as Voveran. Diclo Sodium is absorbed from the stomach, while Diclo Potassium is absorbed from the intestines. You can see how this would be useful for patients with acidity. Diclo Potassium is labeled Enteric Coated – which means the drug is covered by an insoluble layer which does not get digested by the stomachs acids. But wait till it passes through the stomach and gets into your intestine. The thick protecting layer dissolves immediately, the medicine comes into touch with the intestine cells is rapidly absorbed from there, gets into the blood and acts on your pain. Result – pain relief and no acidity at the same time.

The other reason we ask medicines to be taken with food is to decrease the absorption speed of the medicine from the stomach (to the blood) to a more manageable level. While fast absorption of a medicine is very necessary for some diseases- think heart attack- where you cannot have a single minute’s delay between taking the medicine and its effect to take place, it is not always beneficial. On an empty stomach the medicine is rapidly absorbed and acts very fast while its effect also disappears very fast- leading to an increased number of pills to be taken again and again. This causes difficulty when it comes to certain diseases where we need the medicine to be in the blood for a long time instead of disappearing immediately. Like back pain for instance. 

Taking the same example of the painkiller Diclo again, we can either take the regular drug which can act for a time period of 6 hrs for moderate pain or we can go for a RR-form of the medicine- the rapid release form which acts immediately but only for half the time as regular (to be taken every 3hrs) or we can take the SR form- the sustained release form which is absorbed slowly in low doses and acts slowly for a long time- almost double the time (to be taken every 12hrs). so for the same pain we can take a painkiller either every 3hrs, every 6hrs or every 12hrs. That’s 2 tablets or 4 tablets or 8 tablets a day- depending on your doctors choice of the medicine he prescribes for you. So be specific about the severity of the pain when talking to your doctor to help him decide.

And now we come to the medicines which should only be taken on an empty stomach and never with food. The reason is very simple- food interferes with the absorption of the medicine. There are certain antibiotics which cannot be absorbed when food is present inside the stomach and hence should always be taken at least an hour before food. One example is taking Iron tablets. An iron tablet should never be taken along with dairy products like Milk, cheese butter etc. because the cells which should absorb the iron from the medicine is busy absorbing the calcium from the stomach and the entire iron tablet is lost unabsorbed and of no use to the body. So iron and calcium - never mix please.

These are just a few examples of what makes a doctor instruct you to take a medicine at a specific time. I cannot be more exhaustive here as that would mean I end up writing a pharmacology textbook. So please ask your doctor for more detailed explanations. Or read the instructions printed on the label more carefully. Take care.

An Eye for an Eye…

If you can’t laugh at yourself, please call me and I would be happy to do it for you said Groucho Marx once, a statement I once taped over my bedroom wall to remind me to laugh at myself daily before others do.  I don’t have it anymore for with the passage of time I found more worthy things to tape up there, like posters of my favorite film stars and stuff like that. But I have never forgotten that message. I still enjoy a mighty chuckle at myself at every little opportunity. And I do enjoy the humor of being made fun of. My friends Raj and Sangy would say if asked on how they spent an entire train journey of two days, on a trip back from Mumbai, making fun of me, trying to provoke me, but unable to get a single negative reaction from me. They exhausted themselves trying to make fun of me as I laughed boisterously and enjoyed all their jokes with them, so much so they gave up when they realized the joke was on them and it was impossible to make me lose my temper. The point of all this, needless, self publicity is to first state categorically that the rest of this post was written in a pretty cool frame of mind and not out of any malice.

I have been a part of a few flame wars a few years ago, but not much recently. So it was a pretty pleasant surprise when I read a recent post by one of my blogger friends Gitanjali (here: http://rhapsodic-xana.blogspot.in/2012/10/circle-of-life.html ) poking fun at me for one my earlier posts where I had refused to hug a fellow male. It’s an honor first of all to be made the subject of an entire post on someone else’s blog. Especially someone whose blog post are one of my favorite reads. I really enjoyed the way she has portrayed my exaggeration of an ordinary event. Well, what can I say in my defense? Sometimes humor requires a little exaggeration of everyday events- that’s a category called “Farce”, something best exemplified by Charles Chaplin in his movies. But later on in her post she goes on to make the comparison between men and women on being harassed. Her point being that women go through a lot more on a daily basis and rarely complain while here I was blowing up a little incident.  A perfectly valid comment from my point of view too. 

But the point she makes about the comparison between men and women is where she loses me. Does being harassed have different meanings for men and women? Honestly?  A man’s body is lesser sacred to him than a women’s body is to her? So because women go through a lot of harassment on a daily basis, men who are harassed too should keep mum about it? For it’s their turn now? I fail to see the logic in this kind of argument. Dispassionately viewed it smacks of a deliberate enjoyment of the “ah! men- now you are getting it back” kind of mentality. The Germans have a word for it (thanks dad, for all those German lessons at Goethe Institute) called Schadenfreude – meaning to take pleasure in others sufferings (source- wiki : http:/en.wikipedia.org/wiki/Schadenfreude). An equivalent English word is Gloat : meaning a malicious satisfaction, gratification, delight over others misfortune.

Which is unfair to me for I have always been against harassment and supported a womens right to her own body – as I mention in my previous blog posts –

here : http://audialtempartem.blogspot.in/2012/09/hands-off-you-perverts.html

And here : http://audialtempartem.blogspot.in/2012/07/harassing-harassers.html

And I am not saying that just because I understand harassment from a woman’s point of view makes me an all-round good guy. No it doesn’t. Neither does the fact that just because I am a man, a member of the male species who routinely harass women, that makes me eligible for being groped or touched in-appropriately with no right to complain about harassment. Payback time is not for civilized people in civilized societies- an eye for an eye is a pretty archaic concept. And to condemn an entire half of the human race for the misdeeds of a few makes me wonder about the depths of hatred to which people go so willingly. And so I finally get what the Rwanda conflict is all about- the whole Hutu/Tutsi- you slaughtered my ancestors 500years ago- now it’s our turn to slaughter your children- mode of settling scores. I thought we are a civilized society and beyond all that. Are we not? 

Saying a man can be harassed because, face it he is a man, what the heck is he complaining about?? Is as glib an argument as saying “Hey, she is not a virgin, she has known men before, so why not rape her?” The Supreme Court of our country has in several judgments’ pronounced that even a sex-worker had rights over her own body and she cannot be touched without her permission. Can you say men are any less? A lesser breed? That men don’t have any rights over their own bodies and can assaulted anytime by anyone and shouldn’t complain but take it easy. I would have laughed it off if this kind of opinion came from some male chauvinist but I am deeply saddened by the fact that this glib argument is made by a woman, who must know from firsthand experience how traumatic it is for anyone, male, female or child to be touched in-appropriately without their permission.

My point being that everyone has a right to the privacy of their body. Gender be damned. And contrary to what “some” women think, men don’t enjoy being assaulted too. Just like women. Two wrongs do not make a right. And enjoying the discomfiture of men does not help women in their fight against harassment.

I would like to put an end to this argument with this popular dialogue borrowed from Shah Rukh Khan – “My name is Ganesh And I am not a Harasser”. And I have a right to my own body. And to decide who gets to touch it and when. Over to you Gitanjali.

                                                       

How-To Talk to Aliens....evolving communication technologies

(Disclaimer: This is a hard-science post and not recommended for casual readers of this blog. Very, very rarely, I remember that I am a bit of scientist myself and I am tempted to write a blog post on some scientific problem which catches my fancy. This is one such and although I have tried to keep the jargon as simple as possible, the topic might be a bit heavy. So if you get bored easily, please feel free to leave now. On the other hand, if you wouldn’t mind learning a little science, bravely go on and I guarantee you will be rewarded for your patience)

I was watching the movie Green Lantern recently and one scene in the movie especially piqued my interest, the scene where the pilot Hal Jordan talks to an alien entity for the first time and the alien says that they are able to understand each other because their common universal translator works well. That had me thinking on alien communication, human communication and communication as such.

When we first evolved from the ape family into humans, one of the primary advantages for our dominating the rest of the species was our ability to talk and communicate to each other. Speech defined us, it gave us the tools to share knowledge, plan hunts successfully and even helped form social unions. Without speech a man could not assert his right to a woman (in front of his competitors) or even communicate to her that he considered her his own. I think the words I love you must have been one of the first few sentences to evolve in human history. And from there to the organizing of great civilizations transcending all the other species on the planet was but just a step forward.

But in all this the fact that the technology (the organs) involved in this form of communication – the tongue, the vocal cords and its associated musculature remained practically unchanged over millennia is a cause for surprise. There has been absolutely no improvement/no evolution/no refinement in vocal cord technology- unlike what Moores' Law predicted (you know the doubling of technology for transistor chips?) . We still have the same transmitting set- our vocal cord muscles and receiving set – the ear drum (the receiver) and the interpreter – the ear bones or the ossicles (malleus/incus/stapes)which vibrate and carry the spoken frequencies of the sound waves to the brain for interpretation/parsing the contents into separate packets of data. So speech tech evolved millenia ago and stays the same, despite Apple’s Siri (on i-phones) and Samsungs S-tech (on Galaxy mobiles).

The other great form of human communication, the written word was evolved long back in the midst of time, somewhere in the Sumerian valley (or maybe the Indus valley) according to different sources. But this technology really kicked off after the guttenberg press got invented. The ensuing availability of cheap paper based communication devices (also known as books) lead to rapid sharing of knowledge among us humans and helped push us up the next step in evolution. And this stayed true right upto the evolution of e-readers which still depend on the written word being read by the eyes and processed in the brain. Technology stays the same, only the delivery vehicle has improved, somewhat like the automobile technology- from the ford model t to ferrari, a car still has four wheels, a steering column and runs on the road, despite the internal combustion engine being experimented with alternatives like fuel cells. But I digress.

To get back to my premise, the most promising new development in information communication after speech was development of computers and machine language. The fact that you could compress large amount so information into data packets and transmit them over  long distances (yes the internet, is what I am talking about) has revolutionized our communication capabilities. We are no longer constrained by the limitations inherent in the other forms of communication, we dont need to memorize entire books of text (like the vedic scholars did) or print huge volumes of encyclopedias (Britannica's) but use compressed data (thank you winzip) for communicating large bits of knowledge over to wider audiences. The knowledge society we now have is equitable, anyone with access to the Internet can get any information – you dont need to know Latin or Sanskrit or be born in the ruling or priestly class to be able to read certain things. Even the Vatican archives are on the net. How is that for sharing knowledge?

But every silver lining has a small cloud or is it vice versa? I can never remember. Anyway the point is as we develop and transmit more and more data, we find that the transmission time is bound to increase with the sheer volume of the traffic and the integrity of the transmitted data is not strictly preserved. Which means garbled data and lost tempers. Hence in recent years there have been enquiries into alternative forms of data transmission beyond the light beam technology we now use in optical fibres (which is the direct descendant of the reflecting mirrors/candles an old, old device) which has by now reached the end of it tether (pardon the bad pun) and attention has now shifted to biological forms of communication. Specifically at the cellular level. This technology is also known a bio-mimetics or imitating biology.

Bio-mimetics involves copying nature to beat technlogical challenges. For example, by studying the hovering effect of humming birds we were able to get helicopters to hover in mid air. And by studying the underwater propulsion techniques of certain squids/calamari we were able to produce harpoons which work well in the depth of the ocean where the immense pressures will make any gun fired underwater absolutely useless. And the most commonly quoted example is of course the invention of Velcro by observing the sharp burrs found in nature. So by adapting the communication technologies as seen in nature we have progressed a great deal in our own ways of getting ahead.

For example bacteria communicate by a process called quorum sensing. When certain chemicals are released by bacterial cells which form part of a colony, the main body of the colony waits till a critical mass is built up (a quora is formed) before all of them start producing the chemical together which helps this colony communicate to other far off colonies. A direct example of this would be the anti-corruption crusader Anna Hazare's movement last year. When Anna Hazare and his India Against Corruption organization first started their hunger strike, everyone had a wait and watch approach, till the media got into the act and celebrities started turning up to share the platform with the IAC crowd and suddenly the anti-corruption movement was the flavor of the month with all the country talking about it all the time. It had taken a critical mass to build up before the general public decided that this is an issue worth devoting their time and attention to. 

And that is precisely what bacterial communication is also all about. Translated into computer tech it means any high tech signal, which is passed over an unstable line, waits till the data is completely built up before transmitting itself in one high speed burst without loss or drop of any crucial data. Can you see the military aspect involved in secure transmissions with no data loss?

Now when scientists borrowed this idea from the bacteria, they also went a step further and tried to use bacterio-phages which are basically predatory viruses which infect bacteria and force them to make copies of themselves to distribute far and wide. This is a very useful technology when it comes to communication as it allows you to input a single copy of data and allow it to multiply itself at almost instantaneous speeds and then get distributed over a wider network making sure that the data is never lost in translation. This would solve the problem of all those long distance data losses seen with transatlantic fiber optic lines if the lines are coated with bacteria and the data is transmitted in the form of a virus. A fusion of biology and computers to aim for in the future.

A further example of bio-mimetics involves the neural network theory of computing where computers are built mimicking the data transmission seen in neural (nerve) pathways seen inside the human body (familiar to people who use C-sharp). Our nerves are one of the most efficient data transmission devices ever built, as they help the various parts of our body to communicate with the brain at speeds which cannot be matched by even IBM's latest supercomputers. The basic structure of any nerve is the neuron, a cell which sits in the middle and send out branching fibers (long tubes) called axons which communicate with other axons from other neurons. If you take the analogy further neurons are distributed server networks while axons are the connecting cables and the central server is of course our brain. 

 

 

But unlike computers which work wholly by electricity our nerves (and brain) communicate with a combination of electro-chemical processes. The data (or nerve impulses) travel electrically along the axons but when they reach the end of the line where one axon touches another they are converted into chemical signals called neuro-transmitters which helps the signal jump over the gap and communicate with other remote and distant axons too. It’s like a signal which travels over a wire suddenly becoming a wireless signal when it reaches the end of the line and when it is picked up by another wire again travels over the wire. Wire-wireless-wire automatically. Now can you see the resemblance to a wifi-router and see where the idea originated from?

With all this knowledge in transmitting communication we still somehow falter when it comes to the basics of communication. We still cannot communicate with the other species on our planet. The birds and bees. Or the anthropoid apes. Or the whales and dolphins. Recent scientific evidence has found out that the high pitched squeaks of dolphins and the low decibel whale songs do form some rudimentary form of communication, but how rudimentary or how advanced we are unable to judge as long as we are unable to decipher it- the same thing which prevents us from deciding whether the indus valley civilization was aryan or dravidian – we have the data but we just cant interpret it.

The ant species have been found to use complex chemical trails to communicate and so have the bees (which use a variety of pheromones). We know this but we cant understand them. We hear the bird songs and think that they sing to please us and never try to make more of an effort to investigate whether they are actually communicating to each other. We even disregard the communication capabilities of our nearest relatives in the evolutionary scale – the anthropoid apes who have been found to use a large variety of sign language to talk to each other. Remember we once passed through that very same phase of sign language before we developed the spoken language due to our uniquely sensitive vocal cords.

Unless we make more of an effort to try and understand the communication technologies of other species on our own planet, we will be a massive failure when it comes to communicating with species which might try to contact us from outer space. We will be like ants to them in communication technology, running around, laying chemical trails. Or maybe they would have to teach us the basics of their language like how we train apes to speak in sign language. Given the rudimentary vocabulary of apes which use sign language, I fear that any interstellar communication between any advanced species and we humans would leave those aliens clutching their hairs in sheer frustration at the inability of humans to learn anything.

Already we are reaching out to the stars, already the Voyager spacecraft is now past the edges of our solar system and into deep space. And NASA has sent the Kepler deep space telescope after it to try and analyze any signals we might receive back from space. As for our own signals, the Voyager spacecraft carry messages recorded in all human languages – both voice and pictures as humanity's welcome message for any civilization which happens to pick up our broadcast. And also samples from earths music, which is a very sound concept as unlike language, sound waves are essentially on the same scales throughout the universe, as expressed by the vibration/frequency of all bodies in the universe. From the smallest asteroids to the largest pulsars all of them oscillate and produce sound waves of one kind or another in different frequencies. So any advanced civilization should be able to pick up, interpret and respond in kind to any sound wave we produce. This might even be in the form of the definite frequency of their planetary body or the frequency of a large enough nearby pulsar, challenging us to identify their location in deep space by analyzing the sound waves- a sorta location search in a galactic Google map by pinpointing the nearest cell phone tower to where they are currently.

And finally we come to mathematics which all those science fiction movies have conditioned us to think of as the de-facto lingua franca of the universe. Would we be able to converse with other alien species through mathematical constants? I dont know myself although my vote goes for the laws of physics rather than Pythagoras theorem as the universal constant.

But first we have to learn to talk to the apes. And the ants and the bees. And the dolphins and the whales. If we are to ever have any chance of talking to any other intelligence species from anywhere else in the universe. Or we should hope they bring us a universal translator like the one shown in the movie, the green lantern. And forever remain the stupid cousins of the universe. The choice is ours right now, for the sake of all humanity to decide our place in the universe. Learn and Grow Strong. Go forth or Stagnate. I hope we make the right choice.

(P.S. I welcome questions and discussions on all the points I have raised here – as long as they are serious and not frivolous)