Rambodoc at large

There is a guy from SA called Eric who posted this:

"There was a young man from Cape Horn
Who wished he had never been born,
And he wouldn't have been,
If his father had seen
That the tip of his condom was torn."

My reply to him was:
"A good one, Mister Erick!
Let me be real quick
In asking you about the French letter:
Does it make the sex better,
Or is it just a cover for a shy dick?"

"A limerick is a five-line poem written with one couplet and one triplet. If
a couplet is a two-line rhymed poem, then a triplet would be a three-line
rhymed poem. The rhyme pattern is a a b b a with lines 1, 2 and 5 containing
3 beats and rhyming, and lines 3 and 4 having two beats and rhyming. Some
people say that the limerick was invented by soldiers returning from France
to the Irish town of Limerick in the 1700's.

Limericks are meant to be funny. They often contain hyperbole, onomatopoeia,
idioms, puns, and other figurative devices. The last line of a good limerick
contains the PUNCH LINE or "heart of the joke." As you work with limericks,
remember to have pun, I mean FUN! Say the following limericks out loud and
clap to the rhythm.

A flea and a fly in a flue
Were caught, so what could they do?
Said the fly, "Let us flee."
"Let us fly," said the flea.
So they flew through a flaw in the flue.

To which I say:

"Here I am, aroused by a fly,
Tho' true 'tis, I will not lie,
Next to you, or to you,
In Paris or in Peru,
In straight sex will I rely!"

Yes, the Chinese have their own culture, and their solutions, like their legendary torture methods, defy conventional norms of 'civilised' nations. Spurious drugs are a result of lax law enforcement, low level of protection for intellectual property (read patents), and general corruption. The Chinese just decided to say "foggedaboutit" and took a shot at a solution.
Maybe people in India, like Barun Mitra, will have something to say about this.

Don't be surprised if you hear who makes a better surgeon today.
Young surgeons who spend hours playing on their playstations beat their sedate and (possibly) more studious counterparts hollow as surgeons, as you can read here.
You can also read the abstract of the original article here.

Well, the first world has woken up to air travel spreading lethal bugs across to susceptible populations, even as countries like India and Africa sleep in blissful disregard. You can read the story of the TB guy at this site.
Now, if a doctor has to be posed the issue of confidentiality versus the duty to prevent spread, should he warn the State everytime a case of a contagious disease is detected? What happens to patient privacy then?

The New England Journal of Medicine has published articles clarifying the issue of who needs surgery for back pain.
The original article is available here
Below is the extract of the article.

Back Surgery — Who Needs It?
Richard A. Deyo, M.D., M.P.H.

Back surgery is not the final common pathway for everyone with persistent back pain. It offers specific therapy for specific anatomical derangements associated with specific complexes of symptoms. When surgery ranges beyond carefully defined situations, we can expect disappointed patients.

Two articles in this issue of the Journal (text deleted) — bolsters the case that surgery is effective for patients with sciatica owing to herniated disks. Investigators studied patients with sciatica who had not had sufficient improvement after 6 to 12 weeks of nonsurgical treatment. Excluding patients with briefer episodes was important, because even without surgery, sciatica improves within 3 months in 75% of patients.
Even among patients with persistent sciatica, recovery was likely whether or not surgery was performed. Studies involving repeated imaging show that most herniated disks shrink over time. But surgery accelerates the pace of recovery, and for some patients, faster recovery may be worth the risks.

After a year, recovery was about the same with surgery as with nonsurgical care, though almost 40% of patients who were initially assigned to the nonsurgical group later underwent surgery. A similar convergence of results after 2 to 4 years was apparent in earlier randomized, controlled trials. Thus, for patients with persistent sciatica, there seems to be a reasonable choice between surgical and nonsurgical treatment, which may be influenced by aversion to surgical risks, the severity of symptoms, and willingness to wait for spontaneous healing.

Patients in this spondylolisthesis trial tended to have improvement with nonsurgical therapy but to a smaller degree than the authors observed in their previous trial of surgery for herniated disks. Previous studies of nonsurgical treatment for spinal stenosis similarly suggest a low rate of improvement, in contrast to studies in patients with herniated disks. The less favorable prognosis of spinal stenosis may be an important factor for patients considering surgery.

In the two trials presented here, both back pain and leg pain were ameliorated by surgery, but leg pain resolved more quickly and fully than back pain. Thus, benefits are likely to be greatest for nerve-root–associated symptoms.

Degenerative spondylolisthesis with stenosis is primarily a condition of older adults rather than of younger patients, who typically have herniated disks with sciatica. In addition, fusion surgery is more invasive than diskectomy, with a higher complication rate. Surgical complication rates increase substantially after 80 years of age, which changes the risk–benefit equation — a problem that has yet to be addressed directly by researchers.


So who needs back surgery? The consensus seems to be that patients who were excluded from these trials because of major motor deficits need surgery, as do some with major spine trauma. For these patients, surgery may preserve life or function. Absent major neurologic deficits, patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, but the appropriate surgical procedures may provide valuable pain relief. In such situations, decisions should be made jointly by well-informed patients and their physicians.

Check out my review of the Playstation3 in Kolkata's The Telegraph

This is one salad to live for. Fresh, hard tomatoes, extra virgin olive oil, goat cheese or Mozzarella, basil, salt and pepper, go into this awesome Italian salad. You can learn more here.
You can add just a couple of Spanish capers, pimentos or olives, and I definitely love the taste of toasted cucumber seeds on this. Simply superb!

I suggest you try this sometime. It comes out quite interesting to the tongue, though, if your family does not dig Italian food like you do, you are going to have to eat all the leftovers! I found this recipe at this site.
My take on this dish: very nice! If you don't have rigatoni, do with fusilli. I don't think it matters.



INGREDIENTS:
8 ounces uncooked rigatoni
pasta
1 tablespoon olive oil, divided
2 skinless, boneless chicken
breast halves - cubed
1 onion, sliced and separated
into rings
1 green bell pepper, cut into
thin strips
3 cloves garlic, minced
1 teaspoon fresh ginger,
minced
1 mango - peeled, seeded and
chopped
1 cup heavy cream
salt and pepper to taste
1 tablespoon grated Parmesan
cheese
4 sprigs fresh parsley, for
garnish
DIRECTIONS:
1.
Bring a large pot of lightly salted water to a boil. Add rigatoni pasta, cook for 8 minutes, until almost done, and drain.
2.
Heat 1/2 the olive oil in a large skillet over medium heat. Place chicken in the skillet, and cook 10 minutes, or until juices run clear. Remove from heat, and set aside.
3.
Heat the remaining olive oil in the skillet, and cook the onion and green pepper until tender. Mix in the garlic, ginger, and mango, and continue to cook and stir 5 minutes, or until mango is soft. Gradually mix the heavy cream into the skillet, and cook 5 minutes, until thickened.
4.
Return the chicken to the skillet. Stir in the partially cooked pasta, and season with salt and pepper. Cook and stir 2 minutes, until ingredients are well blended and pasta is al dente. Mix in the cheese. Garnish with parsley to serve.

One day, while a woodcutter was cutting a branch of a tree above a river, his axe fell into the river.

When he cried out, the Lord appeared and asked, "Why are you crying?"

The woodcutter replied that his axe has fallen into the water.

The Lord went down into the water and reappeared with a golden axe.

"Is this your axe?" the Lord asked.

The woodcutter replied, "No."

The Lord again went down and came up with a silver axe.

"Is this your axe?" the Lord asked.

Again, the woodcutter replied, "No."

The Lord went down again and came up with an iron axe.

"Is this your axe?" the Lord asked.

The woodcutter replied, "Yes."

The Lord was pleased with the man's honesty and gave him all three axes to keep, and the woodcutter went home happily.

One day while he was walking with his wife along the riverbank, the woodcutter's wife fell into the river.

When he cried out, the Lord appeared and asked him, "Why are you crying?"

"Oh Lord, my wife has fallen into the water!"

The Lord went down into the water and came up with Jennifer Lopez.

"Is this your wife?" the Lord asked.

"Yes," cried the woodcutter.

The Lord was furious. "You cheat! That is an untruth!"

The woodcutter replied, "Oh, forgive me, my Lord. It is a misunderstanding. You see, if I said 'no' to Jennifer Lopez, You will come up with Catherine Zeta-Jones. Then if I also say 'no' to her, You will thirdly come up with my wife, and I will say 'yes,' and then all three will be given to me. But Lord, I am a poor man and I will not be able to take care of all three wives, so that's why I said yes this time."

The moral of the story is whenever a man lies, it is always for a good and honorable reason.

Link

Want to try a low cal tasty dish? I found this corn-and-avocado salsa recipe here.

there was this interesting case of heterotopic pancreas in the small intestine of a young boy who used to bleed a lot. Surgery cured him.

If you want to know how to give good examples in speech or in writing, you couldn't get better examples than these:

Oh, Jason, take me!" she panted, her breasts heaving like a student on
31 pence-a-pint night.


Her face was a perfect oval, like a circle that had its two other sides gently compressed by a Thigh Master.


His thoughts tumbled in his head, making and breaking alliances like underpants in a tumble dryer.


She caught your eye like one of those pointy hook latches that used to dangle from doors and would fly up whenever you banged the door open again.


The little boat gently drifted across the pond exactly the way a bowling ball wouldn't.


McMurphy fell 12 stories, hitting the pavement like a paper bag filled with vegetable soup.


Her hair glistened in the rain like nose hair after a sneeze.


Her eyes were like two brown circles with big black dots in the centre


Her vocabulary was as bad as, like, whatever.


He was as tall as a six-foot-three-inch tree.


The hailstones leaped from the pavement, just like maggots when you fry
them in hot grease.


Long separated by cruel fate, the star-crossed lovers raced across the grassy field toward each other like two freight trains, one having left York at 6:36 p.m. traveling at 55 mph, the other from Peterborough at 4:19p.m.at a speed of 35 mph.


The politician was gone but unnoticed, like the full stop after the Dr. on a Dr Pepper can.


John and Mary had never met. They were like two hummingbirds who had also never met.


The thunder was ominous sounding, much like the sound of a thin sheet of metal being shaken backstage during the storm scene in a play.


The red brick wall was the color of a brick-red crayon.


Even in his last years, Granddad had a mind like a steel trap, only one that
had been left out so long it had rusted shut.


The door had been forced, as forced as the dialogue during the interview portion of Family Fortunes.


Shots rang out, as shots are wont to do.


The plan was simple, like my brother Phil. But unlike Phil, this plan just might work.

The young fighter had a hungry look, the kind you get from not eating for a while.


He was as lame as a duck. Not the metaphorical lame duck either, but a real duck that was actually lame. Maybe from stepping on a land mine or something.


Her artistic sense was exquisitely refined, like someone who can tell butter from "I Can't Believe It's Not Butter."


She had a deep, throaty, genuine laugh, like that sound a dog makes just before it throws up.


It came down the stairs looking very much like something no one had ever
seen before.


The knife was as sharp as the tone used by Glenda Jackson MP in her first several points of parliamentary procedure made to Robin Cook MP, Leader of the House of Commons, in the House Judiciary Committee hearings on the suspension of Keith Vaz MP.


The ballerina rose gracefully en pointe and extended one slender leg behind her, like a dog at a lamppost.


The revelation that his marriage of 30 years had disintegrated because of his wife's infidelity came as a rude shock, like a surcharge at a formerly surcharge-free cashpoint.


The dandelion swayed in the gentle breeze like an oscillating electric fan set on medium.


It was a working class tradition, like fathers chasing kids around with their power tools.


He was deeply in love. When she spoke, he thought he heard bells, as if she were a dustcart reversing.


She was as easy as the Daily Star crossword.


She grew on him like she was a colony of E. coli and he was room-temperature British beef.


She walked into my office like a centipede with 98 missing legs.


Her voice had that tense, grating quality, like a first-generation thermal paper fax machine that needed a band tightened.


It hurt the way your tongue hurts after you accidentally staple it to the wall.

The following was an assessment that I do not share completely today: I agree with the sceptics that there is every reason to avoid over-enthusiastic surgery for chronic pancreatitis. I am very conservative with these patients and advise surgery when pain-killing celiac ganglion blocks, enzyme supplements, etc. fail abjectly.
Anyways, here is what I had to claim in 2004-2005:

Laparoscopic pancreatic surgery has usually been restricted to

staging for malignancy,internal drainage of pseudocysts and

left-sided resections.

However, the more complex procedures for chronic pancreatitis

and cancer of the head of pancreas are also worth considering.

Laparoscopic Whipple’s operation, while affording spectacular

views and being a great exercise in laparoscopic skills, is

unlikely to become popular in the near future, owing to its

complexity and the lack of evidence regarding its benefits.

Laparoscopic palliation for cancer of the head of pancreas is

technically less difficult. 16 bypass procedures have been done

without any major complications.

Laparoscopic surgery for chronic pancreatitis is another niche

area where there is very little world literature.

Of the drainage procedures for chronic pancreatitis, laparoscopic

pancreaticojejunostomy is more classical but more tedious.

The newer procedure of lap pancreaticogastrostomy is

superior because of its near-zero leak rate, ease and simplicity of

the technique, and efficacy. In our developing series of cases, we

have not had any leak or complication with the procedure.

It is likely that in the near future, lap pancreaticogastrostomy will

be the procedure of choice for the disease.



DR.B.RAMANA
DR.T.SEN
DR.P.P.GUPTA

Department of Minimally Invasive Surgery
Anandalok Hospital
Kolkata

an old news article when people were not bothered by the acronym

Laparoscopic surgery for thyroid now
Our Bureau



Kolkata , Sept. 27
A BLOODLESS "Endoscopic Thyroidectomy" through the anterior chest (breast approach) has been successfully performed at the Apollo Gleneagles Clinic, Gariahat, here, by Dr B. Ramanna.
According to him, patients, operated under GA, can leave the hospital or clinic within 48 hours after dissection of a portion of the thyroid gland. The lump is incised through a minimally invasive surgical procedure, using 1.9-mm-thin "needlescopic" instruments.
Briefing newspersons here on Tuesday on the revolutionary surgical procedure, which was also highly cost-effective, Dr Ramanna said the team of surgeons led by him has performed the two-hour operation on an elderly woman patient, who was discharged after three days. Costing around Rs 40,000, he said this was "patient-friendly" affordable treatment, with zero tissue injury and no hospitalisation.
He said the Japanese were now using the more advanced trans axiliary (armpit) approach for similar surgeries, and it would not be long before such advanced techniques are tried in India too. Considering that a large number of goiter cases needing surgery occur in young and middle-aged women, he visualised a major role for endoscopic surgery in the modern management of the disease.
Describing practice of such revolutionary surgical procedures as a huge leap forward for surgical treatment in India, Dr Ramanna said it was an indication of things to come in terms of patient-friendly global best practices in medical field in India. He felt the superior cosmetic and possibly equivalent functional results of `endoscopic thyroidectomy', as compared to conventional surgery, will probably lead to a larger number of patients seeking the above treatment.

A new lap surgeon in a hospital that had never seen lap surgery has a case posted: lap chole. Year 1992. The management of the hospital is keen that the surgeon should feel comfortable and the procedure should be completed uneventfully, and the OR Matron is severely instructed to be cooperative.
The procedure starts. During the course of dissection, the surgeon Oh,shit!s a hole in the gall bladder. I had, long back, postulated a famous rule of laparoscopy, called Rambodoc’s 1st law of laparoscopy:
“Whenever you perforate the gall bladder during a lap chole, there are never less than 763 stones in it”.
So 546 of these madly decide to spill out of the organ, as a result of which the surgeon gets irritated with himself.
“Nurse! Get me a condom, please!”
In the early days of lap chole, a sterile condom was the preferred cheap choice to retrieve stones, appendixes, gallbladders, etc.
However, the junior nurse was perplexed and scandalized at the surgeon’s demand. She rushed out to call the matron. In the meanwhile, Rambodoc did what he does best: flush and suck, flush and suck…..
The stout matron rushes into the theater: “Doctor, what is the problem?”
“Sister, I need a condom! And fast!!”
The Matron also gets flustered. She isn’t sure what to do. She calls up the Manager and says “Rambodoc wants a condom in the OR right now! We don’t have any, what should we do?”
The Manager is cool: “Ok, sister, we will arrange for it…..”
The Matron rushes back to the theater, where our surgeon is scooping truckloads of stones from the peritoneal cavity.
“Yes, sister, did you get it?”
“Sir, we have no stock at present. I have informed the Manager, and he said he will invite a tender for the lowest quotation today itself!”
The surgeon is now infuriated: “What nonsense, sister! I want a condom NOW! Or do you want me to come outside and..?”
“Migod, no, no, Doctor!” the scandalized nurse shrieked, “ please give me two more minutes!”
Rambodoc was now truly breathing fire and dreaming evil thoughts. His surgery was a total mess now. Another 5 minutes later, the Matron and the junior nurse rush in.
“Sir, it is done!”
“Good, where is it?”
“I have asked the patient’s husband to get one pack from the pharmacy!”
“ You what?!?” Incredulity, rage and, finally, hope: “Where is it, anyways?”
A nervous Matron whispered, “Sir…. He is waiting on the phone. He wants to know whether you want the pink one with the dots, or the green one with the banana flavor?!”

Up in Heaven, Lord Vishnu wanted to see what his young Indian devotees were growing into. The Great One could not see anything because the exhaust from the buses and cabs was billowing under the stairway to Heaven, hindering vision.
His spy, Narada, came down to India to find out how the youths were doing and what they were planning for the future.
Narada spent some time in the country, and sent his report to the Creator.
“At the outset Lord, let me tell you that Lord Yama, our Lord of Death, is marketing big time here! His name is mentioned in TV and newspaper ads—it seems he has made a mini-chariot for the youth, called Yama-ha. Can you believe his cheek?
Anyway, the youth is what you sent me for, right, my Lord? The majority of youth wants the job of a cricketer called Sourav Ganguly. This job gives fame and job security—it seems they fire you 3 years late, to give you time to plan your retirement. 43% of boys wanted to be Sourav because they would still have a place off Park Street to park their Merc chariots and get overpriced oily food for free.
Lord, I want to be this person, too!
73% of youths said an honorable exit policy was important to their jobs. Equally important, they said, was an honorable entry policy. They demanded 50% job quotas for various scheduled, disadvantaged classes. An additional 30% reservation was considered mandatory for the un-scheduled, disadvantaged classes, presumably including the persons born out of French letters prematurely failing their warranties. 20% reservation, they said, should be kept for the ‘laid off’ category—this includes job descriptions called item numbers, dance bar girls, ministers, actors called Shakti Kapoor, rapists, alleged rapists, bottom pinchers, etc. Maybe we can keep a section in Heaven for these unfortunates, Sir?
Among older boys, some wanted to become ‘BCCI executive members’. The ostensible reason being the great ideal of ‘Ownership sans Responsibility’ to which these idealistic youth are drawn. Plus you get to eat a lot of 5 star hotel food!
What do our girls want to be? 29% said they wanted to be reborn with fewer clothes and renamed, preferably with multiple, repetitive alphabets to their names, you know, like Nnishha or Mallikkaa. Try it, oh Lord, how blissfully it rolls off your divine tongue: Kkrishnaa, Vvannitaa, and so on! Nnaaraayann!!
Some want to be ‘Fung Shway experts’. The attraction seems to be the ease with which you can make people do foolish things and get paid to make them do that.
A significant number of 14-year-old girls want to be someone called Sania Mirza, because you get to wear such nice skirts and cool T-shirts. Plus you get to lose every time and yet get praised, paid, and proud. Then you get to read 6 columns in the sports pages on the two games you won and only one line on the 12 you lost. Add to that a flattering photograph that is ogled at by every corporate honcho who has a few million bucks to throw on ads and sponsorships…. you get the picture? I must say, Lord, it pays to be a loser in Indian sports!
Sportspersons seem to be the Indian youth’s dominant fascination. The great Indian spirit of unflagging effort, dedication, fitness, and consistent pursuit of excellence are some of the major reasons for this collective, patriotic urge to become a sports star. There are a few minor side benefits that attract youngsters, including a multi-zero income, easy availability of consorts (now called girlfriends), and Government jobs. The fact that a busy sports person wouldn’t be able to attend Sarkari daftar wasn’t considered to be an issue. “Chalta hai re!” was the refrain. Some people, however, were worried about the risk of getting brain cancer. Huh?
It seems if you become a sports star, you have to keep talking on the mobile all the time, answering calls from a certain class of gentlemen called bookies, some kind of ladies called bimbos, and another kind of people called journos. The last are supposed to be a special aquatic species of mammals that eat things called stories, drink a liquid called scotch, and write without fear or favor of facts. Anyways, talking on mobile phones may lead to brain cancer, it seems, leading to worry. Lord, shall I get a mobile with Bluetooth for you? The banks and credit card firms are interested to give me one, FREE!

Where would you like to live, I asked the Indian youth?
A few said they wanted to go to POK, the Kashmir on the other side of the border. Why, I asked? The answer was “ it is the only place on earth where women listen to and obey their men”. Sounds interesting, Lord! Would you like to shift base?
Many boys and girls wanted to live in Bengal, the main reason being the extra 56 days of annual rest days that a benevolent Government ensures for its citizens by sponsored holidays, called bandhs. Some nasty people call them names for doing this. I disagree, as do many learned people like Mr. Karat. The Government wants the people to get rest, breath room air, and have normal domestic fights so that they don’t get carried away in the modern fashion of mindless escape from poverty, ill health and other spiritually empowering experiences. Bandhs also give these overworked people the time to procreate while the kids play street cricket, an important way for India to compete in the coming years with China.
Lord, I hereby recommend reservation of a section of heaven for these wonderful humans called Leftists! The materialistic, modern reformists can go to Hell!
Surprisingly, nobody wanted to live in Chennai. It seems it is unsafe for young people who hope to get kissed at least once in a lifetime. This immoral section of our misguided youth doesn’t realize how bad, demeaning and unhealthy kissing is. Ask the Tamil Nadu cops, they’ll tell you it’s okay to kiss only if the recipient is in Government and the anatomical site chosen for the act is way behind sight. So there!
Some boys wanted to shave their heads and anchor TV programs, attacking all the evil sections of society, like doctors, mothers-in-law, maids, etc. They unanimously said they wanted to establish their opinions without bearing the conventional burden of truth. They claim inspiration from none other than Einstein, who reputedly said, “If the facts don’t fit the theory, change the facts”!
What an admirable country your children are going to create, O Great One! I can then truly say, ‘Mera Bharat Mahaan’!
And, Lord, a place in Heaven for all head-shaved TV anchors, please?!”

Sometimes I scratch my head in puzzlement: why is everybody so concerned about my thinning corona, when I, the alleged sufferer, am not? I have come to this startling, original conclusion that people are obsessed with hair because it helps cover their scattered brains, the way they are obsessed with bikinis and briefs as covers of their underlying assets.
Doctors, you may have noticed, wisen up to your insecurities faster than they can read a para of their obsolete textbooks. That is why they have been, for centuries, devising ways of making people spend money to get some insulation for the brain. Apart from the snake-oil kind of remedies, which claim to create a new thatch on your head faster than it takes our honest politicians to spend your income tax money, we also suffer the hair-raising claims made by the likes of hypnotists! With these thoughts in mind, I started to research the new money-spinner in plastic surgery, the follicular hair transplant. Is it a gimmick, like its less respectable non-surgical counterparts?
The web led me to the concept of corporatisation of cosmetic surgery. Everywhere, I found companies advertising their skilled doctors and their blessed, and newly hairy, patients. I found a Pakistani surgeon travelling to Europe to operate on the whiteheads for a few euro per hair graft! Their sites have gems like “shaadi ke pehle nai bal” (get new hair before marriage). “Aha!” I thought in relief, “this is real scientific advancement, not gimmickry; if corporations sell transplants, rather than exotic panaceas like shark semen or whale poo, they have to be good!!”
Human hair grows in clusters called follicles. These hair follicles are genetically programmed to fall off at an early age, if your father was nicknamed “Teko” or “Motta-Mama” in his college days ( both are local sobriquets conferred on baldies). On the other hand, if your Dad’s name were Einstein or Rabindranath, half your earnings would be spent on hair gels and combs! Another reason for the loss of mane from the front and sides of the head is the action of a male hormone called DHT (dihydrotestosterone), that acts only on those hairs located in the areas where men lose cover (the “male pattern of baldness”). The hairs in other parts of the head and body are not affected. What these obscenely rich plastic surgeons do is excise a strip of hairy skin from the lowest part of the back scalp. They (rather, their technicians) section this skin strip such that each tiny bit of skin contains a few hair follicles. Each tiny piece of skin is implanted on the bald area. If these transplanted hairs stick on, they will live forever and what’s more, look completely natural. So, essentially, this is a form of skin grafting.
So what can the Lock-Less Monster do? Simple things first: healthy eating, drinking and sleeping. Then attend to scalp infections like dandruff, if any. Next comes the attempt to stop the load-shedding with lotions like Minoxidil. Each of these works additively. Your dermatologist, if he has recovered from last night’s party, might also prescribe some drugs.
If all these fail and your incipient trip to superstardom skids on a bald spot, go to the best available cosmetic surgeon for a hair transplant.
Home truths:
• Do check if he is experienced: ask him how many he has done!
• Contact patients who have had the operation a few years, not months,
before. They will be good sources to trust. Get a list from your doctor.
• Ask your surgeon if he does the latest follicular unit hair( FUH) transplants:
these cause less scarring and pain and give better results.
• Infection is a bugbear of all surgeries: ask about how the
instruments are sterilized. Are they reused by a method called autoclaving?
• Beware of a surgeon who tries to hardsell the surgery to you;
remember, nobody died of baldness.
Learn more: visit websites and discussion groups: you will be surprised to learn so much!
When you go for surgery, prepare to shed some serious financial flab. “ I’m middle
class, be reasonable!”, you cry? Ha! Buy a wig, teko!!

20% of India's population is in the group called adolescents.
The vast majority of this group who live in villages suffer from stunted growth and malnutrition. However, an astonishing change in the health profile of these growing children is noticed in the cities. It has been estimated by the WHO that around 7% of our children are obese. In cities, it has been estimated that 30% of school children are overweight or obese.
One in fifteen kids are obese.
These children are at a high risk of suffering from a host of adult-type diseases like diabetes, hypertension, asthma, etc.
It is also known that 70-80% of fat adolescents become obese adults.
In order to ensure the future of the health of the nation, it is imperative to recognize that obesity is one of the most important diseases in India, as it is so recognized in the developed world. The incidence of childhood obesity is tripling, as per international statistics.
While the best way (as per the WHO) of addressing this issue is by preventive measures including addressing the issue of carbonated beverages, school nutrition, television time, and physical activities, it is also true that a large number of these boys and girls are already beyond prevention. These obese kids need help in order that they get back to the school playground and have the psychological competence and confidence to be with their peers on an equal footing.
For morbidly obese children and adolescents, bariatric surgery has an important role to play, as is being increasingly recognized by the medical profession.
Apollo Gleneagles Hospital, which inaugurated its Bariatric Surgery Department in June 2006, announced the first procedure for adolescent or childhood obesity in Eastern India: a laparoscopic Sleeve Gastrectomy. The two hour long procedure, done by a team of specialists led by Dr. B. Ramana, was followed by a painless and rapid recovery. The patient was a super-obese young boy of 20 years.
In this procedure, around 80% of the stomach is removed along its long axis, leading to a low-capacity stomach shaped like a hockey stick.
This operation was performed by using the most sophisticated technology available in the world, including staplers and the new staple-line buttress materials.

The damp hangs thick over the playground. If you could call it that. A brown, bald patch of flat mud at the center of Lake Camp. The park of the 3rd
generation Bangladeshi refugees. The recreation of the season now is football, complete with painted penalty boxes, wooden goalposts and even the odd
spectator and street dog.
Wait, there is even a man watching from a high-rise just behind the shanties. This man looks down today, as he has often in the past, with keen
interest as the noisy proceedings continue a hundred and fifty feet below him.
A sane man would have looked askance at him. What is a man like him studying bustee football so keenly for? Such a man would have concluded, "This guy
is peculiar and probably a good-for-nothing". As things went, not a bad conclusion to make today, thought Raghu.
Raghu was in deep shit, with a floundering law practice and a huge mortgage hanging over in the cloud above his head. In addition, his family was on
the verge of breaking. Any day now.
A loud cheer went up from the 'stadium'. A soft pass faltered in the middle of a patch of slush. Orange went for it, scampering over a fallen Blue,
and darted to the goalmouth and dispatched an anemic kick that was stopped dead by Undefined, the goalie.
As the ball was sent back to the other side, the players rushed and slid past the generous slush of Monsoon Kolkata. A tenuous fight ensued between
Gravity and F-Max. Inevitably, Gravity won in the end.
As blue smoke slithered through the grills of the verandah, Raghu watched with quiet bemusement as Orange, the right-winger dribbled the ball past a
five-year-old boy on a bicycle. The little boy, unconcerned with the near miss, continued sucking his left thumb as he expertly cruised toward the
Southern penalty box.
In the dying minutes of the match, both teams were sweating through the mud to score. As luck would have it, the Red striker got the ball on the
Southern half, saw a gap, and smartly kicked the ball to the goal. Just as the goalkeeper dived in desperation to his left, the thumb sucking kid came
busily in front of him.
The ball brushed the kid's head and deflected into the goal. Undefined's jump knocked the junior off his transport. Off came the thumb. The little
head hit the ground smack. A soft, Indian thud. And went still.
Frantic cries soon erupted from the huts at the sidelines, soon changing into prolonged wails. The dead boy was rushed to some Government
slaughterhouse hospital.
Raghu continued to watch the scene, frozen in space save the burnt out stub in his fingers. He was not surprised at his apathy. He was used to living
with it. Too bad others were not. He thought to himself, unwitnessed by the dwellers below, nor the ones above, "This is it. I have to stop finding
meaning in this life. Maybe I will be different in the next."
Only the lock in the grill prevented him from jumping down the verandah to join the excitement below. Apathy loses the key to Life, he thought. And to
Death.

Abu was married for 22 years. To the same woman, as many teenagers today would have been perplexed to know. His wife of 22 years was unlettered, but now modern. Najma wanted to spend a Vollenteen’s Day with her man, in a speshal way, haan!
As Abu chewed distractedly at the rump end of a soggy cigar, scratching his hairless brainshell, he saw his wife looking at him with aggressive eyebrows. “ I want you to take off on the 14th, and don’t make excuses!” she pouted half-seriously.
Abu couldn’t fathom any reason for his wife’s sudden estrogenic surge. Was it some form of competitive modern feminism, he wondered.
The boy in Abu was tickled at this middle age foolishness. Suddenly, he wanted to surprise his wife with something. Buying a ring was too expensive. Buying anything was too typical. What then could he do for her?
The answer came out like a cockroach from chow mein. “I will cook something truly divine for her!” he decided. The more he thought about it, the better it smelled to him. In more than 7000 days of cohabitation with this woman, he had not cooked one, yes one, meal for himself or for her. He decided to google his way into his new goal. “Real Men Cook” and “Valentine’s Day” gave him few attractive gastronomic entries. For the life of him, he couldn’t make sense out of sweet potato cake, Cajun spices, and smoked catfish, among others. He decided to make the ordinary his precious offering to an oaken romance.
Many monsoons back, a young Abu had married a pretty girl with a boundless spirit and no background. The years had, predictably, dulled the lustful ardor of youth that had overcome the shyness of middle class femininity. But the feelings embered on with scant regard to the changing calendars on the pallid walls of his home.
Today, Abu woke up from his memories to the sound of his wife’s gentle snoring.
On this morning of the 14th of February, he crept out of bed and entered the kitchen. He didn’t even know how to turn the gas on, he realized. Ah, the microwave! The savior of his surprise! His menu was small but assertive. Salad (starring modern Shitake mushrooms from Japan, bell peppers from some exotic South American state, and julienned Arabian dates) was easy. He managed to rustle it up in 10 minutes, bullying a chaotic spill of 5 bowls, 2 plates and 3 spoons. Job done, he started with increasing confidence at his next items. Rice, dal and fried potatoes.
His printout for the Urad dal recipe in hand, he assembled the pulses, ginger, curry leaves, oil, etc. and got ready to start. His mind hiccupped on seeing the first instruction:
“ Soak urad dal for two hours”
“I don’t have the damn time!” he chided his virtual instructor. He decided to improvise the way he had done for most of his life. He doubled the boiling time for the dal from 9 minutes to 18. Job done, he smirked in a short while. He then stroked some oil on a glass casserole and added the spices and cumin seeds to fry them. 5 minutes later, the microwave now looked like the inside of a tandoor. He mixed the dal and the mishmash of spices and stirred them, still afraid to turn on the gas oven. He got the rice from last night’s leftovers and heated it up. On the verge of creative exhaustion, Abu finished his gastronomic adventure by sprinkling some coriander leaves on the rice and dal to give color to his masterpiece. He decided to imagine that there were fried potatoes on the side or, at least, add some chips.
Najma, by now aware of an abnormal phenomenon this morning, was stunned by her husband scooping her up and taking her to the dining table. Plunking her on a chair, the romantic baldie said grandly, “Happy Valentine’s Day, jaan!”
Sleep evaporating from her mind, she stared crazily at her husband. She whispered, “You cooked rice, dal and salad for breakfast? Allah!”
Tears choking her lips, she lifted a frail hand and daintily placed a blob of unsalted dal and rice inside her mouth. She closed her eyes and gulped. The salad is divine, she breathed with emotion. Abu stood by proudly, staring at his mate of long years. He then turned away to blink down a pair of teardrops, looking at a framed photograph of two boys and their parents. Six years away in the past, he remembered a hospital ward and the lifeless bodies of his sons, run over by madness. His wife? She lived, but was perennially in need of physical support from a lack of lower limbs.
Abu lived too. As he saw his pretty wife eating her breakfast, he felt all was not lost. True love was microwave-proof, he thought.

It is meniscus-deep down there. Not a spark of sunlight. Urchins in locally- made Hilfiger T's play football on a flat stretch of water within a sprawling slum. Their shrill, excited cries ricochet off my walls and fail to excite my old memories. The sky is a clichéd grey like a goose. It seems strange how a sleet of nickel-rain floats down into the colorless depths of urban laziness.
Even the expressive trees of the tropical green seem tacitly submissive in the face of nonstop onslaught of a superior barrage.
Down far below, on the streets of Calcutta, tempers are getting fried in the unceasing wetness. Roofs leaking into disaster, stairs hidden by stagnant drainwater, taxi engines sputtering into whimpered silence, bicycles falling off unready hands.
All met with suppressed, feral rage. As if the downpour was the only blemish of an otherwise perfect life. It looks as if the downpour washed away a thin, cosmetic layer of manners that civilizes an underlying intolerance. Even Freud could be forgiven his theories today. The temperamental ejaculation of the soaked pedestrian looks to be an echo of a childhood deprivation of his favorite ball. Others, however, are quietly happy with the fresh deluge. Children in tin carts cautiously wheeling by are gleeful on the way back from closed school gates. Maidservants clutching a paper bag full of singhadas ordered by the korta, wives frying onions and cooking rice for the afternoon’s mandatory khhichuri are some who seem placidly excited at the prospect of a long, relaxed day. Gloomy restaurant managers prepare for a long wait, as do funless doctors in hospitals. Blissfully unaware of the sudden urban upheaval is an infant, silently clutching a comb with his jaws and wetting a pillow with a carefree, well aimed, prolonged squirt from his cute organ. For some reason suddenly, he, too, seems to be enjoying the wetness.

Morbid obesity means excess body weight that causes many diseases and reduces longevity.

It is objectively defined as a BMI of 40 or more. BMI is Body Mass Index.

It is measured as follows:

BMI = Weight (in kg)
Height(m)2
BMI effectively gives us an objective parameter to measure an individual’s state of obesity, relative to his height. If the BMI is more than 40 kg/m2, the condition is known as morbid obesity. In such a state the patient is prone to develop diabetes, hypertension, obstructive sleep apnea, arthritis, gallstones, reflux disease, hernias, cancers, etc. The average longevity of such a clinically severe obese person is cut short by 10-14 years. Indians have a higher proportion of body fat and less bone mass compared to Caucasian and African races. For this reason, the BMI parameters for defining obesity are a little less. For example, in India, a BMI of 37.5 would be the yardstick to call a person morbidly obese. In India, around 15 percent of the population is overweight or obese. Around 5 million people are morbidly obese.
Scientific studies have shown that in this group of patients, supervised weight loss programs using diet and exercise have a failure rate of 95% when it comes to assessing sustained weight loss. Drugs achieve a weight reduction of only 10% at most, and the benefits cease as soon as the drug is withdrawn. In addition, there are side effects of these. The only proven method of weight loss in morbidly obese individuals is Bariatric surgery. This surgery may be of two different types: restrictive (where the capacity of the stomach to store food is restricted), and malabsorptive (where the digestion of fats is hampered). The most common operations are Laparoscopic Gastric Bypass (LGB), Laparoscopic Adjustable Gastric Banding (LAGB), and Sleeve Gastrectomy.
Benefits of the surgery include 70% weight loss in two to six months that is sustained in life, cure of diabetes in 85% of patients, cure of hypertension in around 60%, and cure of snoring in around 90%.
In Kolkata, this kind of surgery is available at Wockhardt Hospitals.

It’s prettier than ever before. It works, arguably, better than ever before. The new Windows Media Player 11, initially introduced as a beta version, is now finally out.
Microsoft, the world’s largest maker of computers, has recently launched WMP 11, a media player that will be part of the new Vista operating system to be out early next year.
The new version is available free of cost only for Windows XP users, so that Mac users have to cool their heels to test this one. When Vista will be launched, the software is going to be a free add-on in the package, like the just-released Internet Explorer 7.
With this new offering, Microsoft seems to have woken up to the needs of its users. The player looks cool and modern. Its user interface (UI in geek-speak) is far better, and it has easy to use buttons that allow you to rip CDs in a hurry and to integrate with portable devices including the Xbox.
WMP 11 boasts of seamless integration with URGE, the digital music store from MTV, which gives you a choice to pick up songs from a bank of millions of titles. Of course, there are plenty of people who will tell you that URGE is the world’s worst collection of online music!
WMP 11 comes with enhanced search capabilities. You can easily scroll and search for music real quick, even if your library contains thousands of songs. Instant Search is the remarkable new feature in 11, with each keystroke narrowing the search results, whether in your own library or in URGE. Mac users are no strangers to these features, with the amazingly powerful Spotlight taking pride of place in OS X, the Tiger.
You can drag-and-drop songs to create playlists, and store these in your MP3 player (surely you don’t use an iPod, do you?). Though Microsoft has a relationship with the MP3 player made by iRiver, it is developing its own iPod killer called Zune. As users know, the world’s largest selling player is the Pod, which needs the iTunes media player installed in your PC.
Back to the 11. It allows you to shuffle songs, navigate easily, and shows you music, photos, and videos by categories. As a user, you can also benefit from the huge network of portable devices that integrate with Microsoft’s products all over the world. Furthermore, in addition to URGE, hundreds of online music and video services and radio stations worldwide are designed to work with Windows Media Player 11.
The player has new formats for ripping and music playback, including Windows Media Audio Professional and WAV Lossless.
Oh, and before one forgets, album art is available, though it may not work if your stars are unlucky! Check out this poser from a user:
“WMP11 Beta made a mess of my album art... turning all my “folder. jpg” images into hidden files that could not be seen, searched, or unhidden.”
In spite of its in-your-face chic, WMP 11 suffers from some incredible flaws. It does not support podcasts. Can you imagine that, in this day and age? They are still going with radio stations. In addition, installation in your PC may be a pretty painful event, if one goes by the many moans resounding in Microsoft’s own discussion lists. Many users have complained about the version 10 working fine, and the comp hanging after installation of version 11. No answers yet from the company’s gurus.
Overall, the new player is like you: cool, savvy and modern.
In fact, it is remarkable how close WMP 11 is coming to iTunes, the slick media player of the Mac.
If imitation is flattery, Microsoft is saying the best things about Apple’s Tiger. Whether you are a Mac addict or a devoted Windows worshipper, you stand to gain from the unending competition between two great companies!

Not for the first time, two powerful enemies have got together to face a common threat.
In the world of cardiology, Boston Scientific Corporation, a giant company worth around $25 billion is working with its arch-enemy Cordis Corporation, part of the $200 billion behemoth called Johnson and Johnson. The agenda: studying a phenomenon called stent thrombosis.

Trouble suddenly blew out in September this year at the World Cardiology Congress in Barcelona when Donald Baim, the chief scientific and medical officer of Boston Scientific let it out to a reporter that there were disturbing reports of late thrombosis after use of their Taxus stent. There was a huge buzz in medical circles that is still ongoing today.

So what is the fuss all about? What, one may be forgiven for asking, is a stent?

The stent, a $5.6 billion product, is a thin metal tube that is used to open up a blocked coronary artery (one that causes a heart attack). Years of fat deposition resulting from unhealthy eating habits, stress, lazy lifestyle, drinking and smoking cause the coronary arteries to get blocked by cholesterol deposits in the disease called atherosclerosis. The heart muscle gets less blood and oxygen from the narrowed arteries and dies, resulting in a heart attack. The stent is deployed by the cardiologist through a wire passed through a groin artery and keeps the blocked artery open, allowing blood supply to the heart.
However, the steel stent irritates the artery’s inner lining and its muscle cells, creating a scar that clogs it, a so-called re-stenosis. Since 2001, drugs that prevent this scar from forming were added to the metal stent. These are the drug eluting stents (DES). In the Taxus stent made by Boston Scientific, the agent is an anti-cancer drug called paclitaxel, while in the CYPHER stent made by Cordis the drug is sirolimus. Many trials confirmed that the incidence of restenosis reduced from 30 percent in six months to around 3 percent. This was the main reason that led to the mass usage of these costly (each one costs over a lakh of rupees) devices all over the world.
The advent of DES threatened to make bypass surgery superfluous in most cases, and led to a boom in invasive cardiology. 6 million stents have been used in three short years. Now, after billions of dollars have been expended and countless lives saved and lost, comes a series of trials, some showcased in the prestigious New England Journal of Medicine, showing that the drug eluting stents are, in fact, not much better than simple, cheap, bare metal stents. In fact, after the initial six to twelve months, the results are that patients with DES have higher rates of heart attacks and deaths, compared to bare metal stents. This is because of late thrombosis (blood clotting) in the stent itself. To prevent this fatal event, stented patients are prescribed blood-thinning drugs like clopidogrel and aspirin for one or two years. Though some experts recommend lifetime consumption of these, the cost and the side effects like bleeding are undesirable.
As the stent makers start poring over fine print to really make sense of the trial statistics, the next generation of stents is already in place.
Says Rabin Chakraborty, Head of the Department of Cardiology, Apollo Gleneagles Hospitals, Kolkata, “Second generation stents have a cobalt frame and are thinner and more flexible, allowing us to use them on smaller vessels, which we cannot access with stainless steel stents. One of these is XIENCE, and the other is Endeavor, which are showing thrombosis rates of only 0.5%.”
Scientists in New Zealand are conducting human trials of the world’s first dissolvable third generation stent: the ‘bioabsorbable’ stent that releases a drug called everolimus. The material used is like the ones used in absorbable stitches. After two years of implantation, the material disintegrates completely, having deployed the drug into the lining of the artery. This way, there is no ‘full metal jacket’ in the artery that could act as a clot magnet.

How are the companies reacting to the adverse results of worldwide trials?
A. Vaidheesh, Executive Vice President of Johnson and Johnson, India, downplays the impact of the studies: “The trials have included complicated cases of multiple vessel disease as well as patients with diabetes, well known as bad prognostic factors”. Vaidheesh and his company assert that their stent is an excellent product and “the complication rates are negligible”.
Medtronics Inc. is now conducting a huge trial, (called the PROTECT Trial) for the first time in India, among other countries, comparing the results of their Endeavor stent versus the Cypher by Cordis, specifically comparing the incidence of stent thrombosis between the two.
The latest treatment of stent blockage or restenosis is an angioplasty using a paclitaxel-coated balloon, just reported in the NEJM.
As things stand, the jury is still out on whether DES is an overrated and overused product. Till such time, try not to get a heart attack!

2025. You have sex only for fun. Want babies? Head to a fertility clinic that takes your sperms or eggs and cooks up a baby for you. Absurd science fiction? Maybe not. Enormous advances in reproductive science are set to change the world of making babies. Already, the portents are clear. Women are set to exercise their choice in the kind of baby they want: they could choose the sex, intelligence level and even hair color of these ‘designer kids’.
What is wrong with plain, old-fashioned sex as a way of making a baby, you ask?
Experts say that natural reproduction can lead to a 1 in 16 chance of a child having a serious physical or mental genetic defect. In addition, smaller genetic factors could lead to the occurrence of major illnesses later on in life. Artificial reproduction, on the other hand, is getting safer by the day, as genetic screening of the embryo is getting more sophisticated and discriminating.
For couples suffering from infertility, in vitro fertilization (IVF) has been the standard treatment for getting a baby. Put simply, in this process, the female egg, called oocyte, is plucked out and frozen in a cryopreservative. It is then mated in a dish with the sperm of the donor (who could be the husband or someone unknown). A primitive embryo, called a zygote, is formed. This is then implanted in the uterus of the woman at the most suitable time for getting accepted by the lining of the uterus. In the best centers IVF is safe and has a 30% success rate, but does have several possible side effects like twins or triplets, premature babies, birth defects, among others. Mothers-to-be commonly suffer from emotional burnouts.
Preimplantation Genetic Diagnosis (PGD) is set to change all this. A woman can have many of her eggs fertilized with sperms, leading to a bank of multiple embryos. PGD can select the best embryos by eliminating the ones that test positive for obvious genetic disorders like Down’s syndrome or cystic fibrosis. Greater knowledge of the genetic maps of intelligence, skin and hair color, emotional and creative makeup, etc. can in the future lead to selection of the embryo as per the specific choice of the parents. In addition, women can store their eggs or embryos for use in the future, whenever they are ready for it. They could even sell their eggs. Cryopreservation techniques now allow the storage of viable embryos for many years.
As recently as the first week of November this year, a group from the Yale University School of Medicine led by Emre Seli presented a paper at the American Society of Reproductive Medicine annual meeting at New Orleans and claimed an 80 percent success rate in IVF fertilization rates, more than double the best current results. They have used sophisticated Raman and Near Infrared spectrophotometric tests that identify those embryos that show metabolic signs of ‘oxidative stress’. Those embryos that do show such signs are eliminated, and those that do not are chosen. This technique, by selecting the best embryos, is slated to reduce the number of IVF attempts before successful pregnancy is achieved. This technology of metabolic profiling of the embryo is now ready for commercial availability from a company called Molecular Biometrics.
Another development is set to increase IVF fertility rates. Researchers in Massachusetts have found that they could select embryos with better chances of successful implantation. The cells are kept in a fluid whose surface oxygen concentration is measured. If the zygote is viable, the oxygen levels are low, because it ‘breathes’ and uses up oxygen. Higher levels mean a non-viable embryo that is sacrificed.
It is likely that, in the future, these forms of artificial reproduction will result in less birth defects and premature births, especially when genetic testing becomes cheaper. Scientific futurologist Randall Parker says “I predict most prospective parents will chose IVF over natural sexual reproduction”. Simon Fishel, one of the original workers in the path-breaking 1978 ‘test tube baby’ team, agrees “It is technically possible”.
Scientific progress by accident is well known, going back to Isaac Newton and the apple. Scientists at the Weizmann Institute in Israel accidentally found that women being treated by IVF had more successful results after they were subjected to a biopsy of the uterine lining. Three Israeli hospitals have now adopted endometrial biopsy as a standard part of their treatment protocol and are expecting the Americans to follow suit.
As with all super-modern technologies, the main problem with the Artificial Reproduction Techniques is the cost. "You have to pay per cycle," points out Fishel, while "natural reproduction costs you nothing."
As competition in the global embryo market hots up, we could soon see Lamarck’s Natural Selection Theory standing on its head, as Man scientifically eliminates Nature’s genetic lottery of natural birth and adopts customized artificial births.

Scrub typhus, 1965, North East India.
Bubonic and pneumonic plague, 1994, Beed and Surat.
Dengue hemorrhagic fever, 1996, Delhi.
Anthrax, 1999, Midnapore.
Mystery ‘encephalitis’, 2001, Siliguri.
All seemingly isolated events in the dismal health history of the country.
Or all diabolically plotted germ attacks to kill thousands of Indians and distract and disturb the Government of India?
Fantasy? Not quite, if some Indian experts on Microbiology like Kamal Datta and Colonel S Nagendra are to be believed. They have even gone on record in journals like the British Medical Journal stating these doubts.
Such flights of fancy do not seem far-fetched in the chilling world of Bioterrorism, the rapidly growing science where the germs of mass destruction could be easily accessible to those who would happily use an A-bomb if they could get their hands on one. In fact, biological weapons are called the ‘Poor Man’s Atom bomb’.

HISTORY:

Though a future threat to mankind, bioterror has old historic roots.
In the Crimean War (1346), the Tartars besieging the town of Caffa suffered from an outbreak of plague. They turned this disaster into war weapon; with catapults, they flung the corpses of the dead into the city of Caffa. The defenders abandoned the city when plague broke out. Their westward migration resulted in the spread of plague to Italy, the harbinger of the Black Death, which killed one third of Europe’s masses.
Much later, in 1763, the English overcame hostile native American tribes in Ohio by distributing the blankets of patients affected by small pox. The resulting epidemic killed most of the tribes.
More recently, the Unit 731 of the Japanese Army launched plague and anthrax bombs on Chinese civilians during World War II, with untold casualties.
In fact, this unit’s germ warfare research was the foundation of the American germ warfare research that is now driving global counter terrorism strategies.
Closer home (India), the first bio-crime occurred in 1933, when Binayendra Chandra Pandey murdered his brother by using Pasteurella pestis, the plague bacterium as was then called, stolen from Calcutta’s Pasteur Institute. Pandey used a pin loaded with the bacteria to prick the victim. He was sentenced to kalapani.

THE MODERN THREAT:

It is no secret that terror groups like Al Qaida have been trying to acquire biological weapons. Two years before 9/11 happened, Al Qaida was working in Afghanistan on a secret bio weapon called ‘Agent X’, which was probably anthrax, according to unclassified US documents.
Even before Al Qaida, cult groups like Aum in Japan and the Rajneeshites in Oregon have used chemicals to kill people.
The anthrax letter attacks in the US in October 2001 killed five people, triggering a massive alarm in the security agencies. Extensive funding and research has been ongoing since then, with the Federal Government trying to find ways to prevent and manage a massive germ attack. Dark Winter was launched in 2001. It was a codename for a simulated exercise in which a localized smallpox attack was launched on Oklahoma City, with the National Security Council trying to control the spreading virus. The dismaying results of Dark Winter convinced the US Government that the country would be helpless in preventing a mammoth catastrophe in the face of a germ attack. The lessons learnt were that not only would there be massive loss of life, but the governmental, social and medical infrastructure would be utterly incapable of managing the situation.
Today, five years after Dark Winter, experts are convinced that even that scenario could be too rosy. An attack with unconventional super-viruses, for example, would render all vaccination and treatment methods ineffective.
The result of such scientific assessment and experimentation has been the BioShield initiative of President Bush, which is a $5.6 billion program to develop new vaccines and drugs to fight this evil knowledge.
There are several ways a terror outfit could target civilians.
Using germs, diseases like anthrax, plague, tularemia, small pox, among others, could be spread to susceptible populations.Chemicals like Botulinum toxin (Botox), ricin, and nerve poisons like soman could be used. Dirty bombs using Cesium, Thallium, etc. could cause a lethal radiation hazard and kill people. There are other ways for mass deaths to be caused, like contamination of water supplies, poisoning food stores, poisoning cattle, etc. All these are known. What is alarming the security world is the result of new knowledge on this subject.

TERROR’S NEW BIOLOGICAL FACE:
In 2002, a group of scientists from the State University of New York led by Eckard Wimmer built a functioning poliovirus from small DNA molecules called oligonucleotides that were purchased over the Internet. In only two more years, the group could build the genome (genetic skeleton) of the more complex smallpox virus. Microbiologists consider these developments to be of staggering importance. Man has artificially created a deadly virus out of chemicals purchased online for a little money, using genetic sequences from Internet sources! This is potentially easy for the smart, net-savvy terrorist.
However, the numero uno among terror bugs is not an exotic virus. “The top three threats, in fact, are anthrax, anthrax, anthrax,” says Dr. Gerald Parker, a senior US health agency official. It is the hardiest germ in the planet, it is easily procured and cheaply grown, is highly lethal in small doses (a millionth of a gram can kill a man), and it cannot be detected.
Small pox is another biowar agent, but only a few countries have access to the stocks, so it is not really expected to go into the hands of terrorists.
What is going to be more effective for the terrorist is innovative delivery systems of conventional bioterror agents. In an article on the subject in the Indian Journal of Medical Microbiology, a team of doctors from the Post Graduate Institute of Medical Sciences, Rohtak, has listed some of the mechanisms. For example, a car could roam around in a city emitting a germ aerosol through a fake tailpipe. Suitcases, backpacks, books, letters, umbrellas and remote control devices are some of the delivery methods listed.
Robotic delivery is also possible. Small robots looking like rocks or wood could be programmed to act at a given time to release Biological Weapon (BW) agents or even stay underground for a long time. Solar power may allow these devices to be functional for a long time.
Another technique, a nightmare for bioterror experts, is the use of “suicide coughers” who have got self-inoculated with lethal strains of anthrax and smallpox and go into public gatherings to spread the diseases, causing mass fatalities.
The phenomenal progress of genetic engineering technology has spurred the terror machine on in its mission to wreak biological havoc. Sergei Popov, formerly of the Russian Biopreparat (the fabled germ warfare research division), was the first scientist to create a bioweapon. According to Ken Alibek, a former head of Biopreparat and author of the book Biohazard, “Popov inoculated into a pneumonia bug, Legionella pneumophila mammalian DNA that expressed fragments of myelin protein (the insulation for our nerves). In the tests, the animals that were injected with the recombinant (engineered) Legionella developed mild transient pneumonia, but the myelin protein fragments stimulated a massive immune response that led to brain damage and paralysis. The mortality rate was almost 100 percent.”
Recently, Popov has talked about an experiment in synthetic biology that fuses plague and Ebola virus. The scientific premise of this Soviet research is to hide a deadly virus particle inside the genome of a more innocuous bacterium.
In this case, infection in the test subject would result in plague like symptoms. Once the treatment (usually tetracycline) for the plague is given, the virus is expressed fully. It is feared that the resultant walking ‘Ebola bombs’ could devastate populations. Ebola, if you didn’t know, has an almost cent percent mortality in man.
If you think such tech ability is out of the reach of terrorists because of the expenses, hold on! Bioterrorists can splice agents like Interleukin 4 (IL-4) into chicken pox viruses using the Internet to order the agent from DNA Biotech companies, buy machines like a centrifuge, an incubator and a transfection kit from Bay for a few thousand dollars. With less than $10,000, a terrorist can assemble a sophisticated genetically engineered bioweapon that can overwhelm any country’s defenses. The future is threatening to become the era of the Basement Biotech.
As amazing is scientists’ ability to use bacteria as vehicles for delivering drugs that affect the brain, like serotonin, endorphins and dopamine. Mathew Meselson, Harvard University Professor of Molecular Biology, confirms, “it is possible to launch biochemical weapons that can cause schizophrenia or passivity in an entire population.”

THE SCIENCE OF COUNTER-TERRORISM:

In the US, a vast network of counter-terror organizations with acronyms like DARPA, FDA, NBACC, and CDC have been attempting a concerted strategy to prepare for a biological Doomsday. The strategies involve prevention of an attack, detecting bioweapons, and immediate and late counter measures in the event of a BW attack.
At a practical level, the US Government is stockpiling antibiotics, vaccines and chemical disinfectants.
Apart from the very new automated biosensors (gadgets that can automatically detect the presence of BW agents), some imaginative proposals have come up to detect the normally undetectable pathogens:
1. Researchers have working on tiny electronic chips that would contain live nerve cells that would warn of the presence of bacterial toxins.
2. Fiberoptic tubes or CD- Roms lined with antibodies coupled to light-emitting molecules could help in identification of anthrax, botulinum, ricin, etc.
3. Recently, plants are being genetically engineered such that they would change from their normal green color in presence of certain chemical or biological agents. Placed in public spaces and water bodies, the change of color of these so-called GMO (Genetically Modified Organisms) sentinels could be detected by overhead satellites, triggering an alarm.
4. A software called KARNAC uses the same kind of information available to the FBI and detects a pattern of purchases, movements and claims to be able to predict an attack.
4. A web-based network called eLEXNET (Electronic Laboratory Exchange Network) coordinates between laboratories and food agencies to look out for BW attacks on food supplies.
In the event of an outbreak, a fast-track response system is being put in place. Central to this are twelve ‘push-packs’ that are located in certain parts of the country. Each push-pack contains a variety of drugs, chemicals and vaccines that can be used for millions of people, transportable anywhere within 12 hours.
These and other innovations are the fruit of radical work in the US Defense Advanced Research Projects Agency (DARPA), the agency that first conceived the Internet as part of a project. DARPA is actively working on development of a new class of kill-all antibiotics that could counter the effects of Multi-Drug Resistant (MDR) bacteria that terrorists could use, including Tularemia and Anthrax.
Development is occurring at multiple levels. Ravi S. Kane and a group of investigators have developed an anthrax anti-toxin in a project funded by the National Institute of Allergy and Infectious Diseases. “If the effectiveness of anthrax inhibitors designed in this fashion is confirmed by additional testing, they could one day be important adjuncts to standard antibiotic therapy for the treatment of inhalation anthrax,” says NIAID Director Anthony S. Fauci, M.D.

THE INDIAN SITUATION:

Bioterror formally visited India in 2001 when Chhagan Bhujbal, Maharashtra’s Deputy Chief Minister, received an anthrax-laden envelope. Since then, the Department of Defence, through its arm called the Defence Research and Development Organisation (DRDO) has been working on bioterrorism countermeasures. Friendly Pakistan has even alleged that India has developed chemical and bio-weapons and has stockpiled them in neighboring countries. Its Information and Broadcasting Minister, Sheikh Rashid Ahmed went so far as to say in 2003 that “India is a fit case for pre-emptive strikes” for this reason alone.
Indian companies NEC Engineers and Protech Consultants have been blacklisted by the US Government for supplying BW agents to Iraq in 2002-2003. The take home lesson in this is that both the public and the private sectors have covert capabilities to work on BW agents.
According to Dr. Venkat Rao of the India Forum at George Mason University, “While the USA is in a league of its own along with Israel in bio-preparedness, it has got some help from India. This country has huge stocks of Ciprofloxacin and could deliver 20 million tablets in the event of an anthrax attack”. Not only that, India is one of few countries with an anthrax vaccine. Says Rajesh Jain, a senior official of Panacea Biotech, the Indian manufacturer of the vaccine “The vaccine is undergoing Phase 2 trials”, and should be in the market in the near future. Incidentally, the anthrax vaccine development program in the BioShield project of the US is in a raging controversy, with ringing criticisms all around about the ineffectual nature of the vaccine and its parent company, VaxGen.
Some movement has been made. The DRDO has developed a Mobile Decontamination Unit. The DRDO also developed in 2003 an antidote for sulphur-mustard gas called DRDE-07. The agency has also been reported to have made underground bunkers near the Pakistan border for the armed forces in the event of a biological or nuclear weapons attack. It has also designed bunkers for MPs to be protected in such a catastrophe. What about measures for the population?
India has four battalions trained to contain a WMD (Weapons of Mass Destruction) attack in the major cities. In terms of preventing and restricting the fallout of a BW attack, India “needs a lot of R&D, awareness and preparedness”, says C Kameshwar Rao of Bangalore-based Foundation for Biotechnology Awareness and Education. Even basic emergency medicine services are lacking at the best of times!
Dr. Sharad Chauhan, DIG, Punjab Police Academy and author of the book ‘Biological Weapons’, lists the lacunae in the Indian counter terrorism strategy:
“Early detection is not possible because of the lack of infrastructure. Law enforcement officers may not even know of the concept of germs, leave alone bioterror. Automated biosensors will not work in India because the wide prevalence of the germs here would result in a constant state of alarm. There is also a lack of accredited labs that could detect germ strains. Without detection, how can you quarantine a population affected by a germ attack of plague?”
Scientist Sagar Galwankar, Co- founder of The Society for Emergency Medicine sarcastically remarks, “With an amalgamation of disease in the country like AIDS, malaria, etc., Indian researchers are taking the initiative to play an alternate role of bio-defense leaders, which is extremely commendable!”
According to Galwankar, the endemic diseases in India constitute a far greater and present danger: “India is now facing the epidemic of MDR-TB (Multi Drug Resistant Tuberculosis), considered in the U.S. as a category C bio-weapon. It would not be a surprise to read future news headlines claiming that Indian MDR-TB crisis is a biological attack from an external source!”
It is likely that the biological terror attack in India, if it occurs, will not be from a fancy, genetically engineered chimeric virus. According to Government sources ricin, a toxic agent from the beans of the common castor plant, Ricinus communis, is the likely agent for the Al Qaida in India.
However, Chauhan differs, “It is more likely that terrorists will target animals with diseases like foot-and-mouth to cause economic devastation. Ricin is good for assassination of individuals, not really for mass murder. Botulinum is more likely the agent of choice.”
All said and done, in the wake of a rapidly evolving evil, Indians are sitting ducks for a bio-disaster of Biblical proportions, with its gaping infrastructural lackings lying exposed to the whole world.

From today till as long back as the Emperor Nero (immortalized by his playing the fiddle while Rome burnt) man has used glasses to see better, whether for watching gladiatorial contests or for reading the fine print of The Telegraph. The normal lens of the human eye is a soft pliable gel that changes its curvature depending on how far or near an object is being focused upon by the individual. This is called accommodation, a process that helps a man watch a movie screen and his ticket number in a second’s gap without blurring or squinting. As man ages the gel like material in the lens in his eyes becomes stiff and fibrous. In that state it cannot change shape and accommodate to near vision. This is why the elderly need glasses for reading. These, say forecasters in the web portal Futurepundit.com, will soon be historical curiosities.
Scientists at the University of Michigan have developed a tool that uses 'ultrafast' lasers that create microbubbles inside the lens of the eye that soften the age-stiffened fibers. This allows the doctor to detect stiff fibers (those that resist the softening process). These are then removed with the help of lasers. The lens becomes softer and gets back to normal. After this non-invasive procedure, normal vision is restored. Voilå, no glasses!
The microbubble is now the froth of Sonoporation, a process that is the research darling of biophysicists all around the world today.
What exactly is Sonoporation about? How is it going to change the world of health care?
In this revolutionary technology, microbubbles of perfluorocarbons are coated with a shell or coating of albumin, gold or a polymer and injected into a vein of the body. When the microbubbles reach the target organ, like the heart or brain for example, they are targeted by ultrasound energy from an external machine. The ultrasonic waves cause these microbubbles to explode instantly. This causes holes to form in the membranes of cells of the organ, allowing delivery of drugs or other agents into the specific desired site. The entire process is done without putting in instruments or tubes inside the body, unlike current modalities of treatment.
Take the example of a common disease like a brain stroke that is usually due to a block caused by a clot in one of the cerebral arteries that supply oxygen to the organ. Using the technology, scientists in Hospital Vall d’Hebron in Barcelona dissolved the clots in 71 percent of patients, almost double the success rate of the conventional clot dissolution with a drug called tPA. The potential impact of this therapy in stroke management is awesome with earlier and more complete recovery from the crippling disease, says Carlos Molina, lead author of the article that appeared in a leading journal. A randomized trial for evaluation of the technique is now in progress.
Similar results are expected in the treatment of another common disease caused by an arterial clotting process, the heart attack. Blocked coronary arteries that cause damage to the heart muscle can be opened up using microbubbles. This could potentially reduce the numbers of invasive procedures like angioplasties and bypass surgeries in the future. Cardiologists, however, can take solace from the fact that their patients who develop re-stenosis (narrowing of the coronary arteries, a failure of treatment) after angioplasties can be successfully treated with sonoporation.
A very impressive characteristic of the microbubble is its ability to carry drugs into places that are inaccessible through normal means. The best example is the brain, where the blood-brain barrier prevents most drugs from reaching the grey matter. The use of Sonoporation is opening up enticing prospects for drug treatment for incurable diseases like Alzheimer’s, as evidenced by research in the University of California Davis. In this disease, treatment options have not developed because of the frustrating inability of drugs to reach the affected grey cells.
In the erupting research on gene therapy and molecular biology, microbubbles are being viewed as excellent vehicles of non-invasive treatment. In patients with Type I diabetes, the pancreas lacks the ability to produce the glucose reducing hormone insulin. Paul Grayburn at the Baylor University in Dallas has used UTMD (Ultrasound Targeted Microbubble Destruction) to deliver insulin genes carried in microbubbles to the rat pancreas. Says Grayburn, “Not only was their blood sugar lowered, but there was no evidence of any damage to the pancreas”. The implication for diabetics is a cure from the disease, without the need to take daily insulin injections.
With more and more complex diseases appearing to be curable in the near future, biophysicists seem ready to open the bubbly to celebrate. After all, alcohol can cross the blood brain barrier easily!

Remember Thomas Edison? Wrongly thought to be the inventor of the electric lamp, but actually the creator of the electric grid? Or Graham Bell, who rang in the first telephone? These men created products that changed civilisation. These, amongst some others, were disruptive technologies: technologies so outrageous that they are considered daring, provocative, and extraordinary. Today, we are on the threshold of possibilities so outlandish that science fiction sounds pretty ho-hum.
Nothing exemplifies this as fundamentally as the field of ‘disruptive’ medicine and, arguably, nobody in the field of medicine understands the future of this ‘outrageous’ medicine as well as Richard Satava. ‘Rick’ Satava is a Professor of Surgery at Washington University Medical Center, Seattle and has written several books and articles on futuristic ‘disruptive’ medicine. Apart from being a surgeon of world repute, Satava was part of the team that developed the first robotic and Virtual Reality systems, before joining DARPA (Defence Advanced Research Projects Agency), the brain bank of the US military. He is soon to take over as the Chief Scientist of theUS Army Medical Research and Command. It is here that he will be funding and overseeing more outrageous medical research. So, what earth shaking developments are afoot in the world of medicine?

A NEW AGE

Satava starts off, “A glimpse of what the future might become was given by Alvin Toffler in his 1976 book ‘The Third Wave’, in which he described the three different ‘ages’ – the Agriculture Age, the Industrial Age, and the Information Age. There appears to be a new age emerging – tentatively called the Biointelligence Age.” But one thought the Information Age is the future? He says, “The Information Era is here and is getting over. Over the past 20 years, there have been no new discoveries. The cell phone, computer, etc. are fundamentally the same as they were 20-30 years ago, the only difference being their level of sophistication and add-on features like small size, Internet access, cameras, etc."
The Biointelligence age features a slew of radical technologies that are set to change the entire way of treating health and disease issues. We examine some of the main issues here.

THE IMPOSSIBLE FUSION OF LIFE AND MACHINE

Scientists have implanted sensors and radio transmitters in bees and cockroaches to control them. The cockroach can be controlled with a joystick, allowing a possibility for cameras to be implanted in the creature for use in the detection of earthquakes and tsunamis. Bees fitted with sensors for biological weapons can transmit the information to the military. This is the beginning of the man-made fusion of living and non-living.
In man, brain implants are promising enormous hope for patients of paralysis, epilepsy and Parkinson’s disease. John Donoghue, a neuroscientist who also owns a biotech company called Cyberkinetics in California has begun implanting the Braingate device in the heads of patients that allow them to mechanically move an attached robotic arm with the power of electrical impulses generated by thought. The brain’s electrical impulses generated from thinking of an action go to a robot that then interprets these signals and performs an appropriate action.
How realistic is it to expect intelligent machines to perform radical functions in place of diseased body parts? Says Ray Kurtzweil, a global authority on science and future technology, “The latest generation of the implant for Parkinson’s disease (a slowly paralysing nerve disorder) is not an experiment, and it is an FDA approved therapy”. Rameez Naam says in his book ‘More Than Human’, “In Lisbon, Portugal, there is a group of blind men and women who can now see. In place of eyeglasses, they wear cameras connected to electrodes implanted in the visual parts of their brains. Some of them were blind for twenty years or more before the surgery. The same research that gives them sight could beam images from one person’s mind into another. “
Aubrey de Grey, a world-renowned scientist at the Department of Genetics, University of Cambridge, says, “There are non-biological organs such as cochlear implants already, and rapid progress is being made on more advanced things like artificial hearts. What will be more dramatic is when we start to be able to make machines that can replace some parts of the brain. For well-understood parts like the hippocampus (the part of the brain that stores memory), this may be only a couple of decades away. At that time we may wonder if ‘non-living’ is really the right word - non-biological, yes, but performing a living, cognitive function.”
de Grey looks even farther: “If we end up being able to replace the hippocampus with a machine that works just as well, there's no reason why we couldn't replace it with something that does more than the natural one. One additional function could be to use it as a knowledge base, an inbuilt Internet. In the more distant future we will probably understand the cerebral cortex well enough to start replacing parts of it too, and that is possible.”



CHANGING LIFE’S BUILDING BLOCKS

Conventional medicine looks at organ systems and deals with disease at the macro level. The dizzyingly fast developments in nanotechnology and genetic engineering are set to make this obsolete, if experts are to be believed.
Nanotechnology deals with molecules at the scale of a few nanometers, and banks heavily on the creation of an atomic ‘assembler device’ or molecular machine: a concept of scientist Eric Drexler that pertains to a group of molecules arranged to perform the functions of a machine or even a computer. Says Kurtzweil, “The golden era will be in about twenty years from now. The real Holy Grail of nanotechnology are nanobots, blood cell-size devices that can go inside the body and keep us healthy from inside.” Molecular machines can clear out clots in arteries, go into cells and correct abnormalities, and kill germs or cancer. Kurtzweil reiterates, “If that sounds very futuristic, let me point out that we’re doing sophisticated tasks already with blood cell-size devices in animal experiments.
One scientist cured Type 1 diabetes in rats with a nano-engineered capsule that has seven nanometer pores. It lets insulin out in a controlled fashion and blocks insulin antibodies. This is what is feasible today. MIT has a project of a sub-cellular nano-engineered device that is capable of detecting specifically the antigens that exist only on certain types of cancer cells. When it detects these antigens, it latches onto the cell, and burrows inside the cell, where it releases a toxin that destroys the cancer cell. This is a sophisticated nano-engineered device in that it is created at the molecular level. So that’s what is feasible already.”

CHANGING GENES OR SPECIES?

The era of transgenic animals is upon us already. Michael Crichton’s latest book 'Next’ deals with apes that speak Dutch and French, because of experiments in crossbreeding with humans.
Genetic engineering can prevent inherited disorders, but more radical is transgenic genetic engineering. Satava cites the example of rhodopsins (color detecting eye pigments). Man has four rhodopsins for vision of which he uses only two. The pit viper snake has one of the same rhodopsins that is unused by humans, and which gives the snake the ability to seek its prey in infrared. He asks, “ Should we genetically engineer our children to give them such abilities, so they can see in the dark? Should they have abilities that others do not have, giving them an enormous advantage? Moreover, who will decide which children can be ‘enhanced’? Are we on a threshold of designing our children to a point where there will be a whole class of enhanced individuals?”
Troubling questions, these! The ethical issues of genetic engineering are being debated fiercely in scientific and political circles, with more questions than answers.
With the establishment of ‘intelligent’ prostheses that function even better than a normal body part (as in amputees who can climb mountains or play), and with all possible organs (except the brain) being replaceable with biosynthetic ones, it is possible to conceive of an ‘enhanced’ man with 95% of his body replaced by artificial ones. “Would such a man be ‘humanoid’ or human?” asks Satava.
Talking of humanoids, a parallel development has been the creation of intelligent robots that help impaired patients. Satava remarks, “Advanced programs such as fuzzy logic can help the robot or computer to learn from tasks. This meets the definition of ‘thinking’. There are machines with life-like robotic faces which can answer verbal questions and attempt to make facial expressions that show six specific emotions”. Robotics is expected to be a $50 billion industry by 2025, with countries like South Korea set to become leaders in domestic multifunctional robots (with a target of one domestic droid for every home by 2013). Companies like Microsoft are working on the same lines. With such research, a thinking and emoting robot is not going to be mere science fiction. It is already reality in research!

WILL MAN HIBERNATE AND REJUVENATE?

American scientists have new insights into the phenomenon of hibernation, with stunning implications for medical care. Animals like the Arctic ground squirrel can turn their entire system off, effectively living with minimal heart rate, breathing, and circulation, owing to a molecule that blocks energy generation in the hypothalamus of the brain. Scientists have been able to create a block in mice such that they are put into a state of suspended animation for about 6 hours – no respiration, heart rate, blood pressure, ECG, EEG, and even no activity on functional MRI of the brain. After 6 hours, they are awakened and they behave normally. Satava points out “while this is an early experiment, it points to the possibility of using these molecules or drugs for anesthesia. If successful, in surgery a patient could be put to ‘sleep’ with no heartbeat, no bleeding when incised (bloodless surgery), unaware of pain and unable to move. When the surgery is over, he can be awakened.”
Drexler confirms, “It is possible to discover a drug that causes biostasis (putting life in pause). A method of producing reversible biostasis could help astronauts on long space voyages to save food and avoid boredom. In medicine, biostasis would provide a deep anesthesia giving physicians more time to work. When emergencies occur far from medical help, a good biostasis procedure would provide a sort of universal first-aid treatment: it would stabilize a patient's condition and prevent molecular machines from running amok and damaging tissues. 

But no one has found a drug able to stop the entire metabolism the way anesthetics stop consciousness - that is, in a way that can be reversed by simply washing the drug out of the patient's tissues. Nonetheless, reversible biostasis will be possible when repair machines become available.”
With much research involving other areas like human cloning, prolonging longevity of man, and tissue synthesis modern science is helping evolve a new breed of professional: the scientific ethicist.

There is something about the phenomenon of twins that has fascinated mankind for centuries. Luv and Kush were Lord Rama’s sons, and find special mention in the mythology of the time. Apollo and Diana were twins, each remarkable in their own way. In culture, twins have a special pride of place—nowhere more so than in India, where kids have grown up on Sita and Gita, Ram and Shyam, apart from innumerable clones and clowns in latter day Govinda starrers.
The world of medicine also boasts of amazing biological accidents. In the phenomenon of ‘vanishing fetus’ one of the twins may just disappear when ultrasound is done during the mother’s pregnancy, a result of fetal death and disintegration. A fetus can grow parasitically inside its twin, a condition called ‘fetus in fetu’.
Another twinning phenomenon is the occurence of conjoined twins. This occurs when the group of cells formed by fertilization, the zygote, splits into two, but the divisions somehow re-unite at one point. So these twins stay united at the chest, buttock, belly, back or the head.
Some facts about conjoined twins:
• They occur once in every 40,000 births
• Indians are more prone to have conjoined twins
• 75% of them die within 24 hours of birth
• Females outnumber males 3:1
• The twins are always of the same sex
• Though they share the same body and may even share the same brain, they have different personalities, even different sex drives. Peculiarly, their thoughts may be common
Chang and Eng were conjoined twins born in Thailand in the 19th century who became famous after joining the travelling circus of PT Barnum, the famous entertainer. These men, who were given the name of Siamese twins, raised between them an astounding 23 children, underscoring once again the remarkable nature of these special human beings to live like other normal human beings.
There was a lot of buzz about the Indian twins who are joined at the head and due for surgery in New Delhi. What exactly was the issue there?
Twins who are joined at the head may have separate brains but may share the same blood vessels. Obviously, the hospital has to be really equipped for this. In an OR like this, there would be a calendar rather than a clock to time the surgery! The surgery has to involve division of the main vein, the sagittal sinus, which is very hazardous. The much-hyped Iranian twins who underwent surgery in Raffles Hospital, Singapore in 2003 died because the main vein bled severely on separation. So difficult is the surgery that teams of surgeons operate for 18 to 40 hours, and may stage the surgery into several installments.
Twin separation can be a fatal and futile exercise, leaving one or both dead. This kind of surgery, the cost of which runs into crores, has raised several ethical issues. How does a doctor decide which twin can live and which allowed to die? Why risk a separation when both could die? The answer is that the twins take the decision to risk life. Informed consent largely solves the ethical dilemma here. Unfortunately, in all the cases where the doctors decided to sacrifice the life of one twin, the other also died.
Another issue is the tendency of the hospitals involved in twin separation surgery to use these cases to launch high voltage publicity, raising hopes and then disappointing everybody, as happened to the Iranian twins in Singapore.
A couple of successful cases of separation of twins joined at the head (craniopagus) has encouraged the neurosurgical community to try more to provide a better quality of life for these unfortunate pairs. Who says medicine is not a noble profession?