HEALTH TRIBUNE Wednesday, November 22, 2000, Chandigarh, India

A killer stalks the North

By Dr Rajeev Gupta
mack, popularly known as brown sugar or the poor man's heroin, is giving sleepless nights to thousands of parents whose children have fallen prey to this highly addictive substance. Starting from the border districts of Punjab, it has been able to spread its deadly fangs in to the entire state and the neighbouring ones.

Turmeric — the wonder herb
By Dr K.C. Kanwar

urmeric or "Haldi" (powder) is derived following the grinding of the rhizomes, the underground stem of a similarly named perennial herb of the ginger family. This plant (Curcuma longa), 0.5-one metre in height, with a short stem and large tufted leaves is native to South and South-East Asia where the spice is much in use in cookery and medicine since time immemorial.

Reading the Book of Man
une 26, 2000, will surely come to be regarded as one of the most significant dates in human history. It was the day when scientists in the UK, France, Germany, Japan, China and the USA, who are taking part in the Human Genome Project, announced that they had mapped 97 per cent of the human genome and accurately sequenced 85 per cent of it.



A killer stalks the North
By Dr Rajeev Gupta

Smack, popularly known as brown sugar or the poor man's heroin, is giving sleepless nights to thousands of parents whose children have fallen prey to this highly addictive substance. Starting from the border districts of Punjab, it has been able to spread its deadly fangs in to the entire state and the neighbouring ones.

Smack addiction is yet another example of how Pakistan, our neighbour, has been able to hit us hard by its narco-terrorism. Most of the smack-users are young adults who, in the normal course, should have been busy in building up their educational career. But, unfortunately, they have been trapped in the strong addictive whirlpool.

What is smack?

Smack is a residue formed during heroin synthesis. Heroin is synthesised from morphine, an opium derivative. Smack comes as an odourless brown powder. The sale of smack is illegal but its availability is hardly a problem for the addicts. One gram of smack costs Rs 300 to Rs 500 and many smack addicts are known to be using 3 to 5 gms per day.

How is smack used?

The smack powder is kept on the silver foil of a cigarette pack and is heated from below with a lighter or a matchstick. The fumes coming from the heated smack are then inhaled. The inhaled smoke immediately gives a kick and sense of "well-being" to its users. Smack is also smoked in cigarette form. It is a strongly addictive substance. Even if used four or five times, it can make a person hooked on to it. Most of the smack addicts use it in public or home toilets. Its use can be suspected by the presence of a peculiar smell and fumes in the toilet. Generally, its users tend to spend a lot of time in the toilet.

The physical appearance

The regular smack-users look weak or malnourished and have a fixed stony look with sunken eyes. Their faces are emotionless. Their food intake is drastically reduced. Because of the low immunity level, they are more prone to developing infectious diseases, including tuberculosis.

Behavioural changes

Most of the addicts show striking changes in their behaviour patterns. They become highly irritable and explosive. Their moods exhibit frequent fluctuations. When smack is not available or when they are confronted by members of their families, they react violently.

Smack users gradually stop taking interest in their work and job. They stop taking their studies seriously and their scholastic performance starts deteriorating. When their employers learn about their addictive habits, they throw them out of their jobs.

Smack addiction is an expensive proposition and the majority of the addicts cannot afford its use. They are driven to poverty and penury. Many of them start stealing money and jewellery from their homes. The places of work find thieves in them. They often join the trade by working as carriers of small-time street smack sellers. Many addicts become criminals.

Sleep is their first victim. They generally remain awake till late in the night and get up late in day time. Even during the day, they look drowsy and doped. Emotional apathy, a common symptom of all addicts, is also common among the smack-users who lose their sense of belonging to their families and friends. They stop showing concern for the problems of their dear ones.

Withdrawal symptoms

The regular use of smack leads to severe physical and psychological dependence and as time passes, its user feels the need to increase the dose. Once an addict stops taking the drug, he experiences withdrawal symptoms like restlessness, sleep disturbances, agitation, muscle cramps, body-aches, loose motions, lacrimation, increased nasal discharge — and a greater craving for smack!

The withdrawal symptoms of smack are compulsively bad and the patient experiences a strong urge for taking the next dose. Because of this factor, the addicts are unable to leave the drug without help.

The treatment

It is very difficult to treat smack addicts as outpatients. They have to be kept within supervisable confines. After the assessment of the motivation, treatment is done in two phases:

(A) Acute detoxification: It is done in a hospital setting under the expert guidance of a psychiatrist and his team. One may need a hospital stay ranging from 15 days to one month. Smack is abruptly withdrawn and the withdrawal symptoms are then symptomatically treated. Severe confusion and violence are evident during the withdrawal period. Fortunately, there are effective drugs to control such manifestations. Visitors, particularly the patients' friends, should be generally kept away. They may bring smack with them.

(B) Follow-up and rehabilitation: These are important parts of the treatment. The addicts must be kept on a regular follow-up prescription, otherwise, there is always the risk of their taking the drug again. Those who leave smack are under tremendous pressure from their friends using it to start again the stopped process. It is advisable to shift the patients to other cities for about three months. This change may give them a drug-free environment.

It is important to remember that smack addiction is a serious problem and that it has to be tackled at the earliest. As the case is with other addictions, one needs a lot of patience in dealing with these cases.

Long-term institutionalisation: Addicts having poor motivation may need prolonged institutionalisation, which may go up to a few months.

Counselling and rehabilitation: The victims lose the trust of their families. Even after they have stopped the drug, their seniors remain suspicious of their old habit.

In order to check a relapse, the cured persons need regular counselling and guidance. It is advisable to put them on a job which can help them regain their lost self-esteem and build a good self-image.

Note: My personal experience of treating a large number of drug addicts shows that smack is one of the worst forms of addiction. It destroys all sensitivity. So, once one is suspected to be an addict, one has to be treated with firmness and compassion.

The author is a Ludhiana-based psychiatrist and a well-known de-addiction specialist. His Email address is:


Turmeric — the wonder herb
By Dr K.C. Kanwar

Turmeric or "Haldi" (powder) is derived following the grinding of the rhizomes, the underground stem of a similarly named perennial herb of the ginger family. This plant (Curcuma longa), 0.5-one metre in height, with a short stem and large tufted leaves is native to South and South-East Asia where the spice is much in use in cookery and medicine since time immemorial.

Now, turmeric is profitably grown throughout the warmer parts of the world. The turmeric powder, orange-yellow to dark-yellow in colour, has a characteristic aroma and bitter-warm taste. India is the largest producer as well as the biggest user of turmeric in the world. The production of turmeric powder involves boiling the rhizomes in water for a while followed by sun drying. The dried tubers then are hand-rubbed or rotated in drums (polishing or dehusking) before these are ready for grinding.

Ethnologically, turmeric, the therapeutic goldmine of the East, occupies an important position in the Hindu psyche. It forms an integral part of many sacred Hindu rituals highlighting its importance for mankind. The use of turmeric for varied human ailments over the centuries had not been put to much scientific evaluation and had been primarily based on the experience of many generations of traditional physicians from different ethnic societies which persistently used this curative herb for varied human ailments.

A systematic scientific study on turmeric in this country was taken up as late as 1970s and that too initially was restricted mostly to its anti-inflammatory characteristics. Lately, this herb has attracted almost globally frantic scientific evaluation on many hitherto unknown and unexplored aspects.

Besides imparting colour and flavour to many oriental cuisines, turmeric powder in ancient Hindu texts is valued for its aromatic, stimulatory and carminitive properties as well as for curing a variety of ailments both minor (such as sore throat and coryza) and major afflictions. In addition, turmeric is considered a tonic and a blood purifier. It is well known for accelerated healing of both septic and non-septic wounds. It is also skin-friendly and constitutes an important ingredient of many creams and lotions. Turmeric improves bile secretion and stimulates the contraction of gall bladder muscles facilitating its proper emptying when needed. Its alcoholic extract prevents even gall-stone formation and brings down the incidence of colon cancer. Allopathic drugs for the management of colon cancer are highly expensive none-preventive and heavily loaded with serious side-effects as against turmeric extract which is inexpensive, preventive, curative and one hundred per cent safe. In Indian folklore, turmeric is considered highly effective in the management of internal haemorrhages and skeletal injuries people suffer accidentally. Current traditional Indian medicine (Ayurveda) recommends turmeric against bilary disorders, anorexia, coryza, cough, hepatic disorders rheumatism and sinusitis (cf. Ammon & Wahl — Planta Medica 57, pp. 1-6, 1991). The antibacterial activities of turmeric now stand substantiated microbiologically which vindicates the age-old use of this herb for sore throat and wound healing.

Haldi is said to be soothing to gastric mucosa even at higher doses needed for managing the crippling joint pains associated with arthritis and osteoarthritis. Antiarthritic drugs of the day, when used for long, change the blood profile and lead to heart-burn and the revival of dormant or healed peptic ulcers. No such effect is noted following the use of turmeric. Curcumin — the major active constituent of turmeric — stands identified as the potent non-steroidal anti-inflammatory agent.

Allopathy has now affirmed many, if not all, of the above said usages so far laid buried in the ancient Indian texts. Turmeric now is experimentally proved to be antibacterial, antifungal, anti-inflammatory, hypolipedemic and hepa-operative. It also shows protease inhibitory effects besides being active oxygen-species free radical scavenger and lipid peroxidase inhibitor (of Ammon and Wahl — Planta Medica, 57, pp 1-6, 1991).

A word at this point about Curcumin — the most active therapeutic ingredient of turmeric. Curcumin is a yellow, crystalline substance which is a potent phenolic antioxidant — the scavenger of free radicals which account for many diseases including cancer. The yield of curcumin ranges between 1.5-3.0 per cent of the total weight of turmeric powder. Turmeric also contains bioactive peptide Turmerin which makes up 0.1% of its dry weight. Turmerin by itself is also a strong antioxidant and hence protective.

The resurgence of global interest in turmeric in the last decade or so primarily emanates from its recently proven antiatherogenic and anticancer potential and also in view of the raging controversy, notwithstanding unsuccessful attempts in the USA to get turmeric patented.

Turmeric and Coronary Artery Disease (CAD)

Turmeric was known earlier to improve circulation. Medical science has lately accepted the anti-thermogenic effect of turmeric, especially of curumin when administered intraperitioneally. CAD is a serious affliction world over and is well high up both in terms of mortality and morbidity. It is basically an outcome of atherosclerosis, a progressive disease caused by elevated levels of triglycerides (TGs), total cholesterol and LDL — the bad cholesterol — in the circulating blood and subsequently their deposition in the blood vessels causing blockage or atheroma. Atheroma formation can occur anywhere. When it involves the coronary arteries, CAD ensues. CAD is managed primarily by treating hyperlipidemia, i.e, lowering of the circulating fat and cholesterol. If this does not work, bypass surgery carrying a prohibitive price tag is the only answer. Undoubtedly, there are drugs available in the market which lower triglycerides (TGs), cholesterol and LDL levels but these are expensive and none without serious side-effects. These restrict, if not prohibit, their life-long use.

Turmeric, especially its alcoholic and possibly even water extract, lowers significantly cholesterol as well as LDL blood levels in cases of those suffering from primary hyperlipidemia. Rats fed curcumin and cholesterol in diet form showed only 1/2-1/3 of serum and liver cholesterol compared to the control group which received cholesterol alone.

Not only this. Turmeric reportedly improves levels of anti-atherogenic protective HDL — the good cholesterol. On top of it, turmeric at the dose levels needed for bringing down hyperlipeidemia has no adverse effect. Further, turmeric is a potent antioxidant, known to effectively prevent oxidation of both cholesterol and LDL — oxidised forms of which are far more atherogenic.

Anti-cancer properties

The rapid resurgence of interest in turmeric stems from its recently discovered anti-cancer potential, though, so far, proven only on laboratory animals with possible extrapolation to the humans. A clue to this was initially provided by studies done in vitro whereby turmeric (and also curcumin) was shown to be selectively cytotoxic to cancer cells and effective in thwarting the effects of a variety of environmental carcinogenic mutagens, including the ubiquitous powerful pollutant compound benzo (a) pyrene, which transform in vitro normal cells into malignant ones. Further, turmeric is known to suppress chemically induced chromosomal aberrations — the prerequisite for transformation of normal cells to malignant ones.

Besides, turmeric elevates the activity of anti-cancer enzyme glutathione-s-transferase which protects against free radical damage, also the root cause of many other human afflictions While extrapolating the doses of turmeric used in animal studies to humans, Krishnaswamy calculated that an intake of about 500-1000 mg/day of turmeric powder in humans would correspond to the doses proved effective in the lower animals in containing mutagenicity.

“The evidence on turmeric constantly suggests a protective effect and it is conceivable that it protects against cancer as a whole", says a book titled "Food, Nutrition and the Prevention of Cancer: A Global Perspective (published by American Institute of Cancer Research).

Dr Kanwar is the former Chairman of the Department of Biophysics, Panjab University, Chandigarh.Top


Reading the Book of Man

June 26, 2000, will surely come to be regarded as one of the most significant dates in human history. It was the day when scientists in the UK, France, Germany, Japan, China and the USA, who are taking part in the Human Genome Project, announced that they had mapped 97 per cent of the human genome and accurately sequenced 85 per cent of it.

This is the end of the beginning, not the completion of the task; at least two more years will be spent filling in gaps in the knowledge. The ultimate aim is to know the sequence of all the bases (chemical sub-units) from end-to-end of the two metres of deoxyribonucleic acid (DNA) in every cell of the human body.

There are about three billion of these bases from end-to-end of our DNA, but only four different kinds of bases, known for short as A,C,G and T. It is the sequences of these four bases in our genes that carry the information required for our cells to assemble the proteins which make up our bodies and which normally ensure that our proteins have precisely the correct structures.

Genes occupy only about 3 per cent of our DNA; the remaining 97 per cent has no known function. But it still has to be sequenced in order to reveal the genes dotted around in it and in the hope of eventually revealing its functions, if it has any.

Sequencing the entire genome is a mighty task. If someone were to start from one end to recite the sequence of the bases in human DNA, at a rate of one base per second, 24 hours a day, it would take 100 years to get to other end.

The UK's contribution to this huge achievement has been massive. The world's largest medical charity, the Wellcome Trust, has committed £210 million to the Human Genome Project (HGP) at the Sanger Centre for gene sequencing. The Centre is named after Fred Sanger who received two Nobel Prizes for discovering how to determine the sequences of the chemical building blocks in proteins and in DNA. The Sanger Centre, opened in 1997, has sequenced approximately one-third of the entire genome.

On June 26, Dr Michael Dexter, Director of the Wellcome Trust, said: "Just as Copernicus changed our understanding of the Solar System and the earth's place in it, and Darwin's work changed our understanding of evolutionary forces, so knowledge of the human genome will change how we see ourselves and our relationships with others. We can now begin to see what makes each individual unique and we also see what makes us all the same: the common humanity set out in the spiral staircase of our DNA."

Small genetic differences between individuals are of great medical importance. About 2,000 diseases are each directly caused by a defect in one single gene. The particular genes possessed by each individual very largely determine the degree to which that person is susceptible to each of many diseases caused by infections of variations in body chemistry.

Genes also largely determine important but little-understood differences in how effective the same medicines are in different people.

As the genes dotted along the length of the human DNA continue to be discovered, with the DNA sequences in them becoming known, the process of identifying the protein each gene codes for, and of assigning functions to the proteins, will continue and will be speeded up. The draft map is already having a big effect on the way such research is carried out.

"With the working draft now complete, something that has taken gene hunters three to four years could happen in a year to a year-and-a-half", said Prof Tony Monaco, of the Wellcome Trust Centre for Human Genetics at the University of Oxford.

The genome map and the techniques it allows are already being put to work. Bill Fullagar, President of the British Pharmaceutical Association, said: "The knowledge of our genetic make-up will herald a revolution in new diagnostic tests and eventually in better and more effective medication. It opens the way for the era of personalised medicine, away from one-dose-fits-all treatments and towards medication designed for specific genetic make-ups."

Data from the HGP is already being used in devising new treatments for diseases, such as muscular dystrophy, caused by defects in single genes.

Although it is important to look at the starts that have already been made on some of these new approaches, it is also necessary to look backwards as well as forward and to realise that the celebration of the sequencing of the human genome is the "celebration of a milestone, not the sudden unveiling of previously unsuspected treasures", as Martin Bobrow, Professor of Medical Genetics at Addenbrooke's Hospital in Cambridge, eastern England, puts it.

"Human Genome Project data has accumulated more and more rapidly and has been publicly available on the web for some years", he added. All the data has been and is being made freely available to the worldwide scientific community.

Sir Aaron Klug, President of the UK"s Royal Society, said: "In 1977 Fred Sanger and his team at the Cambridge Laboratory for Molecular Biology invented the DNA sequencing technique (dideoxy sequencing) which is still used today. Fred Sanger's team also developed many of the techniques which have since gone to improve sequencing technology."

Later, researchers at the same laboratory sequenced the complete genome of the nematode worm, Caenorhabditis elegans (C. elegans). This work, done in collaboration with Robert Waterson's laboratory at St Louis in North America, led the way in large-scale genome sequencing. "It was the evident success of this work," said Sir Klug, "which allowed Dr John Sulston, later Director of the Sanger Centre, and me to approach the Wellcome Trust with the proposals which led to the founding of the Sanger Centre. Meanwhile in 1998, C. elegans became the first multicellular organism to have its genome sequenced."

Courtesy: Wellcome Trust, the Sanger Centre, Genome Campus, Cambridge, England.