HEALTH & FITNESS

After-effects and side-effects 
Dr S.K. Jindal

A recent judgement of the Supreme Court of India on the issue of liability of doctors for the after-effects and side-effects of drugs and other treatments is a landmark step in the annals of legal medicine. The court had clearly pronounced that doctors could not be held responsible for undesirable side-effects of a drug.

Hope for patients of rheumatoid arthritis
Dr Vikas Sharma

For a rheumatoid arthritis patient, the quality of life can be severely affected by relentless pain, stiffness and fatigue. Even activities like writing, opening a jar lid or simple walking inside one’s house can cause great pain and fatigue.

EYESIGHT
Don’t get afraid of eye cancer in children
Dr Mahipal Sachdev

Retinoblastoma is the most common eye cancer in children. Retinoblastoma affects one in every 15,000 to 18000 live babies. The average age for the diagnosis of retinoblastoma is around 18 months.

Asthma linked to autumn and winter births
LONDON: Babies whose first few months of life coincide with high pollen and mould seasons may be at increased risk of developing early symptoms of asthma, research suggests.

Health Notes

 

 

Top







After-effects and side-effects 
Dr S.K. Jindal

A recent judgement of the Supreme Court of India on the issue of liability of doctors for the after-effects and side-effects of drugs and other treatments is a landmark step in the annals of legal medicine. The court had clearly pronounced that doctors could not be held responsible for undesirable side-effects of a drug.

A division bench of Justice Markandey Katju and Justice Singhvi has overturned the judgement of the National Consumer Disputes Redressal Commission awarding compensation for “medical negligence”, causing deafness with antibiotics required for urine infection at Nanawati Hospital, Mumbai.

The judgement, obviously welcome by the medical fraternity, is of immense legal, medical and social importance. It means something or the other to almost every individual who is required to take one or the other type of medicine for an ailment. In brief, the judgement supports what the doctors have always believed that a treatment is like a package — one cannot isolate the side-effects, toxicity and other harms of a drug from its benefits and usefulness.

A simple example is that of sedation and drowsiness with the desirable (or the required) uses of most of the anti-allergy drugs. The worst example is that of a fatal reaction or anaphylactic shock following a penicillin injection. In between these are innumerable examples of toxicities of drugs, including deafness, organ failures, diabetes, hypertension, arrhythmias, blood abnormalities, bone and muscle weakness, effects on pregnancy and so on. The list is endless.

It was Oliver Holmes who had said in 1860 that “if the whole materia medica as now used, could be sunk to the bottom of the sea, it would be all the better for the mankind — and all the worse for the fishes”. Being a doctor myself, I do not support this contention in totality. But it is quite true that “poison and medicines are often-times the same substances given with different intents”. (Peter Latham 1836)

Not only drugs, but several different forms of treatments also have their after-effects and side-effects, which are obviously undesirable, and sometimes harmful. But a good doctor weighs the pros and cons of a treatment. One always calculates the benefits versus harms ratio and decides the plan accordingly. This is not only a general dictum but an essential principle of the practice of medicine — be it the medical, surgical, the intensive care or even a counselling treatment.

Besides the requisite benefits, there are several other factors which determine the prescription of a treatment. Feasibility, availability, ease of administration and costs are important considerations. Incidentally, the difference in the price structure between the “more safe” and the “less safe” drugs is generally enormous. I can cite the example of several newer antibiotics, anti-fungal and blood-thinning drugs which have lesser side-effects but several times costlier than their older counterparts. To decide on the use of one treatment between the two alternatives is neither easy nor absolute. The final decision between different options is either discretionary or made in agreement with the patient, if possible.

Irrespective of the reservations about and problems of treatment, their need is ever growing. People do and will continue to fall sick and seek treatments. The scope of treatment options, in fact, has vastly expanded to include the preventive and health promotional drugs. It will not be entirely out of tune to say that almost every individual in future will be consuming pills or getting surgeries done even in the absence of an actual disease.

It is of utmost importance for a doctor to offer a treatment package after all ethical and professional considerations. It is equally important for the patient to have faith and partnership in the treatment package sought by him from his doctor. He is an equal partner in the profits and losses of medical management.

The writer is Professor & Head, Department of Pulmonary Medicine, PGI, Chandigarh.


Top

Hope for patients of rheumatoid arthritis
Dr Vikas Sharma

For a rheumatoid arthritis patient, the quality of life can be severely affected by relentless pain, stiffness and fatigue. Even activities like writing, opening a jar lid or simple walking inside one’s house can cause great pain and fatigue.

If you thought, living with pain and fatigue forever was the only option for a rheumatoid arthritis (RA) patient, then try homoeopathy. The treatment for rheumatoid arthritis in homoeopathy is very effective in early and moderate stages of the disease. Medicines can control, relieve and even cure rheumatoid arthritis. Although in advanced stages, where the deformities have taken place in the joints, homoeopathy may not be of much help.

Rheumatoid arthritis is caused by inflammation in the lining of the joints (synovium) causing pain, swelling and eventually deformity. The main symptoms of rheumatoid arthritis are pain in the joints, swelling, and tenderness of the joints, stiffness of the affected joints, hard bumps like nodules under the skin in the affected joints, tiredness, fever, reduced appetite and weight loss. The small joints like wrist, hands, feet and ankle are affected first. Big joints like the elbow knee, hip and jaw are affected later as the disease progresses.

Rheumatoid arthritis is caused by a misdirected immune response, also called auto-immune disorders. The immune system (defence system) is a complex organisation of cells (antibodies) designed normally to “seek and destroy”invaders of the body, particularly infections. Patients with auto-immune diseases have antibodies in their blood that target their own body tissues.

This means that in Rheumatoid Arthritis, body’s own defence cells (antibodies, mainly white blood cells whose purpose is to fight bacteria and other micro-organisms entering our body), start attacking the lining (synovium) of the joints. This causes inflammation in the synovium which over the period of time releases proteins. These proteins cause arthritic changes in the cartilage, bones, ligament and tendons of the joints. Although it is not completely understood, researchers believe that genetic and environmental factors are responsible for the triggering an attack of rheumatoid arthritis.

Homoeopathic medicines used for treating rheumatoid arthritis gradually desensitise our immune system and are able to optimise this over-reaction of the defence system, thus controlling the further onslaught on joints. Homoeopathic medicines also reduce the inflammation and fatigue in a very natural way and do not produce any kind of side-effects.

Anaemia that occurs in RA is very effectively treated with homoeopathic medicine Ferrum Metallicum. Medicines that are used in treating RA are Colchicum, Rhus Tox, Caulophyllum, Ledum Pal and Carcinocin. The patient needs to understand that the homoeopathic system is aiming to clear out the disease from the body and not trying merely to suppress or give temporary relief.

Thus, it could take a while before one experiences relief. The time for its treatment is dependent on various factors — the chronicity of the disease (the duration since the disease has been in the body), genetic propensity and the extent of damage.

The writer is a Chandigarh-based homoeopath. email vikas@drhomeo.com


Top

EYESIGHT
Don’t get afraid of eye cancer in children
Dr Mahipal Sachdev

Retinoblastoma is the most common eye cancer in children. Retinoblastoma affects one in every 15,000 to 18000 live babies. The average age for the diagnosis of retinoblastoma is around 18 months.

This tumor originates in the retina, the light sensitive layer of the eye. Retinoblastoma may occur in one or both eyes of the affected child. Most cases (75 per cent) involve only one eye; the rest (25 per cent) affect both eyes. The majority (94 per cent)of patients have no family history of the disease; only a small percentage of newly diagnosed patients have other family members with retinoblastoma (6 per cent).

Retinoblastoma can be present in a variety of ways. The majority of the retinoblastoma patients present with a white pupil reflex instead of a normal healthy black pupil or red reflex seen when photographs are taken of a child looking directly into the camera. A crossed eye or squint is the second most common manner in which retinoblastoma presents. The child’s eye may turn out (towards the ear), or turn in (towards the nose). Retinoblastoma may also present with a red, painful eye or poor vision. Most often the symptoms of retinoblastoma are first detected by a parent.

Diagnosis of retinoblastoma is based on a thorough clinical evaluation aided by ultrasound of the eye. CT and MRI may occasionally be required.

The treatment of retinoblastoma is a modern-day success story. One hundred years ago, retinoblastoma was considered nearly fatal even in developed countries. Early diagnosis coupled with improved treatment protocols resulted in an improved survival from 5 per cent in 1896 to 81 per cent in 1967.

Management of retinoblastoma needs a multidisciplinary team approach, including an ocular oncologist, paediatric oncologist, radiation oncologist and an ophthalmic onco-pathologist. Treatment has to be individualised for each patient. Goals of treatment from most-to-least important ranking are: saving life, saving the eye and saving vision.

There has been a trend away from enucleation (removal of the eye) and external beam radiation therapy towards focal “conservative” treatments. Every effort has been made to save the child’s life with the preservation of eye and sight, if possible. However, primary enucleation continues to be the most commonly used method of treatment for retinoblastoma primarily due to late diagnosis of the disease.

Enucleation is the most common form of treatment for retinoblastoma. It is employed in situations where eyes contain large tumours. In the operation, the entire eye is removed along with a long piece of optic nerve as one specimen, and is sent to a pathologist for examination under a microscope. A ball of silicone or coral is placed where the eye had been so that there is no cavity or hole. After the socket heals, the child is fit for a prosthesis or false eye approximately six weeks after the operation.

Children with one eye have normal vision, play sports, and later drive cars. It is, however, especially important for children with vision in only one eye to wear protective eyewear during sports and other hazardous activities. These children grow up and become famous actors, physicians, lawyers, accountants, et al.

Recent research in the treatment of retinoblastoma has concentrated on methods of combining chemotherapy with other local treatment modalities (TTT, radiotherapy, cryotherapy) in order to save the eye and wherever possible, even vision. Chemotherapy is given intravenously to the child, passes through the blood stream, and causes the tumours to shrink within a few weeks. The child is re-examined at a three or six weeks’ interval and the remaining tumour(s) are treated with laser or cryotherapy. This modality has now become the standard of care for moderately advanced retinoblastoma.

Cryotherapy is a form of treatment in which smaller tumours are frozen. This process of freezing and thawing is known to kill tumour cells. Laser therapy (TTT) is another non-invasive treatment for small tumours. This type of treatment is usually done by focusing light through the pupil onto the tumours in the eye.

Retinoblastoma is a life-threatening disease, but it is rarely a fatal one if treated appropriately. With the correct treatment in the hands of an experienced ocular oncologist and appropriate follow-up, the retinoblastoma patient has a very good chance of living a long, full and happy life.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com
Top

Asthma linked to autumn and winter births

LONDON: Babies whose first few months of life coincide with high pollen and mould seasons may be at increased risk of developing early symptoms of asthma, research suggests.

Children born in autumn and winter were three times more likely to start wheezing by the age of two than those born at other times of the year.

In the region of California where the study took place, air levels of fungal and mould spores rose in November and December, while pollen peaked in the early spring months of March and April.

The Independent



Health Notes
Novel approach may provide new class of diabetes drugs

London: In what may spark a completely new class of drugs to treat type 2 diabetes, University of Oxford researchers have developed a cheap and efficient drug discovery method that can be helpful in identifying a new player in the body’s insulin secretion process.

The researchers say that the new approach may allow small academic labs to search a large database of drugs to find treatments for diabetes and many other diseases. — ANI

Vaccine targeting ‘Achilles heel’ in all flu viruses

Washington: A potential new flu vaccine to cure almost all kinds of the disease, including bird flue, may be available in just two years because scientists have identified 10 antibodies that target an “Achilles heel” in most forms of influenza.

The researchers have revealed that the antibodies they have discovered target the weak spot in the “neck” of the virus, just below its peanut-shaped “head” which stops it shape-changing and infecting cells.

This finding attains significance because one of the reasons why scientists have failed to find a vaccine to prevent even seasonal flu is that the virus constantly mutates in a bid to fool the immune system. — ANI

Parkinson’s destructive pathways

London: American researchers at the Whitehead Institute and Massachusetts Institute of Technology say that they have developed a novel approach to analyse cellular data, and have been gaining new understanding of Parkinson’s disease’s destructive pathways.

Thus far, the researchers have used the new computational technique to analyse alpha-synuclein, a mysterious protein that is associated with Parkinson’s disease. — ANI


HOME PAGE

Top