An open letter to Shri Achuthandan written in 2006

I am presently in Kerala for the past few days. Lack of rains  and lack of any type of help at home are the two not so new elements we face now. In 2006, in one of my earlier visits we saw that Shri V S Achuthanandan took charge as the new Chief Minister of the State. I decided to publish an open letter to him. I chose to publish it in The New Indian Express. In fact after sending it, I had a brief telephonic discussion with Shri George Abraham, the Editor of the daily. The daily did not use it.

Certain unique developments in Kerala troubled any visitor to the State. On October 4, 2005 I referred to some of it in a letter to the editor of The Tribune. You may access it as:

The Tribune October 4, 200

Guidelines needed on campus polls

The editorial “Campus elections” (Sept 21) reminds me of the campus election scene in Maharajas College, Ernakulam, during 1958-63. There were enough political distractions to destroy the career of even hard working students.

Accompanied by my father, I entered the campus for the first time. We had our first shock. Half a dozen students showered notices on us. It was a part of the election propaganda. Different political parties supported them.

Students agitated successfully against the increase in bus fare from six paisa to 10 paisa. Many students became leaders because of this One anna samaram. Hostels were hotbed of politics. But none enrolled as “permanent” students to continue their political activities.

My contemporaries, Mr A.K. Antony and Mr Vayalar Ravi, have made their mark in politics. Now campus politics is taking its toll. There must be guidelines to control this activity. Enough is enough.

— Dr K.S. PARTHASARATHY, Mumbai

 

 

Some conditions have changed in the State. Others remained. I am reproducing the letter below.

AN OPEN LETTER TO SHRI V S ACHUTHANANDAN

Dr K.S.Parthasarathy*

Dear sir,

I was exhilarated to hear that  a person like you from very humble beginnings, took over as the chief minister of Kerala. I attribute your success to your spartan life style, hard work and dedication to the cause of the under-privileged and above all your no nonsense and brutally frank attitude against moral turpitude and corruption.

I have no political affiliations. I work in Mumbai. I retired after 41 years of service, 21 years in the Bhabha Atomic Research Centre and rest in the Atomic Energy Regulatory Board. After retirement, the Department of Atomic Energy offered me Raja Ramanna fellowship

Two unconnected items inspired me to send this open letter to you; campus politics and behaviour of head load workers. My views on them may be very different from yours. But I request you to consider them impartially on their merit.

I  was born in to a middle class family. I  studied in Maharajas College Ernakulam because of the admirable will of my father and the munificence of a relative..

In 1958, as we entered the college campus for the first time, we had our first shock. Half a dozen students showered notices on us. It was a part of the election propaganda. Different political parties supported them.  My father extracted a promise that I shall never enter politics.

He knew my overwhelming propensities to extra curricular activities! I never missed a chance to attend public meetings. I loved to speak. I was secretary of the school literary and debating society  for many years.

Students agitated successfully against the increase in bus fare from six paisa to 10 paisa. Many students became leaders because of this “One anna samaram”. Hostels were hotbed of politics. But, as in northern States, none enrolled as “permanent” students to continue their political activities.

My contemporaries, Mr A.K. Antony and Mr Vayalar Ravi, have made their mark in politics. T.V.R.Shenoy and K.M Roy went into journalism. I do not know whether any one discontinued their studies because of political activities. We may never know that.

I was shocked to hear that mindless violence due to uncontrolled political activities had snuffed out the life of a few students, some of them from the middle class families

I believe that campus politics is taking its toll. There must be guidelines to control this activity. Enough is enough. That brings me to the first point. You know that the  Supreme Court had set up the Lingdoh Committee to examine and consider all aspects relating to the conduct of student elections, such as aspects affecting the academic atmosphere in educational institutions including, but not limited to, indiscipline and divisions on the basis of political beliefs and such other avoidable considerations.

The Committee may submit its recommendations shortly. I request you to act on the recommendations impartially, and courageously whatever may be your political views.

Recently, I have been to Kerala. I never believed that the head load workers extract their pound of flesh in every “head load work” in every village without doing any work!. The instance in point involved, the transport of  a few unproductive cocoanut trees which were bought by a broker at the rate of Rs 10 per metre .

The total amount involved Rs 2000/- The buyer employed six men to cut the trees and to load them on to a lorry. As soon as the loading operation was over, two head load workers appeared from no where; there were some whispering discussions; the broker told me later that he paid Rs 350/- to them as is the practice to “avoid complications”. This criminal extortion is worse than naked thuggery.

I do not grudge paying the workers handsomely their dues; but what is revolting is that they collect the money and do no work.

On May 13, this year a leading Malayalam daily reported that three head load workers were suspended for demanding  and claiming Rs 15,000/- as “Nokku Koolie” from Shri P.Vijayan  who owns a firm in H.M.T. Industrial Estate at Kalamassery. He used a crane on a holiday to unload some machinery imported from Switzerland.

The report also contained a warning from the city police commissioner that he will take strict action against those who violate the existing provisions.  Police did take action on such complaints at Mattanchery. Notwithstanding that, the practice prevailed in Kalamassery. I understand that it prevails in every village and town.

Later, I  read the Kerala loading and unloading(regulation of wages and restrictions of unlawful practices)Act, 2002. I realized that this comprehensive law is violated with impunity. Sir, you must make it unambiguously clear that this law will be enforced strictly.  I did not find anything unfair in this piece of legislation.

[ Dr. K.S.Parthasarathy is former Secretary, Atomic Energy Regulatory Board]

…………………………………………………………………………………………………………………………………..

Now “Nokkukuli” may not be a serious issue. Political violence including even  murders continue in some parts of Kerala. Not a welcome sign!

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Washington Examiner reviews the upsides and downsides of eliminating paper currency

Recently, the Washington Examiner columnist Mr. Kevin Cochrane in an eminently readable article reviewed the upsides and downsides in eliminating paper currency (WE, March 9). He reveals that Kublai Khan who invaded China introduced paper money, started a postal system besides spreading disease in that country.  According to Wikipedia, Kublai Khan established the Yuan dynasty in 1271. The dynasty ruled over present-day Mongolia, China, Korea, and some adjacent areas; he assumed the role of Emperor of China; he was the grandson of Genghis Khan.

Cochrane recalls that it took the Chinese “a few hundred years to overcome the Mongol hordes, build a wall to keep them out, and abolish currency in the early Ming Dynasty”.

“But now, almost 500 years later, the rest of the world is catching up with those Chinese emperors” Cochrane said.

He discovers that now “there is an effort gaining momentum to limit, or even abolish, physical money” He concedes that there are “some very positive upsides and also some very disturbing downsides just like most disruptive events in history – gunpowder, the steam engine, music videos – but this time the ledger of pluses and minuses is a little more difficult to balance”.

Cochrane describes many reasons for abandoning paper currency:

He says that the Chinese abandoned paper money because of inflation though Governments today say they want it eliminated because of crime.

“India recently required its 1.2 billion people to surrender all of their largest notes for smaller bills, effectively eliminating more than 80 percent of the currency in circulation” he refers to demonetization in India.

Cochrane quotes the Indian prime minister as saying that the action was to stop counterfeiting. Cochrane concludes that there was another more subtle reason behind the move – taxes. Mr Cochrane  did not list  all the reasons for demonetization advanced by the Indian Prime Minister.

Please see the full text of Prime Minister’s talk  published by the Wall Street Journal (Accessed on March 13, 2017):

http://blogs.wsj.com/indiarealtime/2016/11/08/full-text-of-indian-prime-minister-narendra-modis-speech-on-replacing-largest-rupee-notes/

Mr Cochrane characterizes tax evasion as “India’s national sport”. He claims that the USA does not have this problem “because less than 15 percent of all transactions statewide are completed in cash, and those only average about $21”.

If you can eliminate cash, transactions will be traceable making it easy for levying income tax.

Cochrane gives an interesting difficulty in cash transactions:

“A million dollars in $100 dollar bills weighs only 20 pounds, but the same amount in $10 dollar bills weighs more than 200 pounds and requires an Olympic weight-lifter to carry it. Having only small bills purportedly moderates or even ends illegal undertakings.”

You may, if you so desire, read Mr. Cochrane’s article at:

http://www.washingtonexaminer.com/the-upsides-and-downsides-to-eliminating-paper-currency/article/2616688

 

 

 

 

 

 

 

 

 

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Unnatural deaths in atomic energy: new wine in an old bottle!

On December 4, 2016, SundayGuardianLive published a report titled “Atomic energy department saw 70 unnatural deaths in eight years “. This news story is similar to a report which appeared in The Times of India in Sept 2014. It is a typical example of new wine in old bottle.

Here is the link to the article in SundayGuardianLive:

http://www.sundayguardianlive.com/investigation/7559-atomic-energy-department-saw-70-unnatural-deaths-eight-years

Responding to the TOI report of Sept 2014 , I wrote an article in Rediff.com  concluding that “overall, data and its analysis used in the reports prove that members of staff of DAE, like others, are prone to cancer and suicides! No more, no less! The sensational reports have the potential to do infinite damage to our nation’s nuclear energy programme and create unwanted fear.”

The Department of Atomic Energy responded promptly to the TOI article.

The Link: http://dae.nic.in/?q=node/775

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Carbon footprint of your sofa, Festival meal

 

Recently, the Scientific American journal reported that  normally the atmospheric level of carbon dioxide is at its minimum in September. However, in September this year, it has peaked at 400 parts per million (ppm). The journal quoted scientists as saying that it may not go below this level ever.Rising levels of carbon dioxide, the most important greenhouse gas is of great concern even at the  individual  level. I thought it is interesting to look at the topic afresh. I wrote an article on it in The Wire.

dinner

 

Here it is:

http://thewire.in/82871/carbon-footprint-thanksgiving-kerala/

 

 

 

 

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Proper communication in medicine

Proper communication in medicine

Proper communication is vital in any field. There is ample scope for changing what we communicate and how we do it based on proper feedback. This effort may  appear to be thankless; however it will be truly rewarding in the long run. These conclusions are specially valid in the medical field. We often hear a  very disturbing trend. Wrong, inconsiderate communications land physicians in harrowing situations. Occasionally fisticuffs may follow.

Many years ago Christopher Martin, Associate Editor of  the British Medical Journal  wondered whether absence of feedback is one of the reasons why there are so many complaints about poor communication in medicine. You can access his article at:

http://www.bmj.com/content/341/bmj.c4490

The article received half a dozen rapid responses

http://www.bmj.com/content/341/bmj.c4490/rapid-responses

I could not resist writing the following rapid response to his article.

http://www.bmj.com/rapid-response/2011/11/02/challenges-physicians-communication.

Thus:

Challenges to Physicians’ Communication

                                             

Mr Christopher Martin convincingly argues in favour of collecting
appropriate feedback, a powerful source for improving communication.

It is not enough to receive feedback from representative group of
patients. A non representative patient may offer valuable inputs. A few
years ago, I distributed an article titled “Medical x-ray examinations: a
note of caution”, to many members of the administrative staff in a large
research organization.

Everyone appreciated the article. A few proposed the need to avoid
scientific jargon if that is possible. While describing the biological
effects of radiation, I explained the small potential for developing
cancer as a late effect of medical x-ray exposure. One of the respondents
was very upset. His niece had a few x-ray tests done a day before. He told
me that if he knew about the cancer-inducing potential of x-ray exposure,
he would not have agreed to the x-ray tests.

I modified the text substantially to assert that a patient should not
refuse a medically needed x-ray test. Feedback from a single respondent
influenced me because the adverse effect of avoiding a clinically
recommended x-ray may far exceed the tiny probability for induction of
cancer.

A physician has to be constantly alert. A wrong word or even the
slightest gesture indicating a mild degree of indifference may put off a
patient.

Once I took my five year old son to a well equipped hospital. He had
a fairly large boil in his eye lid. I described his condition to the
physician.

“We have to cut it”, the unsmiling, thoughtless physician who was
visibly impatient decreed. My son ran out of the room. He declared that he
will never again come with me to any hospital. The boil healed slowly;
some antibiotic cream helped.

Last week I suffered from severe earache. The consultant diagnosed
that it is due to impacted wax. The junior doctor who attended to me was
very considerate; may be a brief explanation on the procedure to be
followed may have been helpful and reassuring. One ear got cleared easily.
The wax in the other ear was stubborn. It was hurting badly.

Further procedure was postponed.” We will not hurt you”, a senior
doctor who was stern but considerate, assured me. The stubborn wax needs
some softening! I am yet to read the material on “ear wax removal”, I
collected from the website of the US National Institutes of Health.

The challenges to communication between physicians and patients may
be more demanding if the patients belonged to an elitist closed group.
Partly because of the patients’ expectations.Some of them may be more
knowledgeable than their physicians.

If a hospital is located in a township in which thousands of persons
serviced by the hospital stay, then all bad news will spread faster than
wildfire; good news seldom gets any coverage.

Communication under stress will be ineffective. If communication to a
patient has to be effective it has to be delivered with compassion. It
will be satisfactory only if the patients trust their physicians.

Advancement in technology particularly medical imaging technologies
is an instance in point. These technologies advance with unbelievably
astonishing speed; the clinical uses lag disappointingly behind. More
often, there is no scientific indication that these technologies are
beneficial. Under those conditions, specialist doctors with clear
conscience will find it very difficult to communicate with knowledgeable
patients.

K.S.Parthasarathy Ph.D

ksparth@yahoo.co.uk

Competing interests:
None declared

Competing interests: No competing interests

 

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How Researchers Found That Tourists Accidentally Carried a Superbug from India to Paris

39 tourists swabbed door handles in 136 airports around 59 countries, finding that a deadly bug resistant to antimicrobial drugs and known to exist in India also exists in Paris, where it is rare. Credit: limaoscarjuliet/Flickr, CC BY 2.0

The most difficult, thankless and uninteresting part of any research, particularly in a field like microbiology, is collecting the samples. Generally, this exercise is expensive, often tedious and at times amenable to justifiable criticism at the end of the study. Recently, researchers from University Hospital Münster and the Robert Koch Institute, both in Germany, used an ingenious method to collect samples for their project. They successfully persuaded 39 tourists (known to them) to collect swab samples from 400 bathroom door handles from 136 airports in 59 countries. And they discovered that a drug-resistant strain of bacteria from India has reached Paris.

The researchers were able to rightly guess that international travellers can acquire antimicrobial-resistant bacteria and carry these unwanted guests from their home countries to the countries they visit. Reporting online on September 23 in the journal Clinical Microbiology and Infection, the scientists noted that “internal toilet door handles are suitable to assess the spread of bacteria because they are the last contact of the hands before hand washing, (and) are frequently used by multiple people after potentially unhygienic activities (e.g. defecation, urination) and are mostly contaminated with the flora of the skin and the gut.”

They instructed the tourists who took part in the study to swab each door handle with special moistened environmental swabs between December 2012 and November 2015. They stored the samples before inoculating the bacteria in a nutrient broth. Finally, they processed each type of bacteria according to specified protocols, identified the species and analysed their genetic makeup.

In this study, the samplers collected most samples (60.5%) from men’s toilets. The median time between sampling and culture was one week. The contamination rates were highest for Staphylococcus aureus (5.5%), followed byStenotrophomonas maltophilia (2%) and Acinetobacter baumannii complex (1.3%). The most important finding was the contamination rate of S. aureus. After detailed genome mapping, the researchers found that one of the strains of methicillin-resistant S. aureus (MRSA) found in Paris was rare, and that it originated from India.

Before we analyse the implications, a caveat issued by the researchers is pertinent: “It is unknown if and how door handles were disinfected by cleaners before sampling. No information on the material of the handles was available. These sources of bias could explain both that we over- and underestimated the true rate of contamination,” they conceded.

Now, the MRSA is not a benign bug. According to WebMD, this bacterium causes infections in different parts of the body. It is tougher to treat than most strains of S. aureus because it is resistant to some commonly used antibiotics. At present, it is known to be resistant to amoxicillinpenicillin  and oxacillin. Evidently, the ability of the bug to resist these substances makes it a superbug. The researchers wrote: “… we detected low contamination rates of internal toilet door handles from airports with drug-resistant bacteria in our study. The detection of an emerging CA-MRSA from India in France shows that antimicrobial resistance could be spread through international travel hubs.”

MRSA develops resistance fast enough to keep specialists developing more effective antibiotics, and it is worrying that international travellers may be carrying the bacterium around. And sadly, only travellers need passports and visas; there are no export/import controls on MRSA, effectively vicious nano-assassins! At the same time, the claim that one of the strains of MRSA isolated in Paris originated from India is suspicious because quite a few papers (here, here and here) have been published showing that MRSA is present universally.

According to the documents,

  • Global surveillance show that  MRSA represents a problem in all continents and countries where researchers have carried out studies, determining an increase in mortality and the need to use last-resource antibiotics, which are also expensive
  • Researchers reviewed the literature on the occurrence of MRSA in hospitals and long-term care facilities in various countries in the Americas, Africa, Asia, Australia/New Zealand and Europe. Increasing prevalence of MRSA is a worldwide problem, they’ve concluded, affecting both affluent and poor countries. We also need better infection control guidelines.
  • Scientists observed very high rates of resistance in all WHO regions in common bacteria (for example,Escherichia coli, Klebsiella pneumoniae and S. aureus) that cause common healthcare-associated and community-acquired infections. These include pneumonia as well as infections of the urinary tract, wounds and the bloodstream.

So, if there is such a mass of evidence for the universal presence of MRSA, how are the German researchers so sure that the bug found in Paris is from India and not from any other country?

“Indeed, MRSA is spreading around the globe even in remote areas, for instance in Australia,” Frieder Schaumburg, a professor of infectious diseases at University Hospital Münster and one of the authors of the paper, told this correspondent via email. “Several MRSA clones are known and mainly circulate in particular geographic regions. However, this particular MRSA clone, sequence type ST672, is mainly reported from the Indian subcontinent and very rare in Europe. This suggests that this clone could have been imported from the Indian subcontinent to France through international travel.”

This minor controversy is of little relevance now as we realise the gravity of the problem. A WHO report from 2014 contained an ominous, first paragraph in its foreword that said it all.

Antimicrobial resistance (AMR) within a wide range of infectious agents is a growing public health threat of broad concern to countries and multiple sectors. Increasingly, governments around the world are beginning to pay attention to a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.

The report also had this to say on the status of penicillin, probably the most commonly used drug:

Reduced susceptibility to penicillin was detected in S. pneumoniae in all WHO regions, and exceeded 50% in some reports. The extent of the problem and its impact on patients is not completely clear because of variation in how the reduced susceptibility or resistance to penicillin is reported, and limited comparability of laboratory standards. Because invasive pneumococcal disease (e.g. pneumonia and meningitis) is a common and serious disease in children and elderly people, better monitoring of this resistance is urgently needed.

It is particularly alarming to note antimicrobial resistance to antibiotics for diseases like tuberculosis, malaria and HIV-AIDS, which have been savaging India for the last decade. In fact, what is the status of India on antibiotic resistant superbugs such as MRSA?

A paper published by the Indian Network for Surveillance of Antimicrobial Resistance group in February 2013 gives some idea. It documents the results of a study in 15 Indian tertiary care centres by 17 researchers during a two-year period, from January 2008 to December 2009, to determine the prevalence of MRSA and susceptibility pattern of S. aureus isolates in India. The authors wrote:

The overall prevalence of methicillin resistance during the study period was 41 per cent. Isolation rates for MRSA from outpatients, ward inpatients and ICU were 28, 42 and 43 per cent, respectively in 2008 and 27, 49 and 47 per cent, respectively in 2009. The majority of S. aureus isolates was obtained from patients with skin and soft tissue infections followed by those suffering from blood stream infections and respiratory infections. Susceptibility to ciprofloxacin was low in both MSSA (53%) and MRSA (21%). MSSA isolates showed a higher susceptibility to gentamicin, co-trimoxazole, erythromycin and clindamycin as compared to MRSA isolates. No isolate was found resistant to vancomycin or linezolid.

The researchers also warned that the “study showed a high level of MRSA in our country. There is a need to study epidemiology of such infections. Robust antimicrobial stewardship and strengthened infection control measures are required to prevent spread and reduce emergence of resistance.”

The WHO also publishes a fortnightly newsletter on the implementation of the global action plan on antimicrobial resistance. According to the organisation,

Antimicrobial resistance threatens the very core of modern medicine and the sustainability of an effective, global public health response to the enduring threat from infectious diseases. Effective antimicrobial drugs are prerequisites for both preventive and curative measures, protecting patients from potentially fatal diseases and ensuring that complex procedures, such as surgery and chemotherapy, can be provided at low risk. Yet systematic misuse and overuse of these drugs in human medicine and food production have put every nation at risk. Few replacement products are in the pipeline. Without harmonized and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill.

Each stakeholder has an evolving role to play in preventing superbugs of the likes of MRSA from developing drug resistance. With this in mind, the US Centers for Disease Control and Prevention published a bookletThe WHO also updated its factsheet in September 2016.

K.S. Parthasarathy is a former Secretary of the Atomic Energy Regulatory Board.

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All about baking soda

For the past several days, I have abstained from reading any worthwhile article.I have voluntarily avoided using the internet.I was away in Kerala attending a wedding.I came back today to my favourite pastime. Yes,  I have an enormous amount of material to read.

One of the first items I noticed was a very informative  essay on baking soda. The very first paragraph itself was loaded with fascinating accounts of the use of baking soda:

” We here at Grist talk a lot about baking soda: how to clean our homes and laundryand hair and teeth and armpits with it, how to kill mold with it, and, naturally, how to cook up tasty treats with it.”

The article in grist.org  turned out to be a very useful resource on baking soda. It gave the following information among others:

  • People mine ninety percent of sodium carbonate using which baking soda or sodium bicarbonate is produced in USA from Wyoming’s Green River Basin.
  • According to the U.S. Geological Survey, Wyoming alone contains 56 billion tons of pure layered trona, plus 47 billion more tons mixed with other minerals. We’re only tapping trona at the rate of 15 million tons per year; the Wyoming Mining Association estimates that we have enough on hand to last more than 2,000 year

You may access the story  and enjoy the content at :

Where does baking soda come from, and is it really so eco-friendly?

 

 

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