Recently finished reading this brilliant, fascinating, (and at times) depressing book. Highly recommended. This book won the Pulitzer Prize in 2011.
#Cancer is a tough topic, across many dimensions. The author Oncologist Siddhartha Mukherjee presents a detailed journey of our understanding of this disease (or a collection of diseases), going back 4000 years. There is good amount of technical details about cancer, its diagnosis and treatment…but explained beautifully so that a non-medical professional can understand it quite well.
The first few chapters read like an interesting history novel. The concluding chapters delve into genetics and core understanding of what is going on internally, inside the cell, inside the DNA.
It is amazing how our understanding has changed and improved over the past few decades. But there is a long way to go. The sobering truth is that we still don’t understand many things in this area.
Fascinating story of how Lipitor almost didn’t make it; but eventually became world’s biggest blockbuster drug
Lipitor has been the biggest blockbuster drug till date with sales of over $120 Billion over the past 14 years. It recently came off patent.
I came across this great article by Linda A. Johnson in Associated Press – “Against odds, Lipitor became world’s top seller”, that chronicles the story of how this drug almost didn’t make it. It was not the first statin on the market. However, early trials showed results that were significantly better than the existing peers. The article also discusses the extensive use of marketing (targeted to the consumers and doctors). To quote a line from the article: “The Lipitor promotion team set new standards for a marketing campaign.”
One wonders if the pharma industry would ever again see such a massive success. Do read the full article, click here.
Having studied the Electronic Medical Records (EMRs) space for a few years now, it’s clear to me that EMR adoption is a huge challenge. Even in developed markets like the US, successful implementation rates are pretty low (especially in small clinics). In spite of a huge Federal Government Incentive Program, the progress is gradual (at best).
In India the picture is a lot worse. My assessment is that EMR adoption here is in low single digits.
There are many theories and observations about why doctors dislike Electronic Medical Records (EMRs). One often discussed observation is that doctors are ‘technophobes’. I personally don’t think that’s true. On the contrary many doctors, whether in US or in India are ‘gadget freaks’ (when it comes to devices like new smartphones, laptops, cameras, etc.).
The primary issue is that of software usability. Many traditional EMR systems are quite complicated and difficult to use. These systems at times resemble heavy duty ERPs (Enterprise Resource Planning IT Systems) that run the operations of large multi-million dollar corporations. A small clinic doesn’t need all this complexity. These EMRs may actually end up hurting the efficiency of a clinic, rather than improve it. Also many of these systems do not enable interactions with patients for chronic disease management, e-consultation, telemedicine, etc. Doctors are looking for simple systems that can improve their productivity, as well as support better patient care. In absence of these, they are perfectly ok going back to their old paper notes based methods.
I recently came across an excellent article in ‘The Journal of Surgical Radiology’ by Shahid Shah, “Column: Why MDs Dread EMRs”. The author has done a great job of summarizing the major reasons that are hurdles to effective adoption. I encourage the readers to go through this article for a detailed insight into the real issues.
Healthcare & Medicine are topics of interest for me, and I occasionally blog about these topics. Recently, my friend Dr. Bhooshan Shukla, who is a Child & Adolescent Psychiatrist here in Pune, started a new blog: http://docbhooshan.wordpress.com/ His first article is quite interesting: “What do you do for living?”. I am reproducing it here on my blog. You can also visit Dr. Bhooshan’s blog for his other upcoming articles.
by Dr. Bhooshan Shukla
It has become my favorite past time to watch peoples’ reactions to my answer to the question – “what do you do?” I am a Child and Adolescent Psychiatrist and most people react to this fact in an interesting way –
1.“ you mean kids go crazy and require a psychiatrist? That must happen in western countries with drugs and broken families and all that stuff! Do you actually finds work in India?”
2.“ we read about student suicides all the time. If parents behaved properly and nicely with their kids, professionals like you would not be needed at all”
3.“ oh, so you are the doctor looking after genetically deformed, retarded kids!”
There are many other reactions but these three are most representative. It just goes on to show that we as a society are still quite naive about concept of mental health and illness.
Adult psychiatry has just started emerging from the closet in India and depression/ anxiety/ phobias have become “okay” illnesses. Still more severe mental health issues like schizophrenia and addictions are struggling for the attention and acceptance they deserve. It is a long way, but at least we have started.
Child psychiatry is a funny thing. We see adverts selling foods and games that claim to make your child smarter, faster, etc. There are parenting discussions in media involving famous personalities, gurus, teachers,etc. So we are aware of importance of a good, healthy childhood and are willing to put our money where our child is….but are we really aware about mental health issues in childhood?
Some people ask me what kind of kids are my patients? Now that is a question that I can answer. More than 90% of my child patients are brought by their parents for just one of two complaints – poor academic performance and discipline/behavior problems.
There are hundreds of reasons why school performance or behavior deteriorates, but most important thing is that unless one of these parameters takes a hit, there is no acknowledgement of a problem that needs professional help.
Children are like the ozone layer around the earth or tigers in our jungles. Their happiness is a sensitive indicator of society’s attitude towards life ! Following is an easy to understand classification of why things go wrong with children –
1.Problems related to brain development and physical health – like attention and concentration problems, reading and writing difficulties ( dyslexia made famous by “Taare Zameen Par”), speech and language difficulties, etc.
2.Problems perceived due to misunderstanding of normal development – certain things appear in development of a child like bedwetting, restlessness, fear of staying alone or dark places, food fads, defiance, etc. If parents are unaware of this “ normal phase” they may try to find solution to a problem that is going to go away anyway.
3.Problems in relationships – Children’s relations with family members, schools, or even friends may sometime become strained and reflect in behavior or academics or emerge as discipline issues.
4.Problems with social expectations transmitted to child by parents and school system.
5.Problematic emotions like anger, sadness, fear, excess competitiveness, etc.
All of the above issues can be assessed and helped by mental health professionals with the help of family and if necessary, schools.
One more commonly asked question is how to identify a child needing help –
there are some clear indicators –
disturbance in usual sleep, eating, interaction pattern lasting for more than one to two weeks.
Sudden and severe change in emotions like – sadness, anger, fear.
Unpredictable and rapidly changing mood.
Return of habits of younger age like- clinging to parents, excessive fear, babytalk.
Sudden change or unstable pattern of friendships.
If you suspect anything, do check –
Most importantly – most problems can be solved with the help of family counseling, child counseling and some help from school ! Medications ( from any ‘-pathy’) are very rarely needed.
Dr. Bhooshan Shukla
MD, DNB, MRCPsych
Child and Adolescent Psychiatrist
Wondering what the top prescription drugs are in America/Globally? Cholesterol lowering drugs? Antibiotics? Blood Pressure Medications? Anti-Depressants? Pain-Killers?
The Forbes Magazine recently published an interesting article America’s Most Popular Drugs that lists the top 15 most prescribed drugs in America. While many from my expected list showed up, I thought that there were a few surprises (inclusions and omissions). For example, was surprised to not find a single anti-depressant in the top 15 list. Maybe because there are many different anti-depressants out there. I am sure that as a category, they will show up quite a high.
The top drug in the list is the pain-killer Vicodin. Cholesterol reducing drugs, blood pressure medications show up in a large number in the top 15 list. So do a few of common antibiotics.
In a sense, this list gives an indirect overview of the types of common ailments, as well as the state of the health of the population. I wonder what such a list would look like in India/other countries. I think, in India more antibiotics might show up in the top drugs list.