Wednesday, November 18, 1998

Holistic medicine: new horizons
By Vrunda Dhawane and P. R. Sakharkar
WHEN science is in ultimate progress, the question should be raised as which science we are talking about. Modern science or traditional science? Medical science today is emerging out of the western windows and its approach is reductionism, physical and individual based.

Night owls and meadow larks
SCHWALMSTADT, (GERMANY): When the alarm clock mercilessly rings away in the early morning hours, a common reaction by people is to shut the nuisance off and crawl back even more deeply beneath the covers.

Potato and diabetes
A genetically engineered potato could offer an edible vaccine against childhood diabetes, Reuter quoting U.S. researchers said.

Thyroid: boon & bane
By J. D. Wig

THYROID disease is common in Indian populations and of those affected, a significant proportion is made up of women. Goitre was observed by the Romans. The term thyroid (Latin — shield-shaped) is attributed to Bartholameus Eustacious of Rome.

The thyroid is made up of two symmetrical lobes, one on each side of the wind pipe. The thyroid gland makes thyroxine which is an important hormone. If too little thyroxine is present, growth and development are retarded in children.

Adults become slow, depressed, fat and constipated.

When too much of thyroxine is secreted, patients become overactive and thin. They have increased appetite, sweating, palpitation and tremor. Elderly patients may develop heart problems and palpitation.

Abnormalities of the thyroid function have important effects on the mother and the foetus. Hypothyroidism (underfunction) in pregnancy is associated with an increased incidence of stillbirths and neonatal deaths, and congenital malformations. Hyperfunctioning (overfunctioning) during pregnancy is associated with increased foetal loss and babies are born small for their gestational age.

The prompt recognition of the thyroid abnormality and a precise diagnosis are important. The enlargement or malfunctioning of the gland can be diagnosed by a clinical examination, blood tests and fine-needle biopsy (to study the cells in the thyroid swelling).

A few patients develop large thyroid glands and there is pressure on the oesophagus (swallowing tube) leading to some difficulty in swallowing, or the windpipe with the feeling that breathing is being restricted.

Laryngoscopy (looking into the mouth to see the voice box and vocal cords) must be done before the operation to detect pre-existing voice problems of which the patient may be unaware.

The operation of the thyroid has always attracted the surgeons’ interest. The surgical treatment is carried out through a curved incision in the lower central portion of the neck which is designed to fit with the skin creases. Careful dissection is done to preserve the laryngeal nerves (which affect the vocal cords) and the parathyroid glands (concerned with the control of calcium in the blood and tissues).

At the end of the operation, the incision is closed (with suture, clips) and a small tube is left for a day or so to drain any fluid or blood.

The drain and sutures are usually removed by the second or third post-operative day. Some swelling under the scar is common for a few weeks after the operation. However, this settles down over time to leave a fine scar.

Immediately after the operation, the patient may experience sore throat, some difficulty in swallowing, discomfort in the back of the neck and local swelling. These symptoms are short-lived and disappear spontaneously. Sometimes, there is derangement of the voice after the operation (due to the irritation caused by the anaesthetic tube) and is usually temporary.

At times because of surgical dissection, one of the delicate laryngeal nerves will not work causing hoarseness and weakness of the voice which will almost recover within two or three months. In operations carried out for cancer, damage to the nerves may be permanent.

When most of the thyroid gland has been removed, a reduction in blood calcium may follow because of the associated parathyroid upsetting.

In most patients this is temporary. If blood calcium falls to very low levels, the patient may develop a tingling sensation around the mouth, in fingers and toes, with muscle spasms. This is relieved by treatment with calcium. Calcium levels return to normal within a few months.

Following surgery, sometimes thyroid replacement therapy (hormones) is recommended. This protects the patients from the underfunctioning of the remaining gland and the occurrence of swellings in the residual thyroid tissue. Following cancer surgery, hormones need to be taken throughout life.

The patients following thyroid surgery should be followed up at least once a year to have their function checked to see that the gland is not under-active. Patients with cancer need to be followed up more frequently for the detection of recurrent disease.

Patients should expect to enjoy good health following a thyroid operation.

Dr J.D. Wig, MS, FRCS, is Additional Professor of Surgery at the PGI, Chandigarh.

Holistic medicine: new horizons
By Vrunda Dhawane and P. R. Sakharkar

WHEN science is in ultimate progress, the question should be raised as which science we are talking about. Modern science or traditional science? Medical science today is emerging out of the western windows and its approach is reductionist, physical and individual based.

Science which believes that man is the ultimate brain, for whom nature and universe are waiting to be conquered, will naturally develop technologies and application of science with the same perceptions. We know of many conquests which won and wiped away treasures, temples and culture. The people involved in conquering are also suffering irreparable losses. Such arrogance needs to be tamed and suggests the need for humility and compassion. Billions of dollars spent on defence research policies globally can be spent to fight hunger and diseases.

When knowledge is monopolised as intellectual property, like the traditional knowledge, and the knowledge of healing properties is getting monopolised for the benefit of corporation at the cost of citizens, it becomes a matter of grave concern. The health care services are still poor and many PHCs do not have enough medicine. What are these people expected to do? Just die quietly with malnutrition, diarrhoea, malaria, TB, Kalaazar? Are these poor patients suffering at the cost of medical advances?

Today, ethical and legal issues like surrogate motherhood, ownership of sperm, ova and embryo are raised as body parts and put up for sale. John More, a patient of spleen tumour, discovered that the cell line of his spleen had been patented by his doctor in connivance with a pharmaceutical company without his knowledge. When he challenged it in the court, the court supported the industry rather than him.

This incidence raised the issue of genes ownership. Hence it becomes necessary that the pain and confusion the human spirit experiences, the ethical and moral value of individuals, the concept of spiritualism should be extensively studied and understood.

Holistic or spiritual medicine believes in the existence of the soul in the individual’s body which unites the body and the mind. Mental perversions affect the physical functions and the morbidity of the body affects the mental activities. Intellectual blasphemy, unwhole-some conjunction of sense organs with their objects and vagaries of weather and time are causative factors of diseases.

Forcible stimulation of natural strength, negligence in treatment, loss of good conduct, avoidance of health activities, malice, fear, anger etc are some of the examples of intellectual blasphemy. Unwholesome conjunction includes vision, sound, smell, taste and touch.

Holistic medicine is a science, art and philosophy which provides a spiritual approach to health care. It is a science, as the principles are enumerated in a systematic and local framework based on the understanding of the body and its relationship with the environment. It is an art because it uses diagnostic techniques based on the creativity, insight, subtlety and compassion of the medical practitioner. And it is a philosophy as it embraces the key principles of altruism, karma and ethics.

Learning about patients’ beliefs simply provides a complete picture, said Dr Dale Methews, a professor at George Town Medical School in Washington. A survey of 268 doctors at an American Academy of Family Physicians’ meeting in 1996 found that 91 per cent had patients who asked a priest, a rabbi, a minister or a faith-healer to help with their illness.

In the 1950s, doctors were discouraged from discussing religion or sex with their patients, but now doctors can talk about everything except religion. The time has come that we must redefine out medical framework. Holistic medicine does not force religion on a doctor or patients.

The National Institute For Health Care Research and the John Templeton Foundation have recently announced a 25,000-dollar grant to eight medical schools in the USA to offer students classes on the role of spirituality and religion in health care. The money will fund courses on religious beliefs, the role of faith among the terminally ill and more, as well as to teach potential doctors how to include a "spiritual history" in their diagnosis.

More House School of Medicine in Atlanta will pair students with terminally ill patients from the day they are diagnosed to the day they die. They will see the whole dying process as to what the patient goes through, how the patient uses religion as "relief." In simple terms, they will see how the patient copes with the whole process.

Acceptance of anything in the name of science, development and modernisation should not be swallowed without assessing the price paid, whether it is the ecological cost or the ethical cost. Effort should be made to find out as to who paid the heaviest price. The price paid could wipe out the possible alternatives, creation of unsustainability and dependence, social instability and ecological degradation, further marginalisation of the poor and the socially disadvantaged.

Holistic medicine has been seen as science based on a totally different paradigm, which looks at the cause of illness as the creation of the imbalance of the mind, body and spirit of self.

A balance between these is considered as essential for good health, for it looks not only at the balance within self, but also with the environment and the creator. The spiritual basis of holistic medicine is probably the single most crucial difference which differentiate the understanding, approach and the basis of the two scientific realities.

The authors are well known medical scientists. The source of the information is IJCP Medinews.

Night owls and meadow larks

SCHWALMSTADT, (GERMANY): When the alarm clock mercilessly rings away in the early morning hours, a common reaction by people is to shut the nuisance off and crawl back even more deeply beneath the covers.

But then, 10 minutes before they are to be at work, they jump panic-stricken out of bed, gulp down a cup of coffee and race, still half-asleep, to their offices.

Then there are those people who know that they have a hard time waking up in the morning, so they usually get up two hours too early in order to slowly get accustomed to the new day. In a daze, they leaf through the morning paper without registering what they are reading.

Insomniac night owls, on the other hand, do not even set an alarm clock. They insist on their "right to sleep as long as possible" — at least so that say in a therapy group in the town of Dreieich. The group is called "Delta T Club for Time Normalcy".

Some 15 per cent of all Germans can be classified as slow starters, ranging from "the lightly to extremely affected", according to a leading medical researcher in Schwalmstadt, Juergen Zulley. He heads the working group chronobiology of the German Society for Sleep Research and Sleep Medicine (DGSM).

The internal clock of the "night owls", as he calls late-night types, ticks differently than that of most people. This is a question of lifestyle, but also possibly of genetic heritage, Mr Zulley says, listing several types.

For example, it can only be determined during the first few hours at work whether a person who only gets out of bed shortly before heading for work is genuinely a slow starter, or whether he or she might have circulatory problems, or simply doesn’t want to work. If that person relatively quickly gets his engines running, he or she is not genuinely a night owl.

But for a small group of slow starters in the morning, the tiredness afflicting them in the dawn hours is a serious problem.

"They cannot go to sleep before 2 a.m. and are absolutely not capable of getting themselves going before 11 a.m.," says Zulley, who works as a sleep researcher in the psychiatric ward of the Regensburg University Clinic.

"Relatives tell us now they have had to pour cold water on them between 11 a.m. and noon in order to wake them up", he adds.

About 500,000 people in Germany suffer under this serious syndrome of what is called a delayed sleep phase. The one hope for them is in getting older.

"With age, we all turn into meadow larks," says Mr Zulley, who himself is an early riser.

But many patients cannot wait so long and so, due to their problems at to work or with their partners, they turn to doctors for help.

The magic word is called "chronotherapy". Using various methods, the internal clock of those affected is changed — starting with "chronohygienic measures" such as moving up mealtimes and undergoing more vigorous physical exertion in the evening.

In sleep research laboratories such as in Regensburg, the "extreme" types — insomniacs by night, sound sleepers in the morning — are treated with light therapy — an extremely bright light from specially-built lamps shining on these people early in the morning.

In addition, medications can be applied, such as Vitamin B 12, or as a temporary measure, sleeping tablets.

But not all night-time people want treatment.

"Medications and light therapy? You feel like a guinea pig," said Juergen Woog, an independent designer and initiator of the Delta T Self-help Group in 1993.

Delta T’s approach is to try to clear up prejudices against those people who are slow to get started in the morning.

Employers should show more understanding for them and where possible assign them work shifts later in the day or at night. Woog says. Children who also sleep longer should not be thought of as lazy, he argues.

"I have tried everything, but I simply cannot, over a longer period, manage to get myself awake earlier in the morning," said Woog.

Getting up early on a regular basis only weakens his immune system, making him more susceptible to colds, he said.

Woog reports that most of the around 100 members of Delta T are academics. He got the idea for the self-help group after one of his customers repeatedly demanded appointments at 8 a.m., getting on his nerves with such truisms like "the early bird gets the worm".

"This made me so irritated that I told him: I get up later and eat the birds’" Woog said. (DPA)

Potato and diabetes

A genetically engineered potato could offer an edible vaccine against childhood diabetes, Reuter quoting U.S. researchers said.

And, they said, they use the deadly cholera toxin to make their vaccine work even better.

William Langridge from the Loma Linda University in California and colleagues have been working on various potato-based vaccines. They have genetically engineered potatoes that produce proteins from other species — first from the cholera toxin and now from human beings.

By engineering a potato to produce human insulin, they have used it to make a vaccine against type-I diabetes.

Type-1 diabetes is often inherited and strikes in childhood. It is an autoimmune disease, one in which the body immune system mistakenly turns on itself.

In this case, the immune cells destroy the islet cells in the pancreas that produce insulin. Victims must take insulin for the rest of their lives and often suffer serious nerve damage because of their disease.

"What we are doing is protecting against this sensitisation against cell," Langridge said, adding it helps the immune system tolerate the insulin producing cells.

To get the potato-produced insulin into the gut where it could be used, they attached it to the cholera toxin — whose deadly effects are due in part to its ability to go straight to the gut and cause severe diarrhoea.

They used a piece of the cholera toxin that transports the microbe but does not affect the body.

Mice bred to be diabetic who were fed the potatoes were much slower in developing diabetes and showed less of the inflammation of the pancreatic islet cells that precedes the disease.

What the vaccine effectively did, Langridge said, was help a faulty immune system recognise and tolerate insulin. This means immune cells would stop attacking the insulin-producing cells. Langridge has produced a cholera vaccine that works in mice and also survives cooking. "We did not cook these potatoes", he said.

"But I would guess that we could probably cook them." He said it was impossible to determine how much of the potato a person would have to eat. His work is a long way off from human trials.

He said potatoes cannot produce enough insulin to make them a useful source of the insulin used to treat both types of diabetes.

Most people have type-2 diabetes, which can be treated with drugs, diet, exercise and, in severe cases, insulin. It is caused when the body ceases to respond to insulin, which is still produced by the pancreas.