Eat less, stay healthy
by Dr K.C. Kanwar
Humans, since their inception, have been struggling hard to enhance their longevity. Death remains inescapable but efforts are afoot to delay the inevitable as much as possible. Researchers have already identified many factors and tried many approaches to increase longevity. Many drug houses all over the world are engaged in examining herbal, non-herbal or certain bizarre potions which could extend longevity. Even hazardous tinkering with hormones as well as the genetic code has not been spared to achieve the elusive objective.

Hope for the sick in mind
by Dr Rajeev Gupta
Schizophrenia is a complex mental disorder, having a wide range of symptomatology. Traditionally, schizophrenic patients, showing abnormal behaviour were considered mad by the general public. Unexplained laughing, self-talking, suspiciousness, bizarre behaviour, paranoid ideas, delusions, unprovoked violence, decline in sociability, abnormal emotional expressions and hallucinatory experiences constitute the predominant symptoms of the disease.

Cutting edge

Dying with dignity 
by James T. Cheatham, JD

It is becoming increasingly difficult to die peacefully today, whether in North Carolina or anywhere else in the United States. If you had the choice, you would probably wish to live a long, healthy, and happy life and, then, die suddenly in your sleep. For a few people, death does come quickly: they have a massive heart attack or stroke or an accident, and it is all over in a matter of minutes. But most of you will face a quite different end to your life. you may become ill and deteriorate over weeks or months or years, or a sudden catastrophe or catastrophic illness may occur. In either case, you may become unconscious or otherwise unable to make decisions. Unless you take certain steps before that happens, you will have no control over the medical decisions that are made for you during your final days.

As an alert, competent adult, you are able to exercise your right to make decisions concerning your own health care. You can decide to go ahead with certain treatments or operations, or you can decide that you would prefer not to undergo them. The trouble arises when you are no longer alert and competent and no longer able to make such decisions. Most of you will pass through that stage toward the end of your life, so you need to make your wishes known now about how you wish your health care managed at that time.

Medical technology has progressed so far in this country that it is often possible to keep people alive well beyond the point where their life has meaning or quality. Patients who cannot communicate their wishes regarding their medical care can be kept alive by heart-lung resuscitation, breathing machines, artificial feeding, and other methods. Many people see this as postponing death rather than sustaining life.

In earlier times, not only were there fewer heroic lifesaving technologies, but most patients had a personal family physician who knew their wishes concerning life-sustaining measures: who would be available and able to ensure a peaceful death with dignity. Today, a personal physician who knows your wishes is still the best safeguard against care you do not want. But many patients do not have a personal physician or, if they do, that physician may not be present when needed for these decisions. For these reasons, written expressions of your wishes have become very important.

Since 1977, North Carolina has had a Natural Death Statute, which just recently was amended to allow even the withholding of hydration and nutrition for terminally ill patients or those in a persistent, vegetative state. In addition to a well-defined Living Will Statute, we now have a Health Care Power of Attorney Statute. Both are in handouts provided free by the North Carolina Bar Association and both specifically protect the physician who acts in reliance on a living will or the instructions of a health care agent.

The North Carolina statutes clearly say, "The withholding or withdrawal of life sustaining procedures by or under the orders of a physician pursuant to the authorisation of a health care agent or under a Living Will or pursuant to the Statute shall not be considered suicide or the cause of death for any civil or criminal purpose nor shall it be considered unprofessional conduct or a lack of professional competence."

The United States Supreme Court has clearly said that individuals have the right to refuse medical care and the states have the right to set up the methods for this.

The laws of several states make it a crime for physicians to assist in suicide. The United States Supreme Court in the summer of 1997 refused to endorse 2 lower federal courts (New York and Washington) who had held a state may not deprive a terminally ill person of how and when one dies. The Supreme Court, in effect, held that it was up to the individual states to decide.

The question may be asked, "What if the attending physician prefers not to follow such directions?" Then my answer is (and this is also the opinion of others who have studied this) that he or she should leave the case or stand to be liable in damages for his or her refusal. Damages could include the cost of extended care, pain and suffering, etc.

Now almost all states have patient self-determination statutes and even the federal government, through the Omnibuis Budget Reconciliation Act of 1990, recognises and endorses living wills and even requires hospitals and other medical providers to inform patients as they are admitted that they have these self-determination options. Unfortunately, many, including their families, are not mentally capable of understanding their right to be left alone and to a death with dignity.

While we are discussing pain, modern medicine leaves no room for someone suffering under a terminal condition to continue to endure pain. Still we see physicians reluctant to prescribe sufficient amounts of narcotic drugs to alleviate this pain. Why are they hesitant? The answer, I believe, is either they do not know how to properly treat pain or they are afraid their narcotic prescription history will be questioned by the authorities who monitor them. Both excuses, I contend, are unconscionable. So a terminal patient becomes a drug addict. What difference does it make? They are not suffering. Isn't that what medicine is all about? Justice Brennan pointed out, in the Cruzan case:

As many as 10,000 patients are being maintained in a persistent vegetative state in the United States — this number is expected to increase significantly in the near future — 80% of Americans who die in hospitals are likely to meet their end in a sedated or comatose state betubed nasally, abdominally and intravenously and far more like manipulated objects than like moral subjects.

As our population gets older, more aggressive methods to assure death with dignity are demanded by the patients. Physicians need to be ready to meet this challenge.

Anyone who observed the events leading to Jackie Onassis' death has to know she had assistance in her death process. We saw pictures of her walking unsteadily in Central Park on a Sunday. On Monday, she went to the hospital where they confirmed her terminal condition and advised nothing else could be done. On Wednesday evening, she passed away. Now anyone who believes she did not have assistance in her death process, I believe, is naive. The fact of the matter is, she had a dignified death while the whole world watched and sympathised with her. Now why should not the rest of us, you, me, and our loved ones be able to choose such a final termination if we so wish?

A 1995 28-million-dollar research project evaluating how critically ill people are treated at teaching hospitals found that critically ill patients who have already asserted their rights to die are often ignored and left to suffer prolonged and painful deaths and that a lot of doctors do not utilise narcotic pain relief medicines as they could, some because of ignorance and some because they are afraid when their narcotic prescription history is checked they might be suspected of improper conduct.

Duke Hospital in Durham, North Carolina now has on staff 2 full-time nurses who offer end-of-life counselling and monitor terminally ill patients to assist doctors in carrying out the patients' wishes. The University of Birginia also is starting a Department of Health Evaluation Sciences to address these issues.

Other hospitals should follow Duke's example and set up a full-time nurses’ team to offer end-of-life counselling and monitor terminally ill patients' wishes.

James T. Chetham, who was invited by the famous US scientific journal "Current Surgery" to write this "Guest editorial", received a BS degree in 1957 in Business Administration and a JD in law in 1961, from the University of North Carolina at Chapel Hill. He is a practising attorney in Greenville, North Carolina, and US counsel with Poyner and Spruill Attorneys. He has a special interest in health law, having served as legal counsel for 15 years at Pitt County Memorial Hospital and having been the chairman of the Health Law Section of the North Carolina Bar Association.

Eat less, stay healthy
by Dr K.C. Kanwar

Humans, since their inception, have been struggling hard to enhance their longevity. Death remains inescapable but efforts are afoot to delay the inevitable as much as possible. Researchers have already identified many factors and tried many approaches to increase longevity. Many drug houses all over the world are engaged in examining herbal, non-herbal or certain bizarre potions which could extend longevity. Even hazardous tinkering with hormones as well as the genetic code has not been spared to achieve the elusive objective.

However, it is to be admitted that gerontologists have succeeded in enhancing marked longevity in lower animals. Merely by selective breeding, the life-span in Drosophila — the tiny fruitfly — has been doubled within a few generations. Laudable success in this area is also reported following experimentation on roundworms.

But can these gerontologic breakthroughs be transpolated to human beings? The protagonists are hopeful. The antagonists, however, say that "mammals are fundamentally different from fruitflies and roundworms". Nor, according to them, experimentation of the type done on fruitflies to unravel the secret of their ageing is possible on human beings.

The fruitflies breed fast, are easy to maintain on the prescribed dietary regimen and, lastly, can be studied over many generations within a span of a few months to conclusively arrive at longevity-related conclusions. On the other hand, the protagonists feel encouraged since some of the age-related experimental studies done on laboratory animals (mice, rats, dogs), despite some hiccups and side-effects, have already yielded results on the expected lines.

The few approaches which are considered 100% safe and amenable to increasing human longevity include a change in one's dietary habits and lifestyle. Eating properly and exercising regularly despite genetic constraints are considered potent to maximise the human life span. Food rich in fibre and proteins, low in fat, cholesterol and salt and the one optimal in minerals and vitamins is considered a healthy dietary potion. Lately, it has been substantiated that overeating even of healthy food predisposes one to premature ageing which, in turn, is an accepted impediment to longevity.

Dr Clive McCay of Cornell University was perhaps one of the earliest workers who linked balanced calorie — deficient diet, particularly during the early part of life, with improved longevity in rats and dogs. it is now well accepted in medical science that long-term health even in humans is profoundly influenced by what we eat and drink in infancy and childhood. further, it is experimentally proved that cutting back on caloric intake, minimal 30%, dramatically increased life expectancy in laboratory animals. The animals, which were fed balanced but calorifically slashed diets, turned out to be healthier and more fertile and lived longer than their controls fed ad libitum. Not only this. Such animals recorded delays in the onset of age-related diseases like cancer, CVDs, diabetes as well as the physiological deterioration of various organs and systems.

According to Dr Anna McCormik, Chief of NIAs Biology of Ageing Programme, "caloric restriction is the only manipulation we know so far that extends the life span for sure notwithstanding the underlying mechanism by which it works".

It was merely a conjecture that what is observed in laboratory animals is relevant "perhaps" to humans too! Lately, however, the above conjecture has been experimentally supported by studies done on monkeys — the close relatives of humans anthropologically. Reducing calories by 30% in these primates slowed the rate of their ageing, thus providing for the first time direct evidence to the effect, that primates (including humans) could live longer by eating less.

A study done at the National Institute of Health (USA) using 200 monkeys showed clearly that a well-balanced but calorie-deficient diet "caused the animals to have a lower body temperature, a slower metabolism and fewer changes in biochemical markers for ageing".

"This shows that what has been demonstrated in mice also can apply in primates", said Dr George Roth of National Institute of Ageing. Roth is the co-author of the study published in the Proceedings of National Academy of Sciences (USA). The above views have since been confirmed independently by Dr Joseph Kemnitz — a researcher at the University of Wisconsin, Madison (USA). The findings to date from several laboratories do suggest the intervention (diet-restriction) has beneficial effects on health and on reducing age-related diseases, and may ultimately extend the life span of primates", said Kemnitz.

Dr Barbara Hamsen of the Obesity and Diabetes Research Centre at the University of Maryland in Baltimore also reconfirmed the effects of dietary restrictions on the life span of Rhesus monkeys studied for 15 years. She added that restricting calories also reduced the rate of cancer, heart diseases and diabetes in the test animals. Whether the maximum life span is also extended along with it is "yet to be known precisely because the studies are continuing and the complete test of the hypothesis would require studying monkeys for a few generations — a full monkey life time approximates three decades or even longer". And if such studies are to be attempted on humans, one would require two centuries to study three human generations to arrive at conclusions which are available within a few months in fruitflies and in a few decades from higher primates. Moreover, from amongst the humans, who would volunteer for such studies involving strict dietary control and partial fasting throughout life?

Simple food, certainly not expensive and fancy superfoods, if judiciously chosen, can make a diet balanced. Make sure you choose a diet rich in fibre proteins, vitamins and minerals and the one which is low in fat, cholesterol and salt. Have a generous amount of green vegetables and fresh fruits in your daily menu.

To slash a 30% allowable calories intake, cut down heavily on sugary items. The greater the variety in diet, the greater is the likelihood of striking a good balance. Eat just enough to satisfy your appetite. Overloading is contraindicated. Never eat when you are not hungry and stop eating before you are full. No affluence is needed to adhere to this dietary regimen. And does exercise cost too much?

Prof K.C. Kanwar is a renowned biophysicist. He has taught at Panjab University for long years.

Hope for the sick in mind
by Dr Rajeev Gupta

Schizophrenia is a complex mental disorder, having a wide range of symptomatology. Traditionally, schizophrenic patients, showing abnormal behaviour were considered mad by the general public. Unexplained laughing, self-talking, suspiciousness, bizarre behaviour, paranoid ideas, delusions, unprovoked violence, decline in sociability, abnormal emotional expressions and hallucinatory experiences constitute the predominant symptoms of the disease.

Patients of this illness show varying degrees of results during and after the treatment. About one-third of the patients are lucky enough to respond well to the prescribed treatment and do not suffer from subsequent episodes.

Unfortunately, another one-third tend to become chronic cases and do not respond to medical and non-medical treatment. The remaining one third keep on getting recurrent episodes of the disease and show a down-hill course as the time passes.

Some of the common drugs prescribed to these patients are: haloperidol (Serenace), chlorpromazine (Largactil), thioridazine (thioril), and fluphenazine deconate (Anatensol). Resperidone (Risdone) and clozapine (Sizopin), which relatively are new entrants, also help a number of patients, enabling them to have a better quality of life.

These drugs help many patients to come out of their negative symptoms like a marked lack of interest in daily activities, poor emotions and reduced will power. Regular blood counts are mandatory with clozapine, which adds to the cost of the treatment and becomes inconvenient to the patient and his family.

In spite of the fact that more than a dozen anti-psychotic molecules have come in the market, the disease continues to elude the psychiatric community.

Recently, a new antipsychotic drug, olanzapine (Olanex or Olanz), has been introduced in the Indian Market. It has been available in the West for quite some time. There, its cost has been very high. However, for our patients, the cost of the drug marketed here is quite low. It can be easily afforded by most of our patients.

The drug has a proven role in the management of negative symptoms. With olanzapine there is no need to have the monitoring of blood counts.

One thing is quite clear. For mental health professionals, schizophrenic patients and their families, the challenge of the disease continues unabated and concerted efforts are needed to find out specific drugs which are more effective and have fewer side-effects.

The author is a Ludhiana-based psychiatrist. He edits Meditrack. He maintains a website for the needy: www.meditrackindia.com.

Cutting edge

Optimists live much longer
Optimists live longer than their gloomier fellow humans, according to a study from the Mayo Clinic in Rochester in the United States of America.

The results of the study indicate that pessimists have a considerably lower life expectancy and a tendency to depression. They are also more prone to illness.

Salty food is bad for eyesight
Salty food encourages cataracts. This is the conclusion of a study carried out by Australian scientists at the University of Sydney.

By examining 3,000 adults, the researchers were able to observe that a diet high in salt encouraged an unusual clouding of the lens in the eye.

The findings appeared in the German Journal Aerztliche Praxis (medical practice), published in Grafelfing, near Munich.

The journal described how 160 participants suffered from a special form of cataract.

By means of a nutritional questionnaire, the team found that those who most frequently added salt to their food suffered from cloudy lenses twice as often as those who consumed less salt.

Prostate cancer cure by herbs
When patients started coming to Dr William Oh with tales of an "ancient Chinese remedy" that helped their prostate cancer, he was sceptical.

After all, he had seen patients who took aged garlic, shark cartilage, selenium and other unproven supplements on their own as well as more accepted home remedies such as vitamin E.

"Ninety-nine per cent of this stuff is not going to work", Dr Oh said in an interview.

But when their lab tests showed their prostate specific antigen (PSA) levels were falling — a sign that their cancer was being controlled somewhat — he sat up and listened.

Dr Oh, a researcher at Boston's Dana-Farber Cancer Institute, was already doing clinical trials of vaccines and drug therapies for prostate cancer. So he enrolled some of the men taking the supplement sold under the name PC-SPES, in a trial funded by the non-profit organisation Capcure.

He presented his findings over the weekend to a meeting in New Orleans of the American Society of Clinical Oncology, a meeting of 22,000 cancer specialists from around the world.

The capsule they were taking is called PC-Spec (PC for prostate cancer, and Spes from the Latin word for hope). Patented by Botanic Lab, a privately held company in Brea, California, it is based on a Chinese formula.

It contains saw Almetto, sold over the counter to relieve some of the prostate symptoms suffered by men as they age such as the need to urinate more frequently, as well as licorice, which the company says helps breathing and digestion.