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A session
mocked Mulayam’s
googly |
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Be
realistic
India’s
role in Sri Lanka
Waste-age
Mixing
up medicines can be fatal
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Mulayam’s googly
Samajwadi
Party supremo Mulayam Singh Yadav knows how to get the maximum mileage out of any situation and his recent comment hinting that the days of one-party rule are over and the future belongs to coalition governments, has got him reams of newsprint as well as much time on various television shows. Coming as it does in the wake of the controversy after Congress minister Beni Prasad Verma’s comments against Yadav, which had escalated into a standoff that was only sorted out after the Congress had to eat the humble pie. It also gave Yadav a good measure of how vulnerable the top Congress leadership is following the DMK pullout. The rise of regional parties has long been an accepted shibboleth, but there is not much doubt that the current state of flux in Indian politics does not bode well for the nation. The junior partners have much more clout than their numbers warrant, and naturally, they are making the most of their current strength. The Samajwadi Party leader’s 22 Lok Sabha MPs provide crucial outside support to the Congress-led UPA. He has also been exploring the option of a third front for a national alternative, but has not found much traction. However, he has the ability to rock the UPA boat, and he knows better than many the fine art of extracting the maximum benefit from any political situation. He is quite capable of using the resultant flux to his advantage. The UPA is feeling the heat of the loss of support from the DMK. While it has been able to cobble together support for the government from other parties, it has left itself open to being exploited by those on whose support it depends. Leaders of small parties are having a field day, and this is certainly making it difficult for the Congress to stick to its agenda, especially its economic goals. Even as it tries to understand the enigmatic political player in Mulayam Singh, it must realise how difficult the days ahead are going to be.
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Be realistic
The
divide between India and Bharat seems to be getting even more pronounced. Some government decisions aimed at appeasing Bharat will eventually affect both India and Bharat. The recent decision of the government to drop the compulsory 100 marks English précis and composition paper for the Civil Services Exam conducted by the UPSC will promote an impractical approach to the functioning of our administrative system. Then the personnel who are supposed to plug administrative leakages in future are introduced to a bad example in logistics. According to the new rules, even less than 25 candidates for a particular regional language will be allowed to opt to write their answers in the language of their choice. How much will this cost in arranging examiners, paper setters, etc, is anybody’s guess. By doing away with English, does the government wish to say that the administrative machinery in India can function without even the basic knowledge of English? On the one hand, the government invites foreign industry to invest in India, creates SEZs and promotes projects in public-private partnership, on the other hand it expects the bureaucratic machinery to carry out all the work in a regional language, which would include dealing with tonnes of legal paper work with foreign agencies and companies. Whereas the entire world is aspiring to adapt to English, thanks to growing globalisation of trade, businesses, education, tourism and what not, India, which has the advantage of a strong base in English, as a second language, is moving in a reverse direction for the sake of populism. To move up the development curve, China is promoting English at all levels — thousands of English clubs function in the afternoons to help people hone their skills in the English language. The forums where regional languages should be enriched and promoted are ignored by the government. By allowing the Civil Services candidates to use a regional language they have not even graduated in, the government is doing a disservice to both English and regional languages. By disrespecting English, regional languages will not evolve.
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We must let go of the life we have planned, so as to accept the one that is waiting for us. — Joseph Campbell
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India’s role in Sri Lanka With
a population of barely 20 million, people in Sri Lanka have, in recent years, shed earlier prejudices and fears about India. Roughly one-thirds of its Tamil population of 3 million constitutes the descendants of Indian workers who sought employment there during colonial rule. They live in the central and southern regions and have elected leaders who have a working relationship with the Sinhala majority. Facing discrimination in the years following independence, Tamils, who have inhabited the island’s northeast for centuries, resorted to an armed struggle, in which India rather unwisely associated with armed Tamil groups in the 1980s. Nevertheless, the 1987 India-Sri Lanka Accord provided substantive autonomy to the Tamil-dominated north. This agreement’s provisions were enacted as the 13th Amendment to the Sri Lanka Constitution. India thus has a historical role and responsibility in facilitating the devolution of powers to the Tamil-majority northern province. After the ethnic conflict became an armed insurrection in the 1980s, sentiments in Tamil Nadu were inflamed and assumed partisan political dimensions between the two major parties, the AIADMK and the DMK. While the AIADMK under MG Ramachandran initially backed the LTTE, the DMK led by Mr Karunanidhi, who is today the only leader in independent India to be elected as Chief Minister on five occasions, chose to back the rival TELO. Mr Karunanidhi strongly condemned Prabhakaran for assassinating TELO leader Sri Sabarathinam in 1985. While he later proclaimed that Prabhakaran was not a terrorist, he asserted in October 2012 that India cannot forgive the LTTE for the assassination of Rajiv Gandhi. This statement came after the culmination of the bloody civil war in 2010, when Prabhakaran was killed. While both the DMK and AIADMK governments have performed far better in economic and social development in Tamil Nadu than most other state governments in India, Mr Karunanidhi has opted for dynastic succession, handing over the reins of power to his third son Stalin. This proposed change has come at a time when DMK functionaries and even members of Mr Karunanidhi’s family are facing investigations and charges of corruption in the 2G spectrum scandal. In the meantime, Chief Minister Jayalalithaa moved swiftly to up the ante on the horrendous deaths in the last days of the Sri Lankan ethnic conflict. Impartial international observers, however, acknowledge that while there were excesses by the Sri Lankan armed forces, the LTTE could not be exempt from blame because of its use of civilians as human shields --- a tactic it regularly used against the IPKF in 1987-1988. The DMK, with its disciplined party cadres responded by organising mass agitations and whipping up public passions, demanding that India should take the lead in getting Colombo condemned for “genocide”. Given the present domestic environment, New Delhi is having a difficult time navigating its way to get Colombo to ease up on the heaviness of its military presence and organise free and fair elections in the Tamil-dominated north. This process should lead to the establishment of a significantly empowered provincial government to address the day-to-day needs and aspirations of the Tamil people. With the Congress party lacking leaders with a mass base in Tamil Nadu, New Delhi appears to lack the potential to directly explain to people there why reason has to prevail over emotions in the conduct of foreign policy. A number of basic issues were never understood in the debate in Tamil Nadu. It was never realised that however hard New Delhi tried in the UNHRC, it was inconceivable that any resolution moved by India describing Sri Lankan actions as “genocide”’ would have picked up even five votes in the 47-member UNHCR. South Korea was the only Asian country, apart from India, to support the Washington-backed UNHCR resolution. Even Japan abstained. The US alone was capable of getting its nuanced resolution passed and that too with only 25 out of 47 members voting in its favour. Washington was in no mood to accommodate even minor Indian amendments. Carried away by the overblown propaganda of Sri Lankan Tamil expatriates from countries like the US, Canada and the UK and determined to leave no stone unturned to use outrage in Tamil Nadu for political advantage in the forthcoming general elections, the main political players in the state are advocating a course of action, which will leave India with no leverage to influence events in Sri Lanka through a combination of persuasion and subtle diplomatic pressure. The presumption of those wanting to get Sri Lanka condemned appears to be that a small neighbour will just crumble before the power of big neighbouring India. They fail to understand the complexities of the present world and the limitations of power, even of the high and the mighty. The mighty United States now finds that use of power or coercion is challenged by countries in its neighbourhood, ranging from Cuba and Venezuela to Brazil and Argentina. China cannot restrain Vietnam from balancing its power through links with the US, Japan and India. Russia cannot raise a finger against former Soviet Republics in its neighbourhood asserting their independence. Those in Tamil Nadu demanding an Indian economic boycott of Sri Lanka and withdrawal from power and infrastructure projects there, mistakenly believing that Sri Lanka cannot manage without us, forget that there will be Chinese, Japanese, South Korean and ASEAN bidders ready to joyously replace us. Moreover, if Sri Lankans start doubting our intentions because of shrill calls for “Eelam” from Tamil Nadu, they will only further strengthen their already well-equipped and battle-hardened armed forces with Chinese equipment to counter external meddling. We are already isolated in Asia because rhetoric is prevailing over reason on how to handle developments in Sri Lanka. There is no alternative to imaginative diplomacy to persuade the Sri Lankan government to move along the path of reconciliation. There are two important tasks New Delhi has to concentrate on. Firstly, efforts for reconstruction and rehabilitation in the Northern Province need to be intensified. Secondly, the Sri Lankan government and the recalcitrant Tamil National Alliance in Sri Lanka have to be persuaded to sit together and agree on measures to implement the 13th Amendment of the Sri Lankan Constitution to effectively empower the government and the provincial legislature in the North after elections in September 2013. Sri Lanka, in turn, would be well advised to thin out the intrusive presence of its military and end military interference in civilian matters, in its embattled north. All this is feasible only if Sri Lankans regard India as a well-meaning and friendly
neighbour.
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Waste-age First
the disclaimer: I am a ‘buffee’ (don’t google — I invented this word). I love buffets and their spread. Yet every time I dig into a buffet, I waste food. Well my guess and observation confirms that I am not the only one but, perhaps, part of a clan large enough to buy out Apple & Microsoft put together. Google ‘Food Shortage’ and reality would hit you: Around one billion hungry people right now — that is like 82 per cent of our population. Experts warn of dire consequences unless “there is a seismic shift in food production, distribution and consumption systems”. Well, most of us neither produce food nor distribute food. But, yes, all of us do consume it, which brings me to the thought of how each one of us can save this extremely essential commodity. Remember the time you’d get a spanking from mom for wasting food in your plate — “Finish or you cannot leave the table....” We’ve all been brought up with this simple sermon and honestly most of us do follow it at home. This brings me to my next question: Why do we waste food in a buffet? Is it just the temptation of a large spread, or over- estimating our palate or simply the urge to try new things? As a hospitality guy, I can confirm our worst nightmare serving a buffet spread — the buffet just cannot go dry. Look around at the buffet spread at the end of the party and you would be surprised at the amount of food left – lying there (apologies — sitting there, after all, we need to respect food. It’s going to be a scarce commodity by 2050.) A lot of my pals ask me as to what exactly do we as caterers do with the food left? Do we throw it, give it to the staff or just refrigerate it for our next hosting? Well, that’s an industry secret. But, yes, food is definitely wasted. So, what’s the solution? Should caterers prepare less quantities / less dishes, or do we as guests (self included) order and eat more responsibly? Honestly, I don’t know. But I do realise that my mom’s spank worked accurately at home. Yet as a self-confessed food waster, I regret my action every time I pick up a buffet plate. As I dig into another buffet and comprehend, I make a resolution (yes, we can have one in the middle of the year): Next time I pick up a buffet plate or order for a spread, I’ll be a responsible ‘buffee’. How about
you?
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Mixing up medicines can be fatal
TO remain healthy is the desire of every living human being. This is especially true of today when we have to face stress of all types each day and at every moment in the life. It is observed that with increasing age, each one would have a disease or two or even more for which many patients would visit doctors for their respective treatment and medications. Some may prefer allopathic system of medicines, while a few may approach other systems of medicine. And some patients may indulge in self medication even. However, when the patient suffers on account of some chronic ailments he visits a doctor. But he may also start on some other medicines on his own for quick cure and recovery from the ongoing diseases. Problem starts when some patients take allopathic medicines concomitantly with herbal supplements on their own without disclosing it to their doctors leading to serious consequences. As per journal Nature, every third American is taking complementary medicine assuming that anything natural is always safe and is without any adverse effects. Concurrent use of herbs may mimic, magnify or oppose the effect of allopathic drugs, and may show pharmacokinetic (what the body does to the drug) and pharmacodynamic (what the drug does to the body) interactions. However, the picture in India is equally grim. Poly-pharmacy Complementary medicines are frequently used in the context of poly-pharmacy. In a study of 3,070 elderly people it was found that 74.2 per cent took at least one prescription drug and one complementary medicine, with 32.5 per cent of them using three or more prescription medicines with three or more complementary medicines. This translates to an increased risk of drug interactions. In a study of 458 US Veterans’ Administration patients, 197 of them reported taking complementary medicines combined with prescription medicines. Of these patients, 45 per cent had potential for interactions, which was rated as serious in 6 per cent of patients. In another study which interviewed 3,000 people (aged 57-85) about prescription, over-the-counter and complementary medicine use, 4 per cent of them were potentially at risk of a major drug-drug interaction. It has been suggested that once a patient is on eight or more medicines, regardless of origin, there is a 100 per cent chance of a drug interaction occurring. Obesity, to gain generalised vigour, loss of libido and patients suffering from chronic diseases (e.g. diabetes, cancer, rheumatoid arthritis etc.) either switch over to other system of medicines and/or use concomitantly the drugs from alternative school of medicine/ herbs leading to serious drug interactions and consequences. Herb-drug interactions Warfarin, aspirin, insulin, ticlopidine has the greatest number of reported drug interactions with herbal and dietary supplements as was found in the systemic review of 85 studies. In one of the studies, 42 per cent of drug interactions were caused by the herbal and dietary supplement altering the pharmacokinetics of the prescribed drugs out of which 26 per cent were described as major drug interactions. One of the most common and prevalent household remedies used for cough is mulathi (liquorice). Its long-term use may lead to headache, fatigue, hypertension and loss of potassium. Drugs like captopril or alike are recommended in hypertension also induce intractable cough. If we use mulathi along with this drug, anti-hypertensive control with captopril will go bizarre leading to failure of therapy. Glycyrrhizin, the active ingredient in mulathi (liquorice), stimulates the release of aldosterone, which may further lead to retention of sodium, loss of potassium and fluid retention, thereby increasing the blood volume, which may cause rise in blood pressure, and failure of allopathic drug therapy. Patients suffering on account of rheumatoid arthritis are normally recommended to take allopathic drugs. To start with pain killers are recommended, which lead to irritation to gastro-Intestinal tract (GIT), and even acidity and bleeding can occur. If the same patient, who is on these drugs, also starts taking castor plant extract from an ayurvedic physician it can cause GIT-related side-effects leading to synergistic adverse effects on GIT (food tract). Many herbalists prescribe guar-gum for obesity, but this herb can interfere with the absorption of metformin and glibenclamide (oral hypoglycaemic drugs) used to treat diabetes leading to failure of diabetic control with serious consequences. These days every alternate patient is taking garlic. Blood thinners e.g. aspirin or anti-coagulant warfarin can interact with garlic, because both will lead to synergistic anti-platelet aggregating activities leading to increase in bleeding tendencies, in such individuals. Guggal is often recommended by ayurvedic physicians for arthritis and hyper-cholesterolemia. Now even some allopathic doctors are also prescribing it. The active ingredient in guggal is bosevilic acid, which is acidic in nature. Therefore, patients on guggal should avoid pain killers i.e. NSAIDs (non-steroidal-anti-inflammatory drugs) e.g. aspirin, brufen, diclofenac etc, otherwise concomitant usage of both drugs may lead to ulcers and intestinal bleeding. Even ginkgo biloba should be avoided with aspirin and oral anti-coagulants for the same reason. Every third person today is suffering from diabetes especially Type 2 i.e. NIDDM (non-insulin dependent diabetes mellitus) in middle age. Wrong lifestyle habits and stress are contributory factors. When these patients start looking for alternative treatments for diabetes management it can cause trouble. While taking allopathic drugs some of them also start taking bitter gourd juice (karela) in the morning on empty stomach. Such interaction can lead to hypoglycaemia or even can induce hypoglycaemic shock if unguarded. In a research carried at the GMCH, Sector 32, it was observed that in patients with Type 2 diabetes mellitus, 45 per cent patients were taking herbal remedies along with the prescribed allopathic drugs for diabetes. Asthma patients who are on Salbutamol (?2 agonist & a bronchodilator) should resist eating paan. Betel nut in paan is rich in arecholine and constricts the respiratory pathways. If a patient taking bronchodilator eats betel nut, it leads to broncho-constriction leading to failure of therapy for asthma management. Some studies say ginseng may be responsible for hypertension and anaphylactic reactions, so it should be avoided by the patients who are suffering from hypertension. Ginseng can over stimulate the central nervous system (CNS) resulting in insomnia. Long-term use of ginseng may cause menstrual abnormalities and breast tenderness in females. Ginseng is not recommended for pregnant and lactating women. Ginseng and garlic supplements together can cause bleeding episodes when taken with oral anti-coagulants. The online purchase of drugs can lead to serious consequences. Fang Ji (Stephania tetrandra), a weight-loss preparation, is potentially nephrotoxic. Forty-eight women who took Fang ji for weight loss had occurrence of renal failure, reported a Belgium Study. St John’s Wort is taken by patients suffering from depression. The active ingredient of St John’s Wort is hypericin, which exerts similar effects like MAO Inhibitors. Never ever combine St John’s Wort with allopathic anti-depressant drugs otherwise there may be a serotonin syndrome leading to agitation, irritability, headache even confusion. Most of these clinical drug interactions are reported with St John’s Wort (British Medical Journal November2012) It is only a tip of the ice-berg. There are so many other herb-drug interactions also which may be detrimental to patients’ health. Avoid
self-medication Advertisements in media about such natural medicines must be stopped so as to curtail the promotion of self-medication of these so called natural, harmless, herbal preparations. There is also a need to have self restrain in taking medicines/ drugs from other system of medicines about which we know the least. In India, where the application of synthetic drugs may still be hampered by economic infeasibility and/or a lack of social acceptance, the use of traditional medicinal herbs may be an interesting possibility but ethno-pharmacological research can play a vital and decisive role in this realm by showing which traditional treatments may be promoted as being effective and well tolerated.
MEASURES TO BE TAKEN Dr Gautam is Professor & Head, Department of Pharmacology and Dr Singh is Professor, Department of Medicine, Government Medical College and Hospital,
Sector 32,Chandigarh
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Self-medication is prevalent not only in uneducated but even among qualified people, that too when we know that all allopathic drugs may lead to the side-effects. But these side-effects can be avoided most of the time. The medicines, which are sold as natural, may produce side-effects which may carry long-term consequences. Situation becomes grim further if the patient unknowingly is concomitantly taking drugs of both systems, which may interact. Such information is neither given by the patient and nor asked by the doctor. Failure of therapy must ring a warming signal for prescribers, so the information regarding the use of herbs may be enquired from the patient. 