Medicine and Quackery
By Dr S.M. Bose
MEDICINE has been labelled as the noblest profession of all, probably from the time human beings began to experience illness, and the healing touch came to be appreciated for its soothing effect. The progress in medical-care accompanied the progress in civilisation.

GIVE THE INDIAN SYSTEM A CHANCE
Ayurveda looks at menopause
By Dr Ravindra Vatsyayan
MENOPAUSE is a natural event which marks the end of a woman's child-bearing years. Perimenopause usually begins during the period of the mid-forties to the late forties and it is the stage prior to (and continuing into) early menopause in which menstruation becomes irregular. A woman is considered to be post-menopausal if she has experienced 12 consecutive months of amenorrhoea, or absence of menstruation.

How the body fights intruding terrorists
By Ivninderpal Singh
WE are living in a potentially hostile world with a bewildering array of infectious agents. To protect our body from such agents, nature has provided the human body with an effective defence mechanism. (The power of our body to fight various disease-producing agents is known as defence mechanism.)

CAN WE LIVE 100 YEARS AND BEYOND?
Search for the ‘Elixir of Life’
IMMORTALITY and eternal youth have always fascinated man. People have invested lifetimes in the quest of the elusive "Elixir of Life". Though the elixir was never found, the efforts have not been in vain because these led to many discoveries. The preoccupation with immortality has not entirely left us.

Medicine and Quackery
By Dr S.M. Bose

MEDICINE has been labelled as the noblest profession of all, probably from the time human beings began to experience illness, and the healing touch came to be appreciated for its soothing effect. The progress in medical-care accompanied the progress in civilisation. Today modern Medicine (including all its specialities and sub-specialities), with the exposition of molecular biology and genetic concepts, is being rapidly engulfed in high technology. Gone are the days of tantriks and so-called sadhus and so also are the days of astrological stones, bitter mixtures, leeches, branding sick persons with hot iron rods, piercing the skin with a thick thread dipped in irritating chemicals, etc.

But as is the case in any other profession, Medicine has been polluted by selfish and opportunist elements to gain advantage for themselves, and quacks are the commonest breed of pollutants one can find in the practice of the science of healing.

The Oxford Dictionary defines a quack as "a person who pretends to have medical skill or knowledge; any person who professes a knowledge or skill which he or she does not have; a charlatan". And I am afraid that quackery is keeping pace with the rapid progress of Medicine!

Evidence-based Medicine
Today the practice of Medicine is evidence-based: if it has been conclusively proved that a particular medicine or procedure is effective for a particular stage of disease, only then it is acceptable and should be practised. Everything else is unacceptable and amounts to quackery.

I am sorry to say that quackery is as much prevalent among qualified professionals as among unqualified persons who try to practise medicine in the garb of "extraordinary gifts and talents bestowed upon them by God Almighty or ancestors". Both categories of quacks are dangerous to society and we should get rid of them.

In a city like Chandigarh, which boasts of the highest literacy rate and also of the presence of one of the top national medical institutes, unqualified people, even jurists and senior bureaucrats, openly distribute medicines for the "guaranteed cure" of jaundice, kidney stones and many other ailments.

Those of you, who have travelled to Delhi by train, might have noticed hoardings on walls along the railway tracks, proclaiming assured success for impotency and sterility. This is not only quackery of the highest order; this is outright cheating as at present no treatment is available in the entire world for congenital diseases leading to the above-mentioned problems. The day is not far off when a deceived patient will knock at the door of the consumer court, suing a quack.

Time and again, we, the medical practitioners, have seen patients from educated and financially sound families coming with an advanced stage of cancer because they had wasted their precious time seeking help from quacks. I have come across numerous cases of advanced patients, who were treated by qualified homoeopaths, ayurvedic experts and even allopaths and had wasted precious days and money. Those qualified professional practitioners of all "pathies" are no less of quacks than the non-professionals who dare to dole out medical treatment. One may like to label this as an unethical practice but quackery also may not be far from this reality.

Medical practice has to be scientific
In the modern era, Medicine has to be practised on a scientific basis; it may not be as scientific as mathematics but it is approaching the sterling, verifiable level very fast.

Impressions and views have no place in the practice of Medicine which deals with pulsating hearts. Every new drug and procedure has to be tried on a scientific basis: double-blind controlled trials with the permission of a competent ethical committee. The results of this have to be openly debated and discussed in scientific forums. It is also mandatory that other investigators should be able to duplicate similar results. In the absence of this, a particular medicine or a procedure may not be scientifically correct and should not be used. I feel that too, legally it cannot be used in general practice. In a developing country like India, we easily get away with avoidable consequences but in developed countries quackery is legally punishable.

In my professional career, spanning more than three decades and a half, I have come across numerous instances when people have claimed that a particular chronic ailment (even cancer) has been cured (completely or partially) by the use of an unnamed medicine. I could never verify the authenticity of such a claim as the diagnosis itself always remained uncertain and unconfirmed. But I have offered my expertise and experience to try the "new wonder" medicine on a scientific basis following the well-laid-down guidelines, which include a complete biochemical and toxicological analysis of the drug, prior ethical clearance and double-blind-controlled trials. Unfortunately, no one till this day has accepted my offer. Nobody has come forward to hand me over the "special wonder drug".

A modern medical practitioner should be willing to take help from all quarters if he can provide relief to the patient under his care because that is his only aim. He, therefore, does not have to hesitate to consult dieticians, physiotherapists, experts in acupressure and acupuncture, psychologists and such other experts. A number of ayurvedic drugs have been incorporated into allopathy with definite advantages, but all these benefits have been evidence-based.

Curbing quackery
No doubt, primarily it is the duty of the Medical Council of India and the Ministry of Health to control the growing menace of quackery. But the professional associations, and professionals themselves, have to be vigilant about it so that the fair name of their profession is not tarnished.

In the modern era, the media is playing a big role in the dissemination of knowledge. It should, therefore, discharge its responsibility positively. A famous dictionary also defines a quack as a person who "advertises extravagantly cures, etc."

It has been seen time and again that the media has magnified — and even glorified — quackery in a big way. Two news items, which recently occupied prominent space in the most prestigious newspaper of our region is worth mentioning although one can scan and find out such instances everyday and in every part of the country.

(1) A seven-year-old child, without any medical education or qualification, has undertaken operations on adults. This news should have been condemned strongly and legal action should have been demanded against the "offending quack surgeon". But the effect of the news item was contrary to the ethical expectations. (Note: the claims of the "kid-doctor" and his promoters were condemned by Emeritus Professor Inderjit Dewan in The Tribune.)

(2) Another news item appearing in a section of the Press gave wide coverage to a surgeon with his photograph when he claimed that he was using ordinary mosquito-net pieces in place of the scientific, synthetic mesh for the repair of hernias. Only a week before the appearance of this news item, the surgeon had been warned in a professional conference that he should refrain from making such claims until he had carried out his research project in a scientific manner. Unfortunately, he didn't pay heed to this warning. He was given wide newspaper coverage.

I believe that the media should take the opinion of senior professionals before giving credence to such claims. This will help in curbing quackery.

Professor S.M. Bose is a renowned academician and a famous cancer surgeon based at the PGI, Chandigarh

GIVE THE INDIAN SYSTEM A CHANCE
Ayurveda looks at menopause
By Dr Ravindra Vatsyayan

MENOPAUSE is a natural event which marks the end of a woman's child-bearing years. Perimenopause usually begins during the period of the mid-forties to the late forties and it is the stage prior to (and continuing into) early menopause in which menstruation becomes irregular. A woman is considered to be post-menopausal if she has experienced 12 consecutive months of amenorrhoea, or absence of menstruation.

Ayurvedic samhitas do not discuss the topic of menopause as such. Based on the philosophy of Vedanta and Sankhya, it accepts the concept of six stages of a human being (1) Asti-existence in an unmanifested state; (2) Jayate — getting manifested or coming to birth; (3) Vardhate —growth takes place; (4) Viparinamate — undergoes changes of childhood, adolescence, youth, geriatrics, etc; (5) Adakshiyate — undergoes decline; (6) Nashyanti — destruction or death takes place. In this chronology, menopause depicts the fifth stage of a woman's life-span.

According to ayurveda, the three body humours — vata, pitta and kapha — dominate the body at the various stages of one's life-span. Adolescence, through middle age, is known as the pitta cycle of life. As the later years of our life are governed by the vata dosha, menopause coincides with a woman's transition from pitta time to vata time.

Most of the women adapt themselves nicely to the physiological changes of menopause. Some may have mild symptoms of putting on weight, joint pains and an increase in sexual desire, followed by its gradual decrease. Yet a considerable number of them approach doctors with more severe symptoms of vasomotor disturbances like hot or cold flushes and psychological upheavals of anxiety, depression and disturbed sleep. Thus, depending upon these mild or severe symptoms, menopause can be described as of two types — silent and loud.

Ayurveda advises certain regimes to be followed in a particular stage of life. There are different regimes for the menstruation period (rajaswala paricharya), pregnancy stage, (garbhini paricharya) and post delivery period (sootika paricharya) which aim at maintaining normalcy throughout life so that the ageing process, including menopause, turns to be a silent one.

Ayurvedic texts do provide ample guidance for the treatment of the Menopausal Syndrome on the basis of dhatukhsheenata which means a stage of general decline of the body tissues and their functioning. It also believes in the concept of maintaining the health of an average woman in spite of the different physiological changes occurring in her body. As controversy regarding the safety of the Hormone Replacement Therapy is still going on, there are many herbs and classic ayurvedic formulations which need attention as they are effective and free from serious side-effects.

For example, the root of a well-known herb called Shatavari (asparagus recemosus) is effective in treating symptoms like lethargy and weakness at the menopausal stage. Aswagandha (withania somnifera) is a drug of choice for body-aches, insomnia and nervousness. Praval pishti, mukta pishti, akik pishti, brahmi (hydrocotyle asiatica) and jatamansi (nardostachys jatamansi) cure vasomotor symptoms of hot and cold flushes and take care of mood variations — irritability, anxiety and depression. Pushyanuga churna, Punarnava mandura, Ashokarishta and Dashamoola qwatha are other classic ayurvedic medicines which are used to counter obesity, swelling and pelvic infections arising during this phase. Regular meditation and the practice of yoga help immensely in balancing the three doshas — particularly vata, which points to the nervous system.

Women experiencing menopause today are busier than ever before. They are working, spending more time with their children and grandchildren and caring for the elderly members of their families. Apart from emphasising the need to adopt simple but nutritious food habits, ayurveda also tells them to adjust themselves to a balanced life-style so that they can turn menopause not only into a trouble-free phase but also into a harmonious and comfortable stage of life.

Ayurvedacharya R. Vatsyayan is based at the Sanjivani Ayurvedic Centre, Ludhiana.

How the body fights intruding terrorists
By Ivninderpal Singh

WE are living in a potentially hostile world with a bewildering array of infectious agents. To protect our body from such agents, nature has provided the human body with an effective defence mechanism. (The power of our body to fight various disease-producing agents is known as defence mechanism.)

The simplest way to avoid infection is to prevent the micro-organisms from gaining access to the body. So the major line of defence is the skin which, when intact, is impermeable to most infectious agents. But when there is skin loss, for example due to burns or an injury, micro-organisms penetrate through those areas causing harm to the body. Therefore, a cut or an abrasion in the skin should not be left open.

However, many micro-organisms reside inside our body which are friendly to it as these, instead of causing any disease, protect us from harmful micro-organisms which make access to the body by not allowing them to settle on those places.

The micro-organisms present in the human saliva secrete a chemical which do not allow the diphtheria-causing bacteria to grow inside the oral cavity. Similarly, the bacteria residing in the female genital tract makes the media acidic which do not allow disease-causing organisms to grow and multiply.

There are few automatic activities of our body known as the "reflex phenomenon" which protect the system from many infections. This phenomenon includes sneezing, coughing and vomiting. Whenever any harmful or irritating substance enters our nose or goes inside the body via the mouth, the body reacts against it by sneezing, coughing or vomiting and tries to expel the harmful substance.

Fever is one of the most important constituent of the defence mechanism. The organ which regulates the temperature of the body is an endocrine gland situated in the brain called hypothalamus. When micro-organisms, after entering the body, release toxic substances, these reach the brain through blood resulting in the activation of the hypothalamus which starts increasing the temperature of the body. Owing to an increase in the temperature, the harmful organisms get killed. Not only this; by an increase in temperature blood circulation also increases. Therefore, each and every cell gets more blood supply. By the increased circulation, all the toxic products secreted by the micro-organisms get removed from the body by way of urination and perspiration. Hence antipyretic medications (which decrease body temperature) should be avoided at the initial stages of fever as it is beneficial to our body.

Many cells present inside the body assist in increasing the defensive mechanism. The most important of these are the white blood corpuscles (WBCs). Because of their defensive function these are also known as "the soldiers of the body." Acquired Immuno Deficiency Syndrome (AIDS) is incurable today because the causal agent, HIV, attacks the immune system making the body defenceless. Some other cells, which help in strengthening the defence mechanism are mast cells, macrophages, etc. Whenever the need arises, these cells come out of the blood vessels and reach the affected area where they engulf and kill the problem-causing micro-organisms.

These defence mechanisms establish a state of immunity from infection. A part of this special power of the body is known as innate immunity. The other part of this special power is called acquired immunity. This we gain through our lifetime and the commonest way is through immunisation.

In a nutshell, we can say that the defence mechanism of the human body is a gift of nature provided to us to fight against many diseases. So we should maintain it, or rather increase it, by way of immunisation.

CAN WE LIVE 100 YEARS AND BEYOND?
Search for the ‘Elixir of Life’

IMMORTALITY and eternal youth have always fascinated man. People have invested lifetimes in the quest of the elusive "Elixir of Life". Though the elixir was never found, the efforts have not been in vain because these led to many discoveries. The preoccupation with immortality has not entirely left us. There are some geneticists who seem willing to extrapolate from animal experiments to suggest that 200 years of the human lifespan may be on the horizon.

It has long been held that the best recipe for a long life is to choose one's parents wisely, because genetic influences are considered, to a great extent, responsible for variance in our lifespan. However, this is not the whole story; lifestyle and environment are no less important in determining our lifespan. In fact, genetic influence is important in earlier years. As years pass by, the genes become less and less important and what you do with your life becomes more and more important.

The picture we need to define, therefore, is how genes, the environment and lifestyles work together to influence longevity and health in old age. At this point, it should be said loud and clear that our primary goal for old age must be to enhance the quality of life, for increasing the quantity without a concomitant increase in quality is not worth the gain.

Why do we age?
Lately, there has been a great deal of research on ageing — why we grow old — and if there is some way we can postpone ageing and prevent degeneration and death. A few important facts, which are of practical importance, have emerged.

First, that we do not really know what the upper limit of human lifespan is, and that we have not yet reached that limit, whatever that may be.

Second, that our cells, the units of life, continue to divide and replicate themselves throughout our lives, but there is a limit to the number of times they can divide. After they have replicated about 50 times, they stop dividing and wither out. This is their old age. For cell division and replication, food and energy are required. If this is in short supply, cell division is slowed down. On the other hand, if the supply of food is plentiful and more than the requirement, the process of replication is hastened and the figure of 50 is reached earlier.

This research points out in simple words that too much food brings old age earlier. Isn't it a common observation that few fat people reach the age of 80?

Animal experiments have also shown that lifespan can be substantially (about 40 per cent) increased by giving the animals a low-calorie diet (equivalent of 1500 calories for humans). This diet is adequate but not fattening.

Third, that volatile and unstable oxygen-free radicals, which are produced as a byproduct of cell metabolism and exposure to sunlight, ozone, environmental pollution, smoke, etc, play havoc with cells by destroying them.

Their cumulative effect is believed to be at the root of the ageing process and degenerative diseases of old age, such as heart attacks, cataracts and cancers. Anti-oxidants (vitamins A, C and E) found abundantly in fresh vegetables and fruits seem to prevent this damage by diffusing these free radicals.

Fourth, the new research is concentrating its efforts on the changes that take place within the cell during the ageing process and trying to find out a suitable chemical which can delay the occurrence of these changes. Already, a few such chemicals are under trial. This chemical, if and when found, will be the "Elixir of Life". During the 21st century, we may be fortunate to have such a chemical available to us — but who knows?

(To be concluded)