Doctors reap profits with bariatric surgery

New York: Doctors and hospitals across the US are scrambling to satisfy the booming demand for surgery that shrinks the stomachs of severely obese people.

Dozens of hospitals are adding special operating suites for the procedure, called bariatric surgery, which attracted wide notice after public figures like Al Roker of Today on NBC, Sharon Osbourne of The Osbournes on MTV and Representative Jerrold Nadler, - a Manhattan Democrat, had it done. Some bariatric surgeons are fully scheduled 12 months in advance, and hundreds of doctors have jumped into the field recently and started to advertise their availability

Bariatric procedures meant for obese people who are at extremely high risk of severe health problems, as defined by a National Institutes of Health consensus surged more than 40 percent last year, to 80,000. This year, the number is expected to climb to 120,000, according to Frost & Sullivan, a consulting firm. Spending on bariatrics is approaching $3 billion a year, at an average cost of $25,000 for each procedure.

With the number of people eligible for the procedures growing by an estimated 10 to 12 percent a year, bariatric surgery can be profitable for hospitals and even more so for surgeons. But the costs are a major concern for insurance companies and employer health plans. Surgeons say that some insurers routinely delay approvals.

One group having trouble winning access to treatment is the poor, among whom obesity is an especially acute concern. At the University of California at Davis, for example, Medi-Cal patients face a 12-year wait for bariatric surgery, said Dr Bruce M. Wolfe, a bariatric surgeon and professor of surgery

Most bariatric procedures produce weight loss by restricting the intake of food. Part of the stomach is partitioned off and the intestines are rerouted. Afterward, many patients lose their outsize appetites.

The procedure is approved for patients at the upper end of the body mass index, a measure of weight in relation to height. Under National Institutes of Health guidelines, widely followed by health plans, candidates must first try diet and exercise regimens.

Aug 31, 2003. TOI


Telemedicine connects villages in Andhra Pradesh with the world...

Telemedicine is picking up in a big way in Andhra Pradesh. Hospitals in rural areas use customized software integrated with computer hardware, and are connected to large metropolitan hospitals through the INSAT satellite system. This facilitates transmission of a patient's medical images, records, output from medical devices and also 'live' two-way audio and video communication. Doctors in remote areas can interact with experts in large hospitals and seek their guidance and advice regarding patient management.

ISRO's SHAR Hospital, Sriharikota and Aragonda Apollo Hospitals, Chittoor District, Andhra Pradesh have been connected to Apollo Hospitals, Chennai. Thanks to the efforts of the Government of Andhra Pradesh, the CARE Foundation and Apollo Hospitals, Andhra Pradesh Vaidya Vidhan Parishad (APVVP) envisages networking of all the 23 district hospitals and 100 area hospitals which will in turn be linked by satellite with the CARE Foundation Hospitals, Osmania Hospital and Nizam's Institute of Medical Sciences at Hyderabad. While this seems to be an inexpensive and efficacious healthcare delivery system, time alone will test the viability and practical feasibility of this model.

 2003, The National Medical Journal of India Vol. 15, No. 4


Health research and ethics in the developing world

The ethical issues involved in healthcare research in developing countries, which is funded by sponsors from developed countries, was the theme of an inter-country meeting on Ethics in Health Research at Delhi (9-13 September 2002). There were participants from Sri Lanka, Myanmar,  Bangladesh, Indonesia, Bhutan, Nepal and Thailand, besides India.

Developing countries need research to help address the enormous burden of disease they carry. The inequalities in resources between the developed and developing countries pose a real risk of exploitation in the context of externally sponsored research. When externally sponsored research is proposed which falls outside the national priorities, its relevance must be justified to the appropriate research ethics committees. The focus of the meeting was to build the ability of developing nations to conduct research based on ethical principles that is relevant to the nation's needs, develop local expertise in healthcare research and ethics committees.

Informed decision-making including cross-cultural issues, evaluation of risks and benefits and the standard of care in the context of international collaborative research were the themes of the discussions. Case studies were discussed on privacy and confidentiality, inducement, compensation and post-study benefits of healthcare research. The meeting was conducted by the Indian Council of Medical Research (ICMR) and supported by the VVHO South East Asia Regional Office.

2002, The National Medical Journal of India Vol. 15, No. 5



Spurious medicines

In Andhra Pradesh, there has been a marked increase in the promotion of so-called alternative treatment modalities' for many common chronic diseases. Often, these are termed 'herbal' or  ayurvedic preparations' and are claimed to be the definitive treatment for obesity, impotence, hypertension, diabetes, among others. Several incidents have been reported where the use of these medicines have resulted in disastrous consequences. In an incident reported from the Krishna district, a person who was allegedly using one such preparation for 'improving general health' died suddenly. The capsules used by that person were found to contain large doses of sildenafil, Obesity treatment centres have been mushrooming even in small towns and these are often managed by people who are not healthcare professionals. Their intense advertisement campaigns often refer to a variety of 'herbal' and 'secret (patented) medicine' for 'instant weight loss'. Chemical analysis of these medicines has often revealed sibutramin. Sildenafil and sibutramin are to be used under expert medical supervision and need to be monitored for adverse drug reactions. It is surprising that even educated persons are succumbing to the temptation of using these dubious remedies when state-of-the-art modem medical facilities are widely available.

 2002, The National Medical Journal of India Vol. 15, No. 5


Sequencing the human genome

The first complete drafts of the human genome sequence were published in 2001 by the International Human Genome Sequencing Consortium (IHGSC), a publicly funded effort, and Celera, a biotechnology company, using different approaches. Both efforts used a random or shotgun approach where the original DNA to be sequenced was randomly broken into overlapping fragments that were then cloned, and 500 base pairs (bp) were 'read' from one or both ends of the clones.

For the draft genome sequences, each base was read six to ten times to optimize the accuracy of the sequence. The stretches of DNA sequence were read by a computer and assembled into a complete sequence. The IHGSC effort randomly cleaved DNA into 200,000-bp fragments and generated a map of these fragments across the 24 different human chromosomes; it then used the shotgun approach to sequence the pre-ordered fragments clone by clone. In contrast, Celera randomly fragmented the entire genome into three sizes of fragments (approximately 2,000, 10,000 and 200,000 bp), sequenced both ends of the clones and then used the end sequences to assemble the entire genome sequence, without the aid of a map.

Celera's 1998 announcement that it would sequence the human genome within three years was greeted with considerable scepticism, but it succeeded in producing a draft sequence and considerably accelerating the public effort. The efforts of both groups benefited science by producing draft genome sequences considerably earlier than expected.

Although minor differences were noted between the two drafts, the overall conclusions concerning gene numbers repeated sequences and chromosomal organization were remarkably similar. For example, both groups identified 30,000-35, 000 genes, far fewer than the 100,000 expected from an earlier (admittedly 'back of the envelope') calculation.


January 2003, Nature Vol. 421


Vi rus trap

Australian researchers have deve­loped a unique technique to check  the rapid growth of mouse population.
The government-backed Cooperative Research Centre (CRC) for Biological Control of Pest Animals has produced a genetically modified herpes virus that makes sexually prolific female mice infertile by blocking sperm from entering their eggs.

         "We know it works in a shoebox  level experimental setting. Now we want to try it in a field setting," says Tony Peacock, director of CRC. The centre has urged the Office of the Gene Technology Regulator -Australia's watchdog on transgenics - to grant permission for testing the virus in sample populations of mice.

Rigorous testing is required to prove that the virus is species-specific - it cannot be transferred to other animals or humans. The main beneficiary of the virus would be Australian farmers, who are one of the world's biggest exporters of grains.

Australia's mouse population explodes into billions every four years or so, usually at the end of a drought. Peacock says a bad mouse plague can cost Australia more than US $90 million in lost crops, while a moderate outbreak could cost US $30 million.


May 15, 2003 Down to Earth



Blood vessel gene could lead to complex birth defect

According to a study, a gene known for its ability to form blood vessels has been found to be a key player in a chromosomal abnormality that causes potentially devastating birth defects in the heart and throughout the body. A group of collaborators from across the globe reports that abnormalities in vascular endothelial growth factor, or VEGF, is a cause of DiGeorge syndrome. This syndrome can cause a wide range of heart defects, many of which are vascular in nature, as well as problems with the thymus and parathyroid gland, craniofacial abnormalities and mental retardation.

Among the follow-up steps, one would be to find why these VEGF defects occur with an ultimate goal of trying to prevent them. Researchers found the target "downstream" of human chromosome 22, which is known to be deleted in 60-70 per cent of people with DiGeorge syndrome. Deletion of chromosome 22 removes a group of 24 genes as well, many of which are transcription genes known to control downstream targets. According to Dr. Conway, although the targets remain largely unknown, it is believed that these 24 genes control hundreds, even thousands, of downstream genes, which helps explain the complexity of the syndrome that can result when the chromosome is deleted. One of those 24 genes is Tbxl, which is widely considered the primary gene involved in DiGeorge syndrome.

March-April 2003, Vatis Update: Biotechnology


Staking a claim

SARS (Severe Acute Respiratory Syndrome) is here to stay. So countries are now applying for patents on the SARS virus.

The ones seriously trying to cash in are the US Centers for Disease Control and Prevention (CDC), University of Hong Kong's commercial arm Versitech Limited and British Columbia Cancer Agency in Vancouver. Once the patents are in place, the holders can charge a licensing fee from other researchers. In the 1980s, France and the US had similarly wanted to patent HIV; they got joint patent rights.

The organisations contend they want the virus to remain in the public domain and not hamper research on drugs, vaccines and diagnostic tests. But experts differ. They feel the step is likely to discourage independent research. "This would reduce the number of people studying the subject and delay a cure or vaccine," Avers Beth Burrows, director, Edmonds Institute, a Washington-based non-governmental organisation. The patent is likely to be finalised after a couple of years. Meanwhile, researchers can continue working on the virus.

June 30, 2003  Down To Earth



Almonds are protein-rich

There is common myth that vegetarian food contains no protein. Almond contains 20 per cent protein - a percentage that is hardly found in the plants. Among all nuts that are used as food, almonds are highly nutritive. They are packed with all the food components, which are vital to health, strength and a sound body. Almonds contain good quantity of copper - the vital mineral that synthesises haernoglobin by aiding proper absorption of iron from gastrointestinal tract. The medicinal action of almonds is chiefly due to phramacodynamic action of copper, calcium, phosphorus and vitamins B1, C and E.

Almond kernels are said to be thermogenic, aphrodisiac, laxative, diuretic, nutritious, demulcent and good as a nerve tonic. It's oil is sweet, cooling, antispasmodic, sedative, laxative, and rejuvenating.

Almonds are an ideal tonic for your growing child. Soak three to six shelled almonds in warm water and then remove the skin. Grind them into paste, and mix it with milk. Add a teaspoonful of honey.

Feed your baby once daily from second month onwards and see how the child grows. It is also very much useful for adolescent girls with delayed puberty. Take crushed almonds, egg, yolk, gingelly powder and a tsp of honey in milk.

It acts as an excellent food supplement in case of general debility and convalescence. Soak 12 to 15 shelled almonds in hot water and remove the outer covering. Grind them into fine paste, and mix it with the butter milk and mash a ripe banana in it. Strain it through a muslin cloth, add four tsp of honey and drink twice, daily. Almonds are an ideal food for diabetics and for those suffering with peptic ulcers.

Almonds increase libido and enhance general sexual performance in case of frigidity. Cut and boil a few drumstick fruits and make a pulp. Grind a few almonds and add 2‑3 pinches of saffron to this pulp and eat every day for 40 days.

It is good for constipation. Grind five tsp almonds and five tsp dried dates. Combine them and add 10 tsp, of honey. Take 3 tsp of this mixture twice, daily.

May 2003, Health Action




Exercise alone may thwart pre-diabetic syndrome

A  small study suggests that sedentary adults who get a few hours of exercise each week and don't lose weight may still cut their risk of developing a pre-diabetic condition called insulin resistance syndrome. In insulin resistance syndrome, a person loses his or her ability to use this key blood-sugar-regulating hormone effectively. More and more people Children as well as adults - are developing the condition as the population eats more and exercise less. Left untreated, the syndrome can develop into type 2 diabetes and increase the risk of heart disease, While previous studies have touted exercise's potential to reduce the severity of illness in people already diagnosed with type 2 diabetes or heart disease, little evidence exists on whether or not physical activity reduces the risk of the syndrome that precedes these illnesses, according to the study published in the March issue of Diabetes Care.

May 2003,Health Action



New heart muscle cells from bone marrow

Mayo Clinic researchers have proved that cells produced by the bone marrow can form new heart-muscle cells in adults, providing an important boost to research that could enable the body to replace heart muscle damaged by heart attack.

           The findings were published in ‘Circulation’. "Until recently, the heart has been seen as an organ that cannot be healed," says Noel Caplice, a cardiologist who led the study. "Heart attack damage to the myocardium, or heart muscle, was earlier considered irreversible. This study points the way to a process that could lead to heart repair."

The researchers studied four female patients with leukaemia who had survived 35-600 days after receiving bone-marrow transplants from male donors.

Heart tissue samples were examined at autopsy using special staining techniques, which showed that a small portion of the heart muscle cells, contained male genetic material and had therefore originated from the donor marrow.

The study is important because it is the first confirmation that progenitor cells from outside the heart are capable of forming new heart muscle cells.

May 2003,Health Action



Study on cell division may yield targets for obesity treatment

Scientists at John Hopkins School of Medicine, the United States, have shown for the first time that primitive fat cells must copy themselves at least twice before they can mature into full-fledged fat-storing cells. Nature ensures a ready reservoir of the cells. This is the first evidence which shows that such divisions are necessary for cell maturation. This discovery was made while studying primitive fat cells in mouse. According to Prof. Daniel Lane at the Institute for Basic Biomedical Sciences, "Food is not scarce in many parts of the world and storing excess calories may lead to obesity and many serious associated health problems.

 March-April 2003, Vatis Update: Biotechnology


HI-tech update

Among automobile manufacturers, Japanese company Honda’s FCX model became the first hydrogen fuel cell vehicle (FCV) in the world to receive government certification. The US Environmental protection Agency and the California Air Resources Board gave it the green light in July 2002 for emission. By December, Honda leased its vehicles to the Japanese cabinet office and Los Angeles city for everyday use.

In March 2003, another auto giant- Daimler Chrysler- received government certification in Japan for its FCV and began road tests. Its latest variant, NECAR 5 developed in 2000, is powered by methanol. Further, it is working with US based multinational Ford Motor Company and Ballard Power Systems Inc to put transit fuel cell buses on European roads, Ford also plans to offer a fuel cell version of an existing model in 2004. General Motors (GM), which is beginning mass production by 2010, wants to be the first car company to sell one million fuel cell vehicles.

Japanese Company Nissan has advanced its original plan to start selling FCVs in 2005 by two years and Daihatsu Motor Corporation announced in January 2003 that the Japanese ministry of land, infrastructure and transport had cleared two of its FCVs.

Two leading French automakers, PSA Peugeot Citroen and Renault, are working to speed up the development, about 20 car manufacturers including Toyota, Nissan and Daimler Chrysler have joined hand to develop technologies for expanding the cruising distance of fuel cell vehicles up to 500 kilometres. They are also working to increase the hydrogen storage capacity by 40 percent.


April 30, 2003. Down to Earth



Food That Fight Cancer

Diet : A Major factor

Cancer usually develops over a long period. Food can block the chemical activation, which normally initiates cancer. Antioxidants, including vitamins can eradicate carcinogens and can even repair some of the cellular damage caused by them. In advanced cancer, the right foods can prolong the patient’s life. Some of the more important foods that prevent and control cancer are discussed herein.

Beet juice: The juice of red beet possesses anticancer activity. It is a rich source of natural sugar and contains sodium, potassium, phosphorus, calcium, sulphur, chlorine, iodine, iron, copper, vitamin B1, B2, niacin, B6, C, and P. This juice has detoxifying activity, which is of great value in treating cancer. Half a glass of this juice can be taken three times daily. Lactic acid fermented and a well balance beet juice will markedly increase the oxygenation of the body cells, it would be advisable to extract juice both from root and tops.

Cabbage and other cruciferous Vegetables: Cabbage and other cruciferous vegetables like Broccoli, Cauliflower and Brussels sprouts are one of the most important food, which may immunise against breast cancer. They speed up the metabolism of oestrogen.

Carrot: This vegetable, as a super food source of beta-carotene, has been found valuable in preventing lung cancer. Beta-carotene acts as an antidote to lung cancer. A recent at the State University of New York at Buffalo shows that eating beta carotene rich vegetables more than once a week dramatically decrease lung cancer when compared with these vegetables. Those not taking munching a single raw carrot at least twice a week reduces lung cancer by 60%.

Citrus Fruits: Citrus fruits like grapefruit, limes, lemons, and oranges possess powerful anti cancer properties. According to toxicologist Herbert Pierson, Ph.D. a diet and cancer expert formally with the American National Cancer Institute, regards citrus fruits as total anti cancer package, because they possess every class of natural substances like carotenoids, flavonoids, terpenes, limonoids and coumarins which neutralize the toxins.


December  2002. Nisargopchar Varta


Pesticides discourage plants to produce healthy compounds

Organic crops contain more healthy compounds than their conventional counterparts, because they are not exposed to pesticides. Work by US based University of California indicates that organic berries and corn     contain up to 58 per cent more polyphenolics – compounds that act as antioxidants and prevents human cells from mutating.

            The researchers compared levels of polyphenolics in marionberries (a type of blackberry) and corn grown organically and conventionally.

            The polyphenolics in the organic crops were seen at levels found in wild plants, suggesting that use of pesticides reduces the need for plants to made these chemicals, says Alyson Mitchell, the lead researcher.

            Polyphenolics are chemicals produced by plants when they are attacked by insects. The bitter taste of these compounds drives away the pests. Studies show that eating a diet rich in polyphenolics can reduce the risk of cancer and heart disease.

April 15, 2024 Down To Earth


US trying to water down tobacco treaty

SIDESTEPPING health concerns, the US government has asked other nations to support the reopening of negotiations on the Framework Convention on Tobacco Control (FCTC). The treaty aims to curb tobacco menace.

The draft prepared in March 2003, is likely to be finalised soon at the World Health Assembly in Geneva. According to Judith P Wilkenfeld from the Campaign for Tobacco‑Free Kids, Washington, reopening the negotiations would delay the entire process. The draft has been prepared after discussions for about four years.

The US government contends that the treaty puts restrictions on advertising and marketing of tobacco products. This, it says, takes away the tobacco companies' freedom of speech. The US wants to opt out of the individual clauses in the treaty, which would allow the pact to be renegotiated on a country‑to-country basis.

Experts feel that the US is acting under the influence of the tobacco industry, which gives huge donations during elections. The industry is said to have donated more than us $8.6 million to election campaigns in 2000.


May 31, 2003 Down To Earth


Another drought, are we ready?

AMONG disasters, drought is the easiest to predict and manage. The Indian Meteorological Department's forecast of a "below normal" monsoon in 2003 - a full six weeks in advance - has sent out a terse warning: prepare to drought-proof the country.

Official estimates show that villages across the country are not in a position to survive another drought. The economic survey for 2002-2003 has already indicated low economic growth and hints that without a bumper monsoon, revival will not be easy. The planning commission believes the country needs three good monsoons to surmount the crisis precipitated by persistent droughts in the last six years. This makes it essential that we move beyond short-term drought relief mindsets to effective programmes for long-term relief against drought. We have said this quite often. We repeat it now. With growing concern and anguish.

However, Union agriculture minister Ajit Singh, in the first official reaction to the forecast, hinted of a ban on export of foodgrains as a drought management strategy. Last year, the government had opened the doors to its overflowing foodgrain stocks, but relief exercises were hamstrung due to a defunct delivery system and a convoluted public distribution system.

Drought in India has become a historic reality and needs long-term proofing, rather than knee-jerk reactions. Currently, India is implementing its largest ever drought relief programme, with 19 states spending a phenomenal Rs 15,000 crore in just one year. Though this money is being spent on - among other things - reviving productive assets such as ponds and water harvesting structures, the implementation is as a short-term programme limited to the drought years only. These assets hold the power to insure our villages from drought by creating ecological security through the availability of water; their revival and protection should form the bulwark of a long-term strategy.


May 15, 2003 Down To Earth


India - Dengue fever and Japanese  Encephalitis

Apart from malaria, another illness spread by mosquito bites is dengue fever, whose  symptoms are similar to those of malaria, plus aching bones. There is no vaccine available and the only treatment is complete rest, with drugs to assuage the fever. Japanese encephalitis, yet another mosquito-borne viral infection causing fever, muscle pains and headaches, has been on the increase in recent years in wet rural rice-growing areas. However, there have been no reports of travellers catching the disease, and you shouldn't need the vaccine (which is expensive and has several potentially nasty side-effects) unless you plan to spend much time around paddy fields during and immediately after the monsoons. India_dengue_fever_and_japanese_encephalitis-i


Murshidabad polio worries World Health Organization

According to the WHO, there are only two poliovirus zones left in the world. One is sub-Saharan Africa and the other spread over India, Pakistan and Afghanistan. The polio zone in India includes Punjab, Haryana, Uttar Pradesh, Bihar and Murshidabad. The Murshidabad district of West Bengal is considered to be the last stronghold of the poliovirus in India, says Arindam Roy, WHO representative for West Bengal for the National Polio Surveillance Project. 'This is called the virus zone and the polio eradication programme will now zero in on Murshidabad, so the last reservoir of wild poliovirus in the state can be destroyed,' he said. The incidence of polio in Murshidabad has far-reaching effects as all the cases have been reported from the Indo-Bangladesh border. Since Bangladesh is already polio free for the past 2 years, the virus cannot be allowed to infiltrate back there. Health agencies are pursuing the matter with great urgency as they are worried about India exporting the virus to its neighbors.

However, penetrating the interior parts of West Bengal with the polio mop-up programme has been difficult. Lack of awareness among people to give pulse polio doses to their children is hampering polio eradication. There are still pockets in Khidderpore in Kolkata where people have refused to administer the polio vaccine to their children. The single case recorded in 2001 was from Khidderpore. Despite this, 4000 families from the same area have refused the polio vaccine. The problem is far more pronounced in Murshidabad where lack of education is a major stumbling block.

  2002, The National Medical Journal of India Vol. 15, No. 4