WHY GOVERNMENT BUSES RUN EMPTY (AND SIMILAR SUCK-CESS STORIES)

Many of my old readers surely know how big a fan I am of Big Government. After all, the tax money collected in the interest of the destitute and the poor needs to be spent on things that are crucial for the poor man on the street. All are agree?, a question Government resolutions are frequently preceded by. Among the various ways our taxes are spent include:
1. Giving employment to unemployable youths.
2. Subsidies to grains, kerosene and sugar so that they can be sold by ration shop owners at a higher price in the open market (after all, the market knows no morals, as everyone knows).
3. Build statues of the great leaders of our country who have saved several billions of dollars of the nation’s monies by transferring them to Swiss banks, thereby ensuring steady and safe growth.
4. Build and run hotels so that the poor relatives and workers of political figures can stay when desire strikes them.
5. Run airplanes that can be used by the poor when regular private airlines are packed to capacity.
6. Pay the bills for helicopter rides and private charter planes that carry our beloved leaders to their farmhouses or mistresses.
And so on. Why rehash this old crap, you ask?
Well, I recently heard of a way whereby another great public service our Government provides us, the Public Transport system, helps us.

(source: http://www.travelindiasmart.com)

Here is an example:
A State Express bus, traveling around 50 kms from point A to point B, is often found to be, in official records, to be running nearly empty. The puzzling contradiction is how those empty buses are never seen in reality. The mystery has been resolved by a group of inspectors who have found that the conductors of the buses are charging a ‘subsidized’ rate, especially from ‘old (monthly-pass) customers’ and allowing them travel without the need to issue tickets. The money is generally split between the hard working driver and the conductor.
Protesting passengers are discouraged– if necessary by eviction from the moving bus. Needless to say, our paying public has found a way to manage this, and a compromise struck with the employees, many of whom have bungalows and cars and marry off their daughters in non-Governmental style. Role models for our wayward youth, surely!
A similarly enterprising group comprises of workers in various Government Hospitals, especially the large teaching institutes.

(source:www.oxfam.org)

A typical example is of a technician in the Radiology Department who performs dozens of x-rays every day, using dyes that are used in the x-ray procedure.
For example, a study called the IVU needs two ampoules of a contrast material (as the dye is correctly called). Now, each ampoule usually contains 50ml. Our enterprising technician uses 40 ml in every case. Every fourth case or so, instead of opening a new ampoule of contrast, he uses the 40 ml of saved material, uses it for the last case, and pockets a brand new ampoule (which has been bought by the last patient).
This ampoule, along with many others that accumulate from his enterprising cost-cutting, is sold to the same neighboring pharmacy from where these patients are asked to get contrast from. Sweet, is it not, how our hard working State employees manage to make some extra money in these hard times?
Extrapolate this to drugs, including third gen antibiotics, anesthesia drugs, suture materials, disposables, implants, catheters, and a hundred other things, and what do you have?
A full-fledged cottage industry of larceny and fraud, complete with 100% tax exemption and 100% job security.
Let us, on this note, dedicate ourselves to Eternal and Enterprising Government!

YOU ARE HOW YOU EAT!

According to a Japanese study published in the British Medical Journal, if you eat fast, and you eat till you are full, you are likely to be fatter: by three times! What you eat makes you fat, how much you eat also does so, but how you eat is also important. Weight gain from eating fast or till fullness is independent of total energy intake.
It makes sense for weight-watchers to eat slowly. The more you chew your food, the faster the satiety. If you are prone to gulp down your food, you tend to eat more. This is why television dinners are such an important factor in weight gain, especially in children. Among the interventions recommended to reduce the obesity epidemic in school children, reducing the time television is watched has been considered one of the most important.
In the Japanese study, eating fast till fullness is associated with insulin resistance, a condition that accounts for that pot belly that is so troublesome to get rid of.
Moral of the story: eat slowly, like the Italians, and eat smaller, more frequent meals.

A FIRST, UNIQUE, UN-DESCRIBED BENEFIT OF STRETCHING!

You can get several resources in the web that give you sound advice on various aspects of physical fitness, like this one. In addition, you get comprehensive websites like Bodybuilding.com, where you can get videos of individual workouts you want to do perfectly, or get more knowhow. I prefer the blogs, finding them free of commercial disturbances.

In all these sites, you can find how exercise builds up your muscles, controls your blood pressure and your heart rate, bring your blood sugar levels down, and so many other things. The only thing exercise does not seem to do is to give you a hard-on.
Let us not, however, get distracted into that related minefield of calories and pelvic thrusts.

I have had a unique benefit from exercise, specifically stretching. This particular stretch consists of lying down supine, one knee folded on the other, and bringing the other knee to the chest, thereby stretching the folded one. I am sure this description is very clear, similar to the various descriptions of the Hadron Collider experiment and the physics behind it.

Okay, let me give it its proper name: the pyriformis-gluteus stretch.

(pic source: http://spyhunter007.com/Images/piriformis_gluteus_stretch.jpg)

This morning, as I was doing this, I heard an enormous pop from my right knee. If Usain Bolt had farted while running the 200 meter sprint, it must have been recorded in history as a similar sound. I am, rest assured, no Usain Bolt, either in running or in other matters. I checked my knee, and sure enough, it looked to be in one piece.

I had a long history of a cyst in the meniscus of my right knee. This was the result of an injury sustained in my college days, when I used to kick-start my Kawasaki motorbike every day, on the way to escorting pretty women who would hug me from behind. This used to be in the city of Bombay.

This cyst just ruptured today, and I am cured of the disease, thanks to my diligent exercising on my back.

Representative pictures only:

(source: here).
I am saved from one surgery.
I always knew I had it in me to be famous for doing something unique one day. Who would have known it would be for this!?

SEEING IS BELIEVING

It is a common and traditional practice for a surgeon to display a removed organ after his efforts.

The patient’s relatives go goggle-eyed as the surgeon describes graphically how difficult the operation was, how risky, and how brilliantly he managed the situation to save the patient.
The bigger the tumor, the better. If, however, a removed gall bladder has only one or two small stones, the surgeon is looked at ( “Oh, is that all? My mother, who was operated by Dr. Enviable, had two hundred and eighty stones”) with raised brows and curled lips, as if the surgeon was at fault for not having produced stones of adequate dimensions. The size problem always crops up to haunt men. The specimen removed at operation is, clearly, of great importance to people.

I have been perplexed in the past, when I was environmentally colored greener, by certain instances of human behavior (in this regard). Once, after doing a circumcision, I went to the parents to reassure them that all was well. The mother insisted on seeing the specimen (the foreskin). We had to scavenge the trash buckets to retrieve the small piece of skin. It seemed that unless I showed them the specimen, I would be clearly identified as a cheat who was charging for nothing, under the pretext of doing a surgery.

After hernia surgeries, people are very disappointed when I come out without any grotesque piece of flesh in hand. So, nowadays, I carry a packet of the mesh that is implanted in one hand and the bill for my services in the other.

When it comes to private parts, you will be amazed to know of peoples’ attitudes. If you asked a man to display his wife’s breasts to his relatives and friends, he would probably assault you. But that same man (in the company of six other people) may well ask to see the specimen of a mastectomy done for his wife’s breast cancer.

Today, I was operating at a hospital where the operation is normally shown live at the reception, where the relatives of the patient watch the proceedings. This patient’s husband was very eager to watch the operation live. The operation was a laparoscopic hysterectomy. As I was, from inside the abdomen, incising the vagina with my instruments (just prior to removing the uterus), I thought that this, most private, part of a woman’s anatomy was being displayed in public, though from the inside. No skin was visible, but the inside of the vagina was what was on sight.

Is a private part private only if seen from the outside? Or is it important only when the viewer realises what is being seen? The relatives, after the operation, wanted the specimen to be displayed, not realising that they wanted to see the innards of a woman, which they would never dare to otherwise.

Is there something here I am missing? I don’t understand people’s notions of private parts.

DOCTORS IN THE DOCK

A recent incident in an Indian hospital: A baby is declared dead, stillborn, and after several hours, discovered to be alive. The doctor in charge was the one who saw the baby in the early hours of the morning, and saw signs of life. The nurse in charge had declared the baby dead the night before. Incidentally, no resident had seen the baby. The doctor in charge was apparently unavailable on phone till the morning. The media had a field day, roasting the hospital and the doctor alive for the ghastly event. The hospital has stood behind the doctor.

In another episode, a doctor gave the wrong cancer drug into the spinal canal of a patient, resulting in paralysis and a possible death. The doctor was told by the nurse that she was giving him the correct drug.

In the second case, the doctor was hauled over the coals, while the hospital concerned tried to shift the onus entirely on the doctor, as if all it did was provide the four walls and roof for the doctors and patients.

Obviously, in both the cases there is likely a strong element of human error or negligence on the part of the physicians concerned. However, it is a disturbing sight to see a hospital put the doctor in the dock and try to absolve itself entirely. This is one of the many instances where corporate hospitals and doctors find themselves in conflict. Recently, a corporate honcho berated a famous doctor blogger (one you may possibly know) for writing allegedly adverse comments about it, even hinting at legal action.

What do you think?

HEART SCANS: GOOD OR BAD?

The New York Times has carried an excellent article on the rampant use of the CT scan for diagnosing coronary heart disease in patients. It gives a balanced picture of the pros and cons of a healthcare system which thrives on modern and expensive investigations.

The basic argument in favor of scanning your heart would be to detect the plaques (deposits of fat) in the coronary arteries and document any narrowing in the passage of blood supplying the heart muscles, thereby warning the cardiologist and the patient of the need for aggressive treatment like angioplasty or bypass surgery.

On the other hand, each scan costs a lot of money, causes radiation exposure equal to a thousand x-rays (thereby increasing the risk of cancers), and may not be as effective in helping detect the specific case of the cardio-vulnerable patient.

In India, all the premium city hospitals, led by the Apollo group, have procured the 64-slice CT scanners that cost nearly a million dollars. These hospitals aggressively position themselves to patients as leaders in preventive cardiac care, which is just an effective way of marketing the cardiac CT scan.
Additionally, they also position the CT-angio to doctors through CMEs, cocktail-dinner seminars, etc.

The ‘cardiac CT’ has taken center stage along with coronary angioplasty and bypass surgery as major revenue earners for these hospitals. The strategy is to screen patients through executive health checkups and diabetes and hypertension screening camps across the rural-urban divide (through peripheral clinics), get them referred to the center with the CT scan, and following the detection of some lesions in the CT, get the patients ready for the expensive angios and bypasses.

The entire delivery system is now well-oiled, and the number of procedures is rising every year, as are the revenues to these hospitals.

Patients are also benefitting, by and large, though there are (unspecified numbers of) patients who are being scalped or milked by the system. Isn’t it always so?

WORLDS APART!

My daily life is replete with ugly sights, foul smells, and sad sounds. Such is the life of practising doctors. I had accepted this long back as a part of surgical life, and trained myself to disconnect my non-professional life from the feedbacks of life with the sick and suffering.
A very minor taste of this:

My nephew, award-winning car designer Harsha Ravi, lives in a different world, as do many of you.
Here is what he is up to. Take a look.

Is it small wonder, then, that I strongly discourage youngsters from getting into medicine? With so many things to be passionate about and excel in, why choose medicine, with all the tensions, ugliness, etc.? What do you think?
One other thing, too: I consider youngsters like Harsha to be not merely lucky to have lives like this, but also smarter, in that today’s kids know what not to do!

Pics: patient pics mine; others from Harsha’s article.

IRAN AS THE WORLD’S ROLE MODEL?

According to certain highly educated and qualified people, Iran could be a surprising model for the rest of the world. No, not just in creating nuclear plants and forcing the West to blink, but in their system of allowing organ trade.
An article in Nature India underpins this point along with some interesting ethics issues. If you do not have access to Nature, you could get the same article here. The author of this piece is a familiar name to some of the readers of this blog, as we have discussed some of his earlier publications.
What is the beef of the article?

In India, a huge demand exists for about 200,000 kidneys, with an estimated annual sale of 2000 kidneys. By making organ sale illegal, this market is pushed underground, and organized rackets thrive by working outside the society’s laws and regulations. One of the spin-offs is the phenomenon of organ theft. Such an organ harvest is obviously illegal. Organ theft and organ sale, however, are not the same thing. Every sane person will surely condemn the stealing of a poor man’s kidney, but if such a person volunteers to sell it for money, would it be all bad?

THE i-UNTOUCH?!

You must have got that email forward that says that your keyboard carries more germs than your backside. The message, apparently, is not that you can scratch your backside and eat with the same hand. The message is that you shouldn’t type on your computer keyboard and then eat without washing your hands. The real implication may be clinical: a new technology that allows surgeons to review CT-scan or x-ray images while operating, without touching the computer keyboard, may actually help prevent wound contamination.
According to the New Scientist, this new touch-me-not technology (likened to that in the movie Minority Report) allows a surgeon to wave his hands in mid-air in front of the computer to flip over to the next pic.

…a screen and gesture-recognition system that allows surgeons to flip back and forth through radiology images, such as MRI and CT scans, by simply groping in mid-air. Their system, called Gestix, comprises a colour video camera above a flat, widescreen monitor placed next to the operating table. The video signal from the camera is fed to a PC, where software trained to detect the colour of the surgeon’s gloves tracks the movements of their hand.

This, they believe, could help stop the spread of the deadly MRSA bug in hospitals.
The catch is that surgeons would have to be taught eight hand movements. Now, isn’t that expecting too much of a surgeon, who is, by popular consensus, the Kanishka (headless/brainless king) of medicine?

(pic source: http://www.exoticindiaart.com)

CAN A ROBOT BECOME AN INDIAN ‘SURGEON’?

You have heard of robotic surgery, if you have heard of You Tube, the iMac or the subprime crisis. What you may not know about is the story behind the man who devised the first (da Vinci) medical robot.
For a fascinating and short story of Frederic Moll, read this NYT article.
In the past, I had written a rather decent article on medical robots, and you could check it out here.
The capital investment of a robot for laparoscopic surgery is to the tune of $1.6 million. Not much for the rich Indian companies that run hospitals, I thought. I approached a hospital Chief Financial Officer.
“I would love it if you buy the da Vinci robot for my department. I will do great work for the hospital.”
“True, but then what about the return on investment?” the CFO asked.
“Em, arr, the procedure will cost around $1500 in disposables per case. That comes to around Rs.60,000 only. Plus all the rest of the hospital costs. Imagine how much you can make per case!”
“Great, so a gall bladder surgery will cost around one lakh-odd (around $2500), you think?”
“Yeah, ballpark!”
“Tell me, doctor, how many cases could we get in a month?”
I wonder how many Indian patients could afford to spend that kind of money for a gall bladder surgery, and keep quiet.
“I think you are getting late, doctor?”
“Sure, actually I am. I need to go to the bathroom to rub butt.”
Bottomline: if Intuitive Surgical, the maker of the da Vinci robot, are making millions, someone has to pay for their prosperity. Can we Indians do so? I don’t think so.