Category Archives: short essay

THE FAT LOSS PLATEAU AND BEYOND

Long post alert!

Many of you may not have realised (as I have not) that this blog has become one of the most Googled sources of fat loss info in the web.

Oh, sorry! I had initially set for this intro to the post to appear in 2025, so let us not move that far ahead. Restart (not you, moron)!

I am writing on fat loss because of the insistent demands of many of my wild-eyed fans like her. “Rambodoc”, they say in different accents, “When will you shine the light on my fat? When will I lose that handle around my waste waist so that I can start looking as young as you, you delishius hunk of meat, you..” And many, many words to that effect. No, Rads did not say any of this, but we can all expect her, as a mark of her eternal gratitude for this post, to send me one of her used 7-series BMWs or, if she feels cheap, the keys to a property in Manhattan (such low prices these days!) or somewhere. Anywhere, actually.

Okay, let us now get serious here. Restart.

Fat loss stops after the initial effort in a program of diet and/or exercise. This is common knowledge. Let us first see what are the reasons for the fat loss plateau:
1. You are not working out the right way.
2. You are working out the right way (maybe you even have a great coach) but you are not eating right.
3. You are eating less calories, working out long, but your metabolism is too slow, i.e., your body burns calories slowly. A common ‘note to self’ by women, men, older men and women, hypothyroid men and women, post-menopausal women, and some other groups we may have forgotten about.
In the next few thousand words (kidding!) I will give you the juice from the research of around 935 (again!) research articles without boring you to death with the sources.
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(Fat people are easily seen everywhere even in India)

Let us simplify issues: if your body needs 2000 calories as its basic metabolic demand (known as BMR or Basal Metabolic Rate), and if you spend another, say, 400 calories in your activities, then you would need to eat less than 2400 calories a day consistently to run a calorie deficit. Right? Many of us know that you will lose a kilogram of fat if you run up a calorie deficit of around 7000 calories. So, a 500 calorie deficit a day should result in the loss of one kilo of fat in two weeks. A pound a week. Clear?
There are lots of compounding issues to this simple equation, but you still have to keep touching base with this simple reality to achieve fat loss:
Calories burnt must be greater than calories eaten.
The most important way to accelerate fat loss is to eat less calories. Not in working out. Trainers are fond of saying that “you can’t out-train a bad diet”. Very true. Unless you are Michael Phelps who, at last Census, was not known to have met a fat loss plateau.
“Oh, no! He is going to talk of diets? Not again?!” Was that you saying that? Can you see me nodding my head sympathetically, like a politician at election time?
Some more basic truisms:

All diets work. But only for some time.
Diets don’t work by themselves in the long run.

What do we do then? Studies show that only 5 percent of people on a supervised diet manage to sustain weight loss. The rest fail. That includes you and me. Let us, therefore, rephrase this:

Diets don’t work; lifestyles do.
If you do lifestyle, you never feel that you are doing something special or stressful. It comes naturally.
What is this stupid, airy, hair-splitting, you ask?
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(a typical dinner of mine, and ALL mine!)

Many people (author included) follow a lifestyle where you mimic the lifestyle of primitive man (an animal who probably did not have obesity). Which means:
* Eat whole foods that are available in nature.
* Don’t eat processed foods (meaning colas, diet colas, bread, cake, pasta, noodles, biscuits, etcetera).
* Avoid grains (rice, wheat, corn, etc.) and artificial sugars.
* Don’t eat meals at a religious rhythm (like 3 meals a day or 6 meals a day).
* Mimic the movements of primitive man (imagine Caveman Rambo with a pointed object hunting a bore boar): sprinting, waiting, sprinting again, crawling, pulling, pushing (imagine wrestling the boar before killing it finally), lifting heavy weights (taking the hunt back to the cave) and then eating it. If he fails to kill it or find some other source, he starves till the next time.
How will you do this in your 9 to 5 life in the US, UK or India?
Easy. Try these:
1. Don’t jog or walk. Sprint (as if chased by a wild dog in heat) for a few short seconds (take 20-30). Rest for a while (as many seconds as you ran or even a minute). Repeat ten times, or six, depending on your ability. That, ladies and gentlemen, is called High Intensity Interval Training (HIIT) or the Tabata workout (Tabata kept a work:rest ratio of 2:1).
In other words, stop wasting time on those cardio machines in your gym or at home. Four to twenty minutes of hard effort (including the rest periods) is enough cardio for you. A month into this, watch yourself improve your stamina and reduce the inches gradually (remember, you have to give your body time- think of one or two years, in many cases).

2. Push or pull your body weight in major, compound exercises like pull-ups (most women I see are unable to do this unless they are well advanced in fitness), push-ups (keep doing ten more than yesterday), squats, and burpees (the best of them all, I think).

3. Stop doing machine-bound training. In other words, don’t waste time in isolation exercises like biceps curls, preacher curls, pectoral decks, ab trainers, etc. You are not going into a bodybuilding competition, are you? If you want maximum bang for your buck, do the bodyweight exercises above, and also do weight training (squats, deadlifts, or anything that involves pulling or pushing a free weight against gravity).

4. Don’t waste time on ab exercises. Do a couple of planks, holding on till you die. You will have done more than enough for your abs and core stability.

5. Didn’t I say ‘crawl‘?! Yes, I did.
You can do mountain climbers, which is not really crawling, or you can actually go on your hands and feet and climb the stairs, first straight up (head first) or reverse (feet first). This would double as a great cardio workout as well.

Anything else about these exercises? Lots, but suffice it to say that you should train harder than you think possible, and not merely go through the motions. Only then can you see results! Each workout should have a decent volume, which means you could do, for instance, three sets of ten reps for each exercise, with 30-60 seconds rest in between sets. Be strict with the rest periods, avoiding chatting and vacantly meditating.

Let us now move on to nutrition, the cornerstone of fat loss management.

Most people are eating way too much to see results. They are also not eating enough proteins, which reduces their muscle building abilities.
One way to address a fat-loss diet is to cut down on carbs (carbohydrates). This is one of the most tried and tested ways of achieving fat loss. Most of the benefits of a low-carb diet accrue from a total caloric deficit. If you are given the liberty of eating loads of fats and proteins (as in the Atkins diet), you won’t be able to eat all that much for too long. Result: lack of variety in foods leading to weight loss. Someone even lost weight on one month’s continual fast food (McDonald’s, etc.) diet!

Low carb diets are often difficult for many people to follow, for cultural and habit reasons. In such a scenario, losing weight is more difficult, but a caloric deficit needs to be created.

Eating six meals a day (a popular advice for most people) is largely impractical in the long term, not least because designing a diet with such low calories is difficult. Imagine a meal with only 300 calories, for example (if you need to eat six meals within a caloric budget of 1800)! In this regard, a more doable lifestyle is IF: Intermittent Fasting.
In IF, you fast through the day, and then eat within a four hour window. You can choose to fast once a week, or every day, for 15 hours, or 24 hours. Your choice. One of the big things going for IF is that celebrities (like myself) endorse it. I fast for 24 hours once a week, and 15 to 18 hours one or two more days in the week. IF is a lot of posts on its own merit, and check my resources at the end of this chapter post, if you want to learn more. Suffice it to say that it reduces blood insulin levels, is a great way to eat ‘normally’ and yet maintain a caloric deficit. I have found that on the days I fast and then eat in the four hour window, I can’t exceed 1400 calories (I don’t pig out with junk food)!

Does when you eat matter in your fat loss plateau?

Is fasted cardio better than cardio in fed state?

Is breakfast the best meal?!

Dinner is the best meal, and you should avoid breakfast like the plague!

Controversies, controversies! Forget all this, and stick to the basics:
eat clean, work out hard, and be happy. Get enough sleep. Drink less. Be active physically. Read fitness articles and blogs. Enough!

So, if we can sum up, how does one overcome the fat loss plateau?
Reassess your diet (definitely keep an online food journal like FitDay), start IF, train harder than you ever have, change the way you are training, avoid long duration aerobic cardio in lieu of High Intensity Interval Training. Take adequate rest and get enough sleep.

Blogs on Fitness/ Primal Living I silently follow (in no particular order at all):
1. Turbulence Training
2. Fitness Black Book
3. Brian Devlin
4. Health Habits
5. Tom Venuto
6. Caleb Lee
7. Straight To The Bar
8. Mark Sisson’s The Daily Apple
9. Muscle Hack
10. Go Healthy Go Fit
11. Alwyn Cosgrove
12. Son Of Grok
13. Robertson Training Systems
14. The Nate Green Experience
15. Gym Junkies

IF Resources:
1. Brad Pilon
2. The IF Life
3. Leangains

Science-based Nutrition/Fitness sites (heavier stuff):
1. Lyle Macdonald’s Bodyrecomposition
2. Alan Aragon
3. Dr. Michael Eades

I heartily recommend any and all of the above, and I think they contribute hugely to the needs of the public seeking help over the internet. I am also very grateful to them for their advice and availability for people like me and you. I am quite sure I am missing out on some of the others I read, but I hope I can include them later.

Disclaimer: I am not a Fitness or Nutrition guru. I use my medical knowledge and apply it to my personal quest for health and fitness. If you feel the need to heed my advice, you are welcome to, at your own discretion and risk. If you suffer from any physical or mental disease or infirmity, please consult your doctor and get properly (mis)guided!

SURGICAL EXPERIENCE

What is the foremost quality you look for when you are looking for a surgeon? Chances are most of you will say ‘experience’. If there is one thing young surgeons would envy older ones for, it is the fact that the latter are known to have experience.

Isn’t it a given that experience is good, then? Yes and no. Experience has made me a man. But it has also made me a sadder man. It has reduced my expectations from people and from life. It has made me harder and stronger (in the wrong places). It has tempered my emotions, but also made me less receptive to the emotions of others. Experience has not only made my arteries hard, but also my heart harder. It has made me a wiser, but balder, man.

Experience is the sum of one’s mistakes in life, they say. A more discerning person would say ‘no’. There are three kinds of experience:
First hand experience: you have been in battle, and are scarred. No one knows it better than you.
Second hand experience: you have studied the phenomenon of the experience and analysed it.
Third hand experience: you have heard of it from somewhere or someone.

Of the three, which would you prefer your doctor to have? Instinctively, I think we all would prefer to have had first hand experience of the various aspects of life. In the case we started out with (surgery), surgeons would all prefer to have seen complications and disasters in our own lives so as to avoid or solve them in future. This is the best thing for a doc, right? Wrong!

Though it is great for a doc to have first hand experience, it is perfectly likely that he would be biased or plain wrong in the lessons he has learnt from them. In a typical (hypothetical) case, a surgeon uses no mesh to repair his hernia cases because the one time he did use it in 1982, his patient got an infection and lots of problems. This is the main problem with first hand experience. While life must have taught a lesson to the doc, it might have taught him the wrong lesson!

Third hand experience is, obviously, of limited value: who knows what someone told you is right or wrong?
Which brings us to second hand experience.

If you have seen, observed and analysed someone do the right or wrong things, you will have learnt the right lessons. You don’t need to start off with a steep learning curve and create all the complications and make all the mistakes others before you had made. Because you have trained for it. Forewarned is forearmed. It is this second hand experience that is commonly called wisdom. So, it is better to be wise than to be experienced. Therefore, whether it comes to choosing a surgeon or a spouse, better chose a wise, rather than an experienced, one!
Finally, should you not choose a young surgeon? Remember, you can be young once, but you can be immature forever! Hence, young and trained is not a bad combination to have, especially in the present days of changing technology and evolving treatment methods.

(pic source: forgotten. Sorry!)

AN IMPATIENT PATIENT?

This blog author has been up to his usual tricks. The ones where he gets paid. And held accountable. No, not for giving ethereal physical pleasures to beautiful women with hour glass figures. The aforementioned never bills for such activity, as it is done with great reciprocal pleasure. Not to speak of the peculiarly perverse view of the world to it. In other words, I am referring to the tender, loving care of surgical patients. Result: no blogging time. No blog surfing time, etcetera.

Allow me some more blogulent digression:
Man is unique in some fundamental ways, compared to the rest of the animal kingdom. The one I am focussing on in this post is the fact that man is one animal whose tail is not much bigger than his head. Except some privileged women.

Well, this post is aimed to correct this human frailty. I will (for reasons of time) posit this very serious issue here, and I expect you, my dearers readers, to wax eloquent in your comments. I will chip in with my views somewhere in between. The beef of the post should reside in the comments!

A colleague in the Western world has a problem:
“Female 99 yrs old, self inflicted stab LUQ, CT scan confirms splenic laceration with extravasation of contrast. Mildly hypotensive – Patient says she ‘DOES NOT’ want an operation, did not want to come to hospital, ‘let me go, I want to die…..’, knows what she has done and where she is, understands that she will die without an operation.” She also takes aspirin, which makes blood thinner, and may increase bleeding. In other words, she has stabbed herself, and is going to bleed to death, unless the doctors operate on her.

Ambulance workers, her GP, and all concerned say she is compos mentis (of sound and reasonable state of mind). Her husband is not available.

What should the doctor do? Plus, what opinions do you have on aging and death?

Let’s hear your tail!

DEATH BY IMPOTENCE!

ED AND THE MALE WORLD

Erectile Dysfunction (ED), originally from the Latin Impotentia coeundi, is one of the major diseases of mankind, and can be loosely defined as an inability to achieve an erection for successful penetration.

In normal populations, the incidence of major Erectile Dysfunction (ED) is 5 to 20%. Even in the young, ED occurs in around 13%, according to a study on boys between 18 and 25 years. This is remarkable, because ED is known to be seen in older, not younger men, as a rule.

One of the most respected and cited studies on the epidemiology of erectile dysfunction is the Massachusetts Male Aging Study. The study showed that 52% of 1,290 men aged 40 to 70 years had some degree of dysfunction, and almost 10% had total absence of erectile function.

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A new article in The International Journal of Impotence Research has some interesting things to say, based on a large study on the sexual habits of more than four thousand men, both gay and straight.

Most men in the prime of their sexual lives (18 to 44 years) use no drugs for sex, while some do it for recreational use, and fewer because they need to use them medically.

The recreational use of ED drugs is increasing, and seems to have a negative effect. The study says that, on surveying the participants’ perceptions and self assessments after taking ED drugs, their confidence and performance suffered unless they took drugs again.

As lack of confidence in one’s ability to gain and hold erections has been identified as an important psychogenic risk factor for ED, the findings have important implications. Recreational users of ED medications may be vulnerable to becoming psychologically dependent on pharmacologically induced erection.

Therefore, the young kids out for a trip on Viagra are rooting for trouble!

WHO CARES ABOUT ED, A BORING MALE DISEASE?

ED is now more than an andrologist’s way of making bread. It is now a sentinel for a variety of diseases. What are they?

* ED may be the first symptom of coronary heart disease in a young man. In fact, ED is now considered a strong indicator of heart disease, with strong correlation as to severity. In other words, the more severe the heart disease, the greater the liability to be having ED. Men who have less than expected degree of erection, or have it only to lose it midway (lazy erections) are likely to have a cardiovascular cause of ED.

* ED may present in an undetected diabetic.

* It is seen in long-standing smokers, alcoholics (whiskey dick or brewers’ droop), and those with lipid disorders, prostatic diseases, etc.

* Evidence has linked hypertension to ED.

* Drugs used in the treatment of various diseases can also cause ED.

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IMPOTENCE IN INDIA

India has been called the country of unconsummated marriages because of the phenomenon of ‘honeymoon impotence’, when ED manifests on the first attempt. Impotence in India is mainly psychogenic, unlike the rest of the world, where three-fourths of cases are said to be due to organic, not psychological causes. Of course, once a man becomes impotent, he suffers enormous loss of confidence and self-image, leading to further performance anxiety. So the psychological overlay (no pun intended, for once) is also visible here.

HOW DOES ONE TREAT ED?

If you are a man facing ED, the sensible thing is not to hide it, but come out with it to a physician. Screening for hypertension, diabetes and heart disease will follow. Smoking should stop, as should excessive boozing.
Then what?
Based on what is wrong with the patient, the treatment is commenced.
Usually, drugs like Cialis (tadalafil) are the first line of treatment. Among the ED drugs, a lot has changed since Pfizer came out with Viagra. Leftist limpos: please note that Viagra was not invented by a Government pharma company.
Cialis (Tadalafil) is now a preferred drug for ED patients. It works for 36 hours, can be taken irrespective of food, and one does not need to time the drug intake with sex, thereby making for a better experience. In contrast, Viagra (sildenafil) works for only four hours and needs to be taken half an hour or so before sex.
In some cases, the doctor may advise the patient to inject a substance like papaverine or a prostaglandin (Alprostadil) into the penis just before sex. Rigidity is best achieved with injections.
In psychological cases (performance anxiety, depression, schizophrenia, etc.), counselling and appropriate treatment is advised.
Specific cases where the penis loses rigidity due to blood leaking from the veins respond well to vacuum suction devices.

SURGERY FOR IMPOTENCE?

In a small percentage of cases, where there is no response to any of the above, the andrologist might consider implants. These are devices that are implanted inside the penis (and partly in the scrotum). One device (essentially a semi-rigid rod of silicone with metal wires), called the AMS prosthesis, may lead to a permanent semi-erect state. In India, it costs around 60,000 rupees (around 1150 USD). A local version has been made by andrologist Rupin Shah and costs only Rs. 10,000 ($250). The better prostheses (e.g., the three-part inflatable AMS prosthesis) enable erection only during sex (on demand). A pump (implanted in the scrotum) needs to be activated to push in fluid inside an implant in the penis. The implant fills with water, and the penis becomes hard. This costs around Rs.220,000 ($5050).

One problem with the penile implant is that any infection is disastrous, leads to removal of the device, and permanent impotence. Hard luck!

It should also be remembered that any treatment of ED, like drugs or injections, may cause a persistent, painful, permanent state of erection, called priapism. This condition is an emergency.
Unless treated within four hours, it leads to permanent impotence.

To sum up, a man’s inability to achieve a satisfactory erection is not a laughing matter. It may be a sign of serious underlying disease which can eventually kill him.

Note: pictures are mine!

TWELVE THINGS I HATE ABOUT WOMEN

I have this incredible tectonic, platonic love for women, as readers of this blog must have sensed by now. However, there are certain things about certain women that put me off.

1. Women with dirty navels: The ultimate revulsion. This hatred must be something I got from the time I was attached to an umbilical cord! As a laparoscopic surgeon, I am, um, bilious about the unclean umbilicus, one that strikes a chord in me.

2. Women with garlic or onion in their breath: this is a real no-brainer. Who likes ‘em? If a girl smells leek this, I spring away: my light bulb movement. As far as these women are concerned, I know my onions.

3. Women with male genitals: I somehow can’t seem to gonad gomad about their confusing plumbing system.

4. Bad English: call me snobbish, but I like women who speak good English, and have long been a lingo-raj for the Queen, her English, I mean! I have no problems with women who don’t speak English at all.

5. Women who can get hysterical: Hysteria is, etymologically, a disease which springs from the woman’s uterus (hysteros). I believe it. A hysterical woman is bad all the way inside. Avoid, dude!

6. Obsessively clean women: Married to one myself, I can speak on this with messive authority. They have a reason to find fault with you for every little thing you do:
“Why have you kept the chocolate wrappers and the orange peels on the bed? There are ants all over the place!” Well, idiotic, won’t you say? As if I invited all the ants over for dessert or something!

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“Why are you eating here? Look how much of sauce you have spilt here. Oh, my Gawd, you have kept the banana peel and the apple core on the table, like this? How horribly dirty you are! Get up, get up right now, that glass of water is just going to fall!”

You get the idea. She could drive me up the wall. Only that I can’t climb it because a bowl of soup landed on it last night as I was showing my son how to hit an extra-cover drive, forgetting that the bat was a bowl of soup, and a large one at that. She asked me, as the tallest member of the family, to clean it, but I told her, “Are you kiddin’ me? With Yuvraj batting like this?! Tomorrow is a Sunday, and tell me then.” This morning, she has been after my ass to complete the job, but it’s amazing how inconsiderate and lacking in understanding some women can be, isn’t it? Sourav Ganguly is batting now, I have three newspapers to read (with their supplements), I have so many blogs to visit, so many comments to defend, so many mails to read. Sigh. It will take me till lunchtime to get free. After which I will do it. Only if there is no movie I am forced to watch….

7. Organised women: Yes, once again, as one married to an organised woman, I can tell you they are serious risk factors for one’s healthy heart rate and rhythm. You keep a very hot phone number, flavored with a wee hint of lipstick, which you have jotted down on the reverse of a bill for the petrol you bought last week, and when you want to find it next week, it is not there. Why? The obsessive organiser has thrown it into the trash! How much injustice does a man have to suffer, tell me?! One can’t live life if one’s important phone numbers are trashed as if they have no importance in one’s own house. I have decided not to take this lying down. From now on, I am going to start writing the numbers on the wall with my son’s crayons. Let’s see what she does about that!

Are you actually thinking of asking me to get an organiser or diary? Huh. Silly things don’t work, and diaries are for sissies, anyways. No man with baseline levels of testosterone will ever stop writing on chits of paper, leaving them in the organised free market of his study table.

8. Jewelry-obsessed women: I am fine with a woman wearing a single pendant on a silk or leather thread. But never trust a woman who buys gold and diamonds on the specious plea that they are investments for the future. Never. If ever you get to the future and wish to redeem your investment, said woman and attached mother will rain on you like popcorn from a fat man choking on a mouthful when sitting behind you at a movie. Sell off jewelry?! Dhishhum, dhishhum! Bang! Crrash!!

9. Young women with BO: I have, over the years, learned to distinguish the various types of body odor in women and men. I will, perhaps, classify them one day for posterity. Readers may recall my earlier olfactory ordeals.
The typical BO is one of honest sweat, accentuated by local global warming. It is redolent of acidic, even rancid flavors (like French Blue Cheese), and goes well with crackers and wine, or even as a dressing. I meant the cheese, not the girl. Talking of which, these girls seem to be fond of fish, and avoid vegetables, too, for balance. Any woman who leaves an elevator before I enter it has it, somehow. Medical representatives, girls working in malls, girls assisting dentists, etc. are some of the brand ambassadors of BO.

10. The Delhi Police type of woman:
Imagine me sitting in the bedroom with my Mac, and WonderWoman comes in and asks me to shift because it needs dusting and cleaning. Once I shift to the den and start watching the cricket match, she comes in and says that the curtains and sheets are going to be changed, and I need to shift somewhere else. How inconsiderate can a woman be! A man can’t rest in peace without being treated like a hawker on the streets of Kolkata driven from road to road by a corrupt cop?!

11. The dirty, unorganised woman: A woman with chipped nails or one that throws things around carelessly, is just not my type. An irritating thing about her is her cell phone. She gets a call, and it rings inside her large handbag. One can then see, while the strains of a Hindi song call-her tune fill the room increasingly threateningly, the entire contents of the handbag: comb, papers, a coin purse, lipstick, compact case, migraine pills, spare sanitary pad, keys with extra-large keychain of Popeye (or Garfield or Mickey or Jerry), before the cellphone is dug out by its bejewelled chain. Why can’t these ladies keep the phone where they can always find them before driving others crazy with their bad taste in music? Where would they keep it, you ask? Why, they could hang it around the neck, so that the phone rests in the inter-mammary fold, always accessible….

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(pic: http://femailcreations.com/products/sku-51402.html)

12. A submissive woman: A woman of character should make up her own mind. She doesn’t act as a Yes-girl for her husband or her father. Supposed to be an endangered species in urban India. I have, somehow, never met this species of womanhood. All the women who have loved me have been on top of their relationship, nice, submissive guy that I am!

If I have missed out, tell me about it, guys! Ladies, what are your reactions?

IS THE NEJM A LEFTIST MAG?

The New England Journal of Medicine has published, today, a few leading articles on the subject of child obesity, especially its implications for heart disease and the costs thereof to society. For more on childhood obesity, see my previous post.
The Journal pontificates on the subject and calls for action:

Unfortunately, the U.S. government has thus far invested only a fraction of a cent in research for every dollar that obesity costs society. And although broad consensus exists regarding the dietary and lifestyle habits needed to prevent and treat childhood obesity, we lack anything resembling a comprehensive strategy for encouraging children to eat a healthful diet and engage in physical activity. Such a strategy would include legislation that regulates junk-food advertising, provides adequate funding for decent lunches and regular physical activities at school, restructures the farm-subsidies program to favor nutrient-dense rather than calorie-dense produce, and mandates insurance coverage for preventing and treating pediatric obesity.

In other words, what it is saying is that the responsibility for some kids becoming fat should be shared by all of society, and that no kid should be exposed freely to a Macdonald’s burger or French fries. Not even an ad of the same.

It is, therefore, suggesting that tax money be spent on providing nutritious lunches in schools, and providing gyms and playgrounds for the kids. In addition, it is advocating insurance for all kids. The question I have for the learned journal is: Who is going to pay for it? And why?
Can one dare ask the high-and-mighty Journal, “What gives you the right to assume that State-funded care is all that is possible to tackle healthcare issues? As far as the issue of taxing people for these services, may I ask: By what right?”
What gives an obese kid (or anyone else, for that matter) the right to be a recipient of a part of my hard-earned money, unless I choose to do so?

The Journal assumes a Socialist position on healthcare rather casually.

Elsewhere in the same issue, it thunders on the cough preparations for children (that have been scientifically proven to be useless) and calls for banning them or, at the least, banning the ads. In other words, if your child has a persistent cough, and you want him or her to just take a bit of cough syrup and sleep it off, you don’t have the right. They have the right to stop you. You, the user, can do nothing. You see, you don’t have the brains to know which is good for your kid, or which ad to believe and which one to dismiss as crap. The Government will do this thinking for you.

To get back to the issue of child obesity, the most important things are for each of us to choose consciously what we need to do: watch less television, avoid junk food, and play or work out every day, for example. I accept that all this is easily said, but not done. The responsibility and the outcome squarely rests on the individual, his parent and his doctor.

The NEJM would have none of this. It would want everyone to be deprived of their choices (ads and junk food) just so that some of society would benefit. It is a moot point if any of these interventions will ever work on a large scale in society.
It gets shrill as it raises its political voice:

But why should Mr. and Ms. G.’s efforts to protect their children from life-threatening illness be undermined by massive marketing campaigns from the manufacturers of junk food? Why are their children subjected to the temptation of such food in the school cafeteria and vending machines? Why don’t they have the opportunity to exercise their bodies during the school day? And why must Mr. and Ms. G. fight with their insurance company for reimbursement to cover the costs of their children’s care at the OWL clinic?

Hello, did we hear right? We are all subjected to temptation. I want to be subjected to temptation: do I have a right or not? The NEJM says no, because temptation is bad for kids, at least some kids.

Isn’t a defence against rape to the effect that “she tempted me, it wasn’t my fault!”? So where is the concept of free will here? Where is the parental or school responsibility for the health of the children? Who, gentlemen, are going to pay for those ‘opportunities’ that you demand?

Every modern health problem seems to inspire Statist solutions, irrespective of the fact that State control in anything has not worked anywhere as well as capitalist solutions. Unfortunately, people living in First World countries and occupying prestigious chairs in the NEJM have not (possibly) seen the ground reality of Socialism in healthcare. They need look no further than India.

I wish to ask one final question to the Editors of the NEJM: Is the NEJM a leftist journal mag?

CHILDHOOD OBESITY: THE COMING OF AN EPIDEMIC

Children are getting fatter. Seriously fatter. To the extent that they are getting all sorts of major, adult-type ailments like diabetes, hypertension, heart disease, acid reflux, orthopedic problems, psychiatric problems, sleep apnea, etc. These kids are not a tiny minority. In the West, they are around a third of all kids.

In Indian society, 70% of kids are too thin to be called normal. Amongst Indian children obesity affects, almost exclusively, urban kids. In several studies, the incidence of weight problems (mild to severe) in urban Indian kids has been as high as 30 percent. In the West, a third of the children are already obese, and around 80% of these are likely to grow up into fat adults. The incidence is expected to grow (more in minorities and the poor), and the obesity epidemic has three phases.

Quote from the New England Journal of Medicine:

Phase 1 began in the early 1970s and is ongoing: average weight is progressively increasing among children from all socioeconomic levels, racial and ethnic groups, and regions of the country.
Though it has attracted much attention from the medical profession and the public, childhood obesity during this phase has actually had little effect on public health, because an obese child may remain relatively healthy for years.

Phase 2, which we are now entering, is characterized by the emergence of serious weight-related problems. The diabetes, the bone problems, the psychiatric problems I mentioned initially are all part of this phase.

It may take many years to reach phase 3 of the epidemic, in which the medical complications of obesity lead to life-threatening disease.
By 2035, the prevalence of CHD (Coronary Heart Disease) will have increased by 5 to 16%, with more than 100,000 excess cases attributable to increased obesity among today’s adolescents. Preliminary data from Canada suggest that adolescents with type 2 diabetes will be at high risk for limb amputation, kidney failure requiring dialysis, and premature death.
Shockingly, the risk of dying by middle age is already two to three times as high among obese adolescent girls as it is among those of normal weight.

In Phase 4 permanent, possibly genetic changes in the body will occur and result in a cohort of hungry, fat people of all ages.

The NEJM likens this epidemic to the global warming theory, but with easier solutions.

For more on adolescent and child obesity, click here (old post of mine).

THERE ARE LOTS OF SUBSTITUTES FOR HARD WORK!

My twelve year-old son is presenting a debate in favor of the motion: “THERE ARE LOTS OF SUBSTITUTES FOR HARD WORK!”
I present his thesis for your disapproval.
Start speech.

Let us look at what one would do hard work for.
A story first.
A man was lying under a tree, listening to the sound of singing birds.
Another man came by and accosted him: “Why don’t you go and do some hard work?”
“And then do what?”
“Then you can get a good job, and earn a lot of money.”
“And then do what?”
“Then you can eat well, sleep well, and enjoy your life!”
“What do you think I am doing now?”

So, friends, life is not all about hard work.

Let us say a word in favor of the opposite concept: laziness.

Now, people tend to look down on lazy people (like me) but, with my vast experience, let me tell you, laziness is no bunny-job. Try doing NOTHING. Just try it. You will instantly give it up. If you practise long and hard, and get really lazy, maybe the Guinness Book people will recognise you for record-breaking levels of doing nothing, and you could make a pot of money and get immortalised in the record books.

In addition, if we all got lazy, and did nothing, we would emit less heat. We would reduce so much of the heat that is part of Global Warming these days! If we all become citizens of Lazipore, our successful reduction of atmospheric temperatures could inspire a documentary by National Geographic channel or somebody. How far is a Nobel Prize away from this point? Only a few more sleepy days!

So, how about laziness as a substitute for hard work?

Not that there aren’t more of these.

I strongly recommend bathroom singing as a replacement for hard work. Bathroom singing can drive out all the rats and cockroaches from your house, if you can learn to sing like me. Why, by doing so, I have successfully driven out even the stray dogs and cats in my street! Now, you no longer run the risk of getting bitten on your backside if you want to come home to give me an iPod or something. So, no pesticides, no injections, just some songs, Bollywood at its, er, best. The animal rights people won’t exactly be unhappy!

Watch cartoons, too! Science is now saying that kids who watch TV are more likely to be smarter and cleverer, and their reflexes are faster. So, can hard work do this for you? Probably, but with such a better option, who cares?

I had planned to list a few more substitutes to talk about, but I didn’t have time. Too busy lazing around, you see?! Laziness at my level is a lot of hard work!
While there are substitutes for hard work, there is no substitute to laziness!

End speech.

MAN, MONEY AND MALARIA

Wait, wait, wait!” I told myself,“You are not going to drive out your readership by talking about malaria, of all things, are you? Write on things you know well, like the bathroom habits of boozed-out businessmen and sober socialites. Write on how bad other doctors are, compared to you. Etcetera.”

wjs-pic.jpg

A recent paper published in the World Journal of Surgery interested me. First of all, the author’s name was familiar. In fact, I had written a blog post on one of his publications and scoffed at his pretentiousness.
This time, however, I wondered what his beef was. What was a surgeon trying to do by publishing an edit piece in the World Journal of Surgery on a very old medical disease like malaria?
My twisted mind told me that this was no scholarly treatise on the disease. Rather, underneath the medical jargon, there was a scathing indictment of Governments and world bodies like the WHO, and a hot story involving money, politics, global warming, the environment, and sex. Okay, not the last, but I thought I should raise your hopes a bit before I proceed.

A global perspective on malaria reveals that:
* It affects around 40% of the world’s population.
* Around 500 million cases of malaria occur every year (about 10 cases per second).
* 1 to 3 million children die of this disease annually. One could translate that to a death of one child every 30 seconds. Most deaths occur among young children in tropical Africa.

The author, perhaps, felt a need to justify writing on this topic:

……why do Third World surgeons and internists care so much for what, after all, is another ‘‘bug’’ for which cures have been discovered and Nobel Prizes long conferred? The question is answered by looking from the past to the future of malaria.
Malaria has defied all the predictions and plans of organizations such as the World Health Organization (WHO) by staging a massive comeback from the brink of extinction during the 1960s and 1970s. According to many public health experts, environmentalists must bear a significant burden of guilt for this owing to their campaign against the pesticide DDT. This agent removed malaria from endemic areas such as the United States (in 1951) before its use was almost banned a decade later for suspected (though unproven) damage to animals and humans. The use of DDT led to massive drops in the number of malaria cases, and the end of its use led to a massive resurgence.

Damn, damn, damn! Someone was actually attacking environmentalists?! WTF?
Actually, DDT was banned after Rachel Carson, in Silent Spring (1962), accused it of a range of dangers to human health (notably cancer), to the ecosystem and to thinning the eggshells of bald eagles. Ted Lapkin claims that “no scientific peer-reviewed study has ever replicated any case of negative human health impacts from DDT”.
He asserts that of all Carson’s charges “the only contention that has been scientifically proved is the thinning effect DDT has on the eggshells of predatory birds”. Several others have trashed Carson’s contention.


Bjorn Lomborg (The Skeptical Environmentalist)
:

Our intake of coffee is about 50 times more carcinogenic than our intake of DDT before it was banned…the cancer risk for DDT is about 0.00008 per cent.

Ted Lapkin:

(DDT is) still widely regarded as the single most powerful weapon at our disposal in the war against malaria and its disuse has been a scandal of public policy.

Author Michael Crichton:

Banning DDT is one of the most disgraceful episodes in the 20th century history of America.

It has even been speculated that the DDT ban (with the resultant deaths from resurgence of malaria) has been a Western ploy to control the population growth of the developing countries.

The environmentalists scoff disdainfully at the opposition, arguing that there are better alternatives to DDT, and that resistance of the malaria parasite to DDT was the main reason the world chose to ban DDT.

Crichton indicts the West, and especially the environmentalists. Take this quote from an article:

For Crichton, the most imperative of contemporary challenges is to retrieve responsible environmentalism from the clutches of those zealots for whom it has become a substitute faith….
“I am thoroughly sick of politicised so-called facts that simply aren’t true. It isn’t that these ‘facts’ are exaggerations of an underlying truth. Nor is it that certain organisations are spinning their case… in the strongest way. Not at all — what more and more groups are doing is putting out lies, pure and simple. Falsehoods that they know to be false. This trend began with the DDT campaign and persists to this day.”

Crichton estimates that between 10 and 30 million poor people of Asia and Africa have died because of aggressive environmentalism.

According to the WJS article, the return of malaria stems from several issues that, in turn, stem from interventionist Government business policies. Weak drug patency laws in Asian (including China, Thailand, and Cambodia) and African countries led to spurious chloroquine (the curative drug for malaria at the time) flooding the markets. The malaria parasite quickly became resistant to the drug. In spite of this, for long years, the WHO continued to push the drug as the main weapon against the bug.

So how much money is needed to fight malaria? The Bill Gates Foundation is at it, as is the WHO with its Roll Back Malaria program.

According to the WHO, around $2 billion per year is
required to halve the disease burden by 2010.

The WJS article quotes studies that trash the premise of this assessment:

Critics assert that public health spending and injection of foreign capital do not result in desired results. Filmer and Pritchett (1999) showed that although mortality in very young children could be massively reduced in the poorest countries by spending only $10 per child, the actual amount spent by governments to spare one child death is an incredible US $50,000 to $100,000. Among the several reasons for this, a couple are worth mentioning.
Public health agencies are inefficient and corrupt, with only a fraction (30–70%) of funds ending up in the community, and aid-financed drugs are sold in the black market. In addition, the presence of free public health
services drives out the private sector, resulting in a slothful monopoly in the health services
, a fact known to the people of Africa and Asia.

So, if pouring tax money on malaria prevention and control is not going to work, what is?
The article ends off lamely by saying:

Malaria, a disease that has survived a million years,
cannot be eliminated unless humankind eradicates what the
American playwright Eugene O’Neill called ‘‘the most
deadly and prevalent of all diseases’’—poverty.

There are very cogent arguments in scholarly studies that espouse a free market society as the ultimate solution to curb the ravage of malaria. The most wretchedly poor and socialist countries are the ones most affected by malaria.

Capitalism (as the most successful wealth-creating system) as malaria vaccine. Some concept, isn’t it?

WRITER’S CAMP

Nita, the Meme Sahib of our blogging community, has tagged me. For some reason, indubitably related to a chronic intake of the toxin-laden waters of Mumbai, she has this delusion (or hallucination, whichever is whatever) that I can write, and things like that.

Well, one must not disrespectfully treat a lady these days, unless one is an Indian policeman.

So here I am, deliberating on a subject I know little about. Therefore I shall proceed to write with the utmost confidence on it. As always.

A writer should have many qualities, but let me say what qualities I have always considered necessary for me to develop or nourish. Pardon me for sounding tastelessly didactic, pompous and verbose. Use the comments section freely for abuse, none of which will ever be deleted.

TEN TIPS FOR BITTER REWORDS IN WRITING:

1. Write in short sentences, or use long ones only when sure your long sentence is unavoidable, tantalising, magnetically mesmerizing in its complexity. Then you delete it.

2. Write because you love to. Write on things that you care about. Or don’t.

3. Never be afraid of writing on anything. Even if the article is as scary as committing to posterity your limited mono-neuronic understanding of the art of writing.

4. For humorous writing, you must possess an abundance of imagination. The wilder the better. But the zany figures of speech should strike a chord in the reader. Or you will sound like a broken cord.

5. Just when one starts to take one’s writing seriously, one realises that one is committing a multitude of blunders in the structure. In other words (especially if you are a smartass officially numbered in the last Census), reassess your prose.
It is quite a useful experience to have worked with an editor-type in a newspaper. Aeons back, I had a girlfriend who used to edit stuff, and I learned some valuable things from her. At that time, I did not even know that it was a given to press the spacebar after a full stop or comma, for example. Once you know what the newspaperwallahs want you not to do, then you get out of it and start blogging.

6. Write on a regular basis. Writing is like potty training. Unless you sit every day and go through the motions, the smoothness in flow is never going to be achieved, even if you burst a blood vessel trying. A lot of such efforts are unfit for human consumption (to stretch the pungent figure of speech), but it will all count later. And did I say that one thing not to do is to torture figures of speech just so that they can fit in your sentence?

7. While those who write do know that it is necessary to spend time on your creation, it is important to know what those minutes and hours are to be used for.
So, use time for:
*reading
*research
*re-doing
Actually, this is well known to everyone. But I just wrote this up to complete point number seven. I wish to underline how important it is to use a round figure (like the ten points here) to impress on your readership how scientific and thorough you are.

8. Control of language. This is one thing I feel so deficient of (Another point: never let a preposition end a sentence with). There are writers who are capable of notable fluency and flow ( like an infant peeing just when you have changed the bedsheets and nappies, and barely closed your eyes to the cruel, wet world). And they can do it again and again. Did you notice how I never use ‘And’ to start a sentence?

9. Take your writing and your diction seriously. If you are not careful of your spilling, your metaphors, and those other thingies that are called adverbs, punctuations, etc., chances are your readers will treat it the same. And never preach to your readership. Also, when you feel that insane urge to highlight, underline or italicise what you think are particularly clever passages, just do one of the things that can save the world from a population explosion: desist, withdraw, and, if you didn’t get this particular message, abstain. Readers don’t consider this in good taste, and think you are a loud, tasteless fool. Not me, but you.

10. More imagination: use your mind to bring in analogies between the most bizarre or the most logical, depending on if you think a donkey looks better in tails or in pajamas.

I end this Foolitzer-nominated post by tagging Ergo and Krishashok to tell us, if you can, a thing or two about your particular impression of the art of writing. Ergo brings a philosophical depth and clarity in his deliberations on abstract profundities. Ashok, though not a professional writer, can bring a levity to even a pan pizza. He is seriously funny and creative, though his particular genre of language is a sort of Tamil-English hybrid.
Here is to you, guys!