A pioneer in biotechnology

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Har Gobind Khorana is credited with making the first synthetic genes by cutting and pasting DNA bits

Who was Har Gobind Khorana?

Nobel Laureate Har Gobind Khorana’s contributions to biology are of contemporary relevance for some of the most exciting areas such as synthetic biology and gene editing. A Google Doodle on Tuesday to mark the 96th birth anniversary of the Indian-origin American scientist this week stoked much interest in his work.

What were his contributions to biology?

After James Watson and Francis Crick found that DNA (De-oxy ribonucleic acid) had a double-helix structure, Khorana was among those who significantly built on that knowledge and explained how this sequence of nucleic acids (better known as the genetic code) goes about making proteins, which is critical to the functioning of cells. The Nobel Prize in Physiology or Medicine for 1968 was awarded jointly to Robert W. Holley, Har Gobind Khorana and Marshall W. Nirenberg “for their interpretation of the genetic code and its function in protein synthesis.” Khorana was able to create nucleic acids in the lab and did so by figuring out the order in which nucleotides needed to be to make a suite of amino acids, which are the basic units of proteins.

Khorana is credited with making the first synthetic genes by cutting and pasting different bits of DNA together. This is considered a forerunner to the method called Polymerase Chain Reaction that is among the methods used to commercially read the unique genetic structures of organisms today. He further placed the lab-made gene in a living bacterium and was, in that sense, a founding father of biotechnology. The CRISPR/Cas9 system, which is the glitziest new toy in genetics and is used alter the functioning of certain genes, references the work of Khorana as a key influence.

What was his connection with India?

Khorana was born in 1922 in Raipur, a village in Punjab now part of Pakistan. He was the youngest of six siblings and his father was a ‘patwari’, a village agricultural taxation clerk in the British Indian system of government. He lived in India until 1945, when the award of a Government of India Fellowship made it possible for him to go to England for a PhD at the University of Liverpool. Khorana became a naturalised U.S. citizen in 1966.

The life of a remarkable fighter and survivor

This doctor’s life, against the odds of kidney disease, ought to be a beacon of hope for all in similar circumstances

Dr. Georgi Abraham

Robin Eady, dermatologist and survivor extraordinaire, created a record for the longest number of years on dialysis, before he got a kidney transplant. When he passed away in August 2017 at the age of 76, he left a legacy of hope, motivation and determination for millions of renal failure patients, as the longest surviving kidney patient in the world. The Royal Society of Medicine in London dedicated an evening to celebrate his remarkable life.

Born in Egypt in 1940, Robin enjoyed a relatively privileged childhood and early youth, before being diagnosed with kidney failure at 23. He was given just a few months to live. Ground-breaking advances in medical science and access to treatment at the right time, together with his resolve to hang on to his health against all odds, made it possible for him to live a full life. That included the pursuit of an eminent professional career.

Ian Reekie, who started medical training with Robin Eady in 1959 at Guy’s Hospital in London, became his close friend. At the Royal Society event, Dr. Reekie recalled the onset of Robin’s disease in 1962 and admission to Hammersmith Hospital. Dialysis was not available then in the U.K. or the rest of Europe, and the future seemed hopeless. Robin’s parents had read about the ground-breaking procedure that Dr. Belding Scribner had started in Seattle, U.S., and got Robin accepted for treatment. Robin spent two years in the U.S. and Canada and finally returned to London to continue dialysis at the Royal Free Hospital in Hampstead under Dr. Stanley Shaldon.

Joy Bennett, who started nursing with Ann (and who became Robin’s wife), worked on the renal unit at the Royal Free Hospital. She remembers the arrival of Robin who had just come from Canada: he was not only self-sufficient but knew a lot about dialysis. Robin made it clear he would continue with his medical studies.

After Ann and Robin married, Joy and her husband Adrian remained friends, especially after Robin’s transplant in 1987, when dietary restrictions he had endured for years were lifted! Up until his transplant, Robin was the person who had survived the longest on dialysis.

Alastair Heath could be called Robin’s kidney-twin, as they were jointly the beneficiaries of a young woman donor. When the transplant took place, Robin had been on dialysis for 25 years, 19 of which were at home. This was not Alastair’s experience, however, as he had not been on dialysis. The ‘twins’ met annually to remember their good fortune.

As an eminent dermatologist, Robin is remembered for his innovative research into EB (Epidermolysis bullosa), that causes blisters. He passed his professional examinations during his time on dialysis. He was awarded an honorary fellowship of the Royal College of Medicine, a fellowship of the Academy of Medical Sciences and an MBE for services to charity and medical science.

Appreciating his own good fortune, Robin travelled the world, talking to various organisations as a survivor of dialysis, and in addition to recording his own experiences, he never failed to inspire others about the possibility not just of recovery but of returning to work and enjoying all that life has to offer.

Delivering the Krishnan-Ang endowment lecture organised by the TANKER (Tamilnadu Kidney Research Foundation) in Chennai in February 2010, he said, “After 47 years of coping with renal replacement therapy, I can say good family back-up and being a bit selfish about one’s own needs does help.”

Robin died in London following heart surgery.

Dr. Georgi Abraham is a nephrologist based in Chennai

Prescription for the future

The National Medical Commission Bill, aimed at reforming Indian medical education and practice, is in trouble. After countrywide protests by the Indian Medical Association, the Bill was referred by the Lok Sabha to a Parliamentary Standing Committee for a re-look. Whatever be the outcome of this exercise, the altered Bill is unlikely to please everyone.

This is because the questions it seeks to address are knotty, with no straightforward answers. First, how can India produce enough competent doctors to meet its evolving health-care challenges? Second, how can it minimise opportunities for rent-seeking in medical education and practice? So poorly did India’s current medical regulator, the Medical Council of India (MCI), perform on both counts that policymakers believed the only way to redeem the body was to replace it.

MCI’s failures

The MCI’s failures are well known. For years, it was mired in allegations of bribery and going soft on unethical doctors. Under its stewardship, the medical curriculum grew obsolete, resulting in a cadre of MBBS doctors who frequently couldn’t perform basic procedures. This led to a rush among MBBS doctors to specialise, competing for a small number of post-graduation seats. Today, India neither has enough basic doctors, nor specialists.

Enter the National Medical Commission (NMC), intended by policymakers to be a dynamic regulator responsive to India’s needs, unlike the opaque MCI. In contrast with the MCI, which does everything from advising universities on curriculum to disciplining errant doctors, the NMC distributes powers among four autonomous boards — those for undergraduate education, postgraduate education, medical assessment and rating, and ethics and registration. Also, unlike the MCI, the commission includes non-doctors like patient-rights advocates and ethicists, in line with the medical regulators of the U.K., Australia and Canada. These are all steps in the right direction.

Where the NMC bill trips up is in how it chooses the members of the new regulator. The authors of the NMC bill, a committee headed by ex-vice chairman of Niti Aayog, Arvind Panagariya, argued that the electoral process through which MCI members were picked was fundamentally flawed, because conscientious doctors tended to avoid such elections. Because there was no bar on re-elections, this had created a revolving door through which the same group of members controlled the MCI for years. Sometime around 2008, Gujarati urologist Ketan Desai was elected MCI president, even though he had been prosecuted in the Delhi High Court for abusing power as president in 2001. Further, corruption charges against Dr. Desai and his team led to the MCI being disbanded in 2010.

The NMC Bill’s solution to the pitfalls of the electoral process is for the central government to select most of the commission’s members. But this would tip the scales towards bureaucracy, say experts. “The babudom is now extreme,” says Rama Baru, a health-policy researcher who served on the ethics committee of the MCI between 2012 and 2014. Such political hold on the commission is especially problematic, she adds, given the close ties that private medical colleges in southern India have with politicians. Ms. Baru is in favour of more elected members in the commission, but with limited terms of office, so that corrupt members aren’t re-elected.

Another option to keep the NMC free from political influence is for an independent body like the Union Public Service Commission to select its members, says Sujatha K. Rao, a former Union Health Secretary. Such a model is followed in the U.K., where the Professional Standards Authority oversees the selection of members to the General Medical Council. Whatever route the NMC takes, it is critical that its members are professionals of high integrity, something that isn’t ensured in the current Bill. “Any law will succeed if it is implemented by good people. The best law, if implemented by corrupt people, can fail,” says Ms. Rao.

Shortage of doctors

The NMC Bill also misses an opportunity to plan for India’s rural health- care needs in the coming decades. While it eases regulations to set up private medical colleges, a move that will hopefully produce more doctors, this measure isn’t enough. As of today, India has one doctor for 1,700 people, compared to the WHO norm of 1:1,000. Most of these doctors are in urban regions, while close to 70% of Indians live in rural provinces. This gap isn’t going to close any time soon. A 2015 Parliamentary Standing Committee report mentioned that even if India were to add 100 medical colleges per year for five years, it would take till 2029 to achieve the WHO prescribed ratio.

Even in States like Tamil Nadu, which has successfully attracted doctors to rural primary health centres (PHCs), tribal regions like Sittilingi are underserved and rely heavily on informal health-care providers, says Meenakshi Gautham, a health policy researcher at the London School of Hygiene and Tropical medicine. This is why India must think of quicker fixes to the doctor shortage instead of waiting for MBBS doctors to fill the gap. “We can’t ask populations here to wait for ten years till we produce enough doctors. Neither can we wait for rural areas to become urbanised,” she reasons.

Training non-doctors

Several sub-Saharan countries have successfully addressed this problem by training non-doctors in basic medicine and even surgery. Such non-doctors include nurses, or even informal health-care providers, often referred to as quacks. A 2016 study published in Science magazine showed that nine months of training led to a marked improvement in the ability of informal providers in West Bengal to correctly manage chest-pain, respiratory distress and childhood diarrhoea. International organisations like Médecins Sans Frontières and Red Cross have endorsed training programmes for non-doctors to carry out critical surgical procedures like caesarians and intestinal resections. Evidence from countries like Mozambique and Thailand shows that such training can be a safe, effective and cheap way to provide life-saving health care when no doctors are available. This is why even Chhattisgarh attempted to create a cadre of rural doctors in 2001, through a three-year programme. Even though the Indian Medical Association has strongly opposed such ideas, they cannot be off the table, given the evidence backing them. Ms. Gautham says it is time to recognise that MBBS doctors may not be the best means of health-care delivery in isolated parts of rural India. The NMC Bill should, at the very least, include a provision to debate this idea.

The 1956 Indian Medical Council Act, under which the MCI in its current form came to life, set the agenda for nearly 60 years of medical education and practice. The NMC Bill could do the same for the next few decades. If policymakers do not address the many questions that health-care experts have raised over the Bill today, they will miss their chance at truly game-changing reform.

Miss World 2017 to focus on menstrual hygiene

manushiNewly crowned Miss World, 20-year-old Manushi Chhillar, is using her medical background to focus much-needed attention on an issue that is often regarded in Indian society as a subject that is taboo.

At a media interaction on Monday, Chhillar said, “There are very basic things about menstrual hygiene that people are unaware about. One year into medical college, during my project to create awareness about it, I realised that education alone wasn’t enough. We needed to give them a sustainable system women could follow to practise menstrual hygiene.”

In the year ahead, she will be travelling abroad to participate in ‘Beauty with a Purpose’ projects along with coparticipants at the Miss World pageant. “I am really excited that I will be visiting four continents this year and spreading awareness about menstrual hygiene. So, Bollywood is something that isn’t on my mind right now,” said Chhillar, adding that she would want to work with Aamir Khan in a movie though.

Various campaigns advocating lower taxes on sanitary napkins have the beauty queen’s support. “Menstruation is a natural process and sanitary pads are a necessity. They should be available at a low cost. The good thing about my project was making sanitary pads available at low cost and I would like to take it forward,” said Chhillar, who won the fbb Colors Femina Miss India in her journey to the Miss World title.

Another difference that she wishes to make is in her home state of Haryana. “Right after I won even the state and national contests, a lot of young women had queries about it. I am hoping this win will encourage them to take a step ahead… I have been lucky to have very supportive parents but if there is someone who doesn’t have support, they must still never give up. If you have the courage, you will make it through,” said Chhillar.
When quizzed about the ‘Padmavati’ controversy, she said, “We women have one thing in common. We don’t feel persecuted for who we are and face challenges head on. We feel it’s not a women-friendly society at times, but as individuals we set examples and make women confident.” Julia Morley, chairman and CEO of the Miss World Organisation who was present with Chhillar, said, “While India has waited for 17 years (to win the Miss World title), some countries have also waited for more than 60 years.” Priyanka Chopra was the previous winner from India in 2000.

Miss World 2017 wants to be a cardiac surgeon

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If you are a cardiac surgeon in the making, start by stealing a nation’s heart. That could well be the prescription of Miss World 2017 Manushi Chhillar, the medical student whose blue surgical cap recently made way for a jade blue crown.

Fresh from the glow of having ended a 17-year wait for India with the title she won in China’s Sanya City on November 18, the leggy beauty landed in Mumbai early on Sunday, proud of having broken another, more personal, dry spell. “Finally! Indian food after 40 days,” screamed a temporary Instagram post of the 20-year-old, whose eyes lit up when they found an Indian section at the Hong Kong airport on the return journey. Although her mother had packed a suitcase full of ready-to-cook Indian snacks like poha and upma, the sweet-toothed vegetarian wolfed down piping hot “Indian bread and chhola” with relish.

On Sunday evening, she looks like a couture version of a mermaid in an emerald off-shoulder Gauri and Nainika gown paired with matching gemstone earrings, her flawless skin and auburn curls embellished by the dappled evening sunlight inside a five-star hotel. There is a pageant-patented poise about her and the dimple on her left cheek appears unfailingly after every question. “There is more pride in being called India than Manushi,” she says, recalling the grand welcome at the airport with chants of “India, India”.

But her favourite homecoming refrain is: “I have a friend in every country now.” Given that the Miss World pageant had 120 participating countries, that means 119 friends from places with “hard-to-pronounce” names. The camaraderie was so strong that “the final day seemed like a rehearsal”, says Chhillar.

Born to doctor parents Mitra Basu and Neelam Chhillar, modelling happened to the Haryana girl by chance. The extrovert in her loved being on stage and the nerd in her lost herself in her books, says this product of St Thomas School in Delhi who was studying in Haryana’s Bhagat Phool Singh Medical College before she took a break last year.

Manushi Chillar

It was a contest in Delhi’s AIIMS, where she was crowned Miss Campus Princess, that set the tone for her history-making victory—the sixth for India that put it on a par with Venezuela in terms of beauties churned out. After several modelling assignments for print ads, Chhillar found herself crowned Miss Haryana and later, standing at the altar of the fbb Colors Femina Miss India. “I didn’t even know how to do make-up and hair then,” she says.

Though she doesn’t believe in lucky charms, the two rings—a pearl one on the index finger gifted by her mother and a coral one on the ring finger gifted by her father who calls her his dragon—may have worked their magic. She also took a small Ganpati idol gifted by her aunt to the pageant.

An intuition kicked in when she entered the final five. That was when she caught a glimpse of her parents in the audience. “I instantly felt that something good was about to happen,” Chhillar says about the “emotional” moment that was the spark for her final answer which was lauded by many for reigniting a dormant debate on the economic worth of an otherwise thankless job—motherhood. “To me, my mother is very beautiful and the epitome of a woman. She knows how to balance a busy professional life with family life,” she says.

The 20-year-old is a Kuchipudi dancer—she wowed everyone at the Miss World pageant with her dance moves —and is also a poet who has captured moving experiences in the dissection hall, pressures of practicals and emotionally demanding clinical postings in words. During her first posting in surgery, for instance, she came across a breast cancer patient who had come in with her four-year-old child. “It was a serious case at an advanced stage. I felt helpless as I realized you cannot cure, you can only assist. I called up my father to ask how he handles such cases,” says Chhillar. “He told me it’s important to keep your emotions in check.”

As one of the winners of the Beauty With A Purpose contest at Miss World 2017, she hopes to turn the spotlight on menstrual hygiene. As an MBBS student in rural Haryana, she had come across women who used wood pulp and torn curtains instead of sanitary pads. “They had no access to sanitary pads and some felt shy asking shopkeepers for one,” says Chhillar, who had later tied up with an initiative selling affordable sanitary pads.

In the next few days, she will be visiting her friends in other countries for their respective Beauty With a Purpose projects. The cardiac-surgeon in the making says she also wants to build non-profit hospitals in rural areas to help make cardiac surgery more accessible to villagers.

When a doc gets too attached to a patient

 

Siddhartha Mukherjee2

Every medical case, to paraphrase the writer Viet Thanh Nguyen, is lived twice: once in the wards and once in memory. Some of what follows is still intensely vivid, as if it were shot in high-def video. Other parts are blurry — in part because I must have subconsciously deleted or altered the memories. I was 33 then and a senior resident at a hospital in Boston. I had been assigned to the Cardiac Care Unit, a quasi ICU where some of the most acutely ill patients were hospitalized.

In mid-September, I admitted a 52-year-old man to the unit. I’ll call him M. As medical interns, we were forewarned by the senior residents not to identify too closely with patients. “A weeping doctor is a useless doctor,” a senior once told me. Or: “You cannot do an eye exam if your own eyes are clouded.” But M.’s case made it particularly hard. He was a doctor and a scientist — an MD, a PhD, like me. He must have been about 15 years ahead of me in his schooling; I could imagine him returning to my class in med school to teach us “Patient-Doctor,” in which students are taught how to deal with real-life patients. He was now an assistant professor — it seemed like such a victory to have that title — and ran a small laboratory. I knew a student who once worked with him. Six degrees of separation? There was barely one.

Earlier that year, in March or April, M. became short of breath in the middle of his run. His legs turned cold and blue. He had dizzy spells and lost words in midsentence. He saw a cardiologist — presumably one of his own colleagues — and the diagnosis was amyloidosis, a mysterious heart condition in which misfolded proteins begin to be deposited in the organs of the body. Sometimes the proteins come from cancer cells; sometimes from poorly understood sources. The deposits choke the organs: heart, liver, blood vessels, kidneys. “And then, bit by bit by bit, I was all pro-te-in,” he said dryly, paraphrasing the Tin Man in Oz. We laughed.

M. needed a new heart. I’m writing this casually, as if you go to the used-heart salesman on Long Island and pick one up on a three-year lease. Hearts are notoriously hard to find; someone has to die for you to get one.

M. was on a list of supplicants. His own heart, meanwhile, was failing so precipitously that he needed constant medical monitoring. Weird, deadly electrical rhythms arose out of his dying cardiac muscles, like ripples on a stagnating pond, necessitating defibrillating shocks to reset his rhythm. Fluid pooled in his feet, and the skin on his calves came off in strips.

There was a second reason to monitor M.’s status. Hearts are so rare that patients have to be under constant surveillance to ensure that they are in the best possible condition before receiving the donor organ. An innocuousseeming infection, or kidney failure, can spiral out of control after the transplant. “If it’s bad now, it’ll only be worse later,” the transplant nurse told me, grimly.

And so we watched him. Every vital sign — temperature, respiratory rate, heart rate — was dutifully recorded. I was on call every third night. I would stop by to say hello to M. and wait for the transplant nurse to come around. He would be puzzling over 40-across on the Sunday crossword. She would check his numbers. “Maybe there will be one tonight,” she would say, before signing off for the day.

It must have been on the third or fourth week of M.’s hospitalization, sometime late in the evening, that the transplant unit called up to the ICU. A kid had dead-ended his motorcycle on the expressway. He was declared brain-dead, but his heart was intact. M. was on the top of the transplant list. I half-ran, half-walked to his room to bring him the news. He had been dozing through most of the day and night — a sign, perhaps, that he was having trouble pumping blood to his brain. He woke up, smiled wearily and then drifted off to sleep again.

Around midnight, I was paged to the unit. “He’s spiked a small fever,” the unit nurse said. She tried to look at me blandly. “It’s nothing,” she wanted me to say. “It’s not real. Get back to work.” “How small?” “101.”

“Well, let’s retake the temperature.” She measured it again. 101. His systolic blood pressure had also dropped ever so slightly — a few, barely discernible notches. I paused for a moment, weighing my choices.

“Try another thermometer. And check the pressure again. Actually, let’s wait and try in 10 minutes.” She brought another instrument out from the nurse’s station. M. began to sense the slowly building hubbub in the unit. He sat up woozily. “Do you feel anything wrong? A chill?” “Nope,” he said. “Nothing.”

I examined him, pore by pore, looking for a potential source.

The nurse entered the room and made a tiny motion to see her outside. I met her by the nurse’s station. “Should we record the temperature?” she asked, whispering, as if the intercom might be eavesdropping.

The stakes could not have been clearer to both of us. If we put the number in the chart, M. would temporarily fall off the list for the next morning. The transplant surgeons at this hospital, I knew, would never risk taking a febrile, potentially septic, patient to the operating room.

I felt paralyzed. Medicine depends on looking at data objectively, dispassionately; a decade of training had taught me that. But it also depends on understanding that tests can mislead us, that data can deceive: What patient ever fits squarely into an assigned box? My fingers hovered above the computer, where I was meant to write my note and record the fateful temperature spike, but I found that I couldn’t type a word.

At 1 am, I called the attending physician. I felt foolish: I imagined her scuffling around her nightstand for her spectacles, anticipating a question about an acute cardiac crisis. Instead, there was a mumbling, hesitant resident trying to decide whether to write a note. But she understood immediately. She walked through the details of the case. Had I really evaluated the infection? Yes, yes, I reassured her — or rather, tried to reassure myself.

“It’s really your decision, Sid,” she said. “But you’ve got to consider that in some other hospital, there’s some other young guy — a doctor, with a PhD — waiting for that same heart. If your patient goes to the OR infected, he’s not going to make it, and the new heart is going to die with him.”

I put the phone down and turned to the nurse. The fever had come down to 100 degrees. What if we hadn’t measured it in the first place? How about all the things we don’t measure? Muscle tone? Wakefulness? If a temperature spikes in a forest… I returned to the computer, tried to type my note, hesitated and stopped again.

I wrote my final note at 2 in the morning. Temperature: 101 degrees, currently 100. No obvious source of infection. A chest X-ray showed no signs of pneumonia. A complete history and physical exam was unrevealing. Awaiting blood-culture data.

At rounds the next morning, I felt as if I had let the team down. I presented the case quietly, feeling the eyes of my co-residents burning holes into my skull. No one had any questions.

There were just a few more days left in the rotation, and I went to say goodbye to M. His fever had subsided on its own after that overnight spike. “I’m sorry,” I said, and he nodded.
M. died of a fatal arrhythmia a few weeks later. No other heart became available. The fever never returned.
Mukherjee is the author of ‘The Emperor of All Maladies: A Biography of Cancer’

Female physicians make professional adjustments for home responsibilities: Study

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Female physicians are more likely to make professional adjustments to accommodate their responsibilities at home, according to a new study.

In particular, male doctors tend to have more help at home for childcare or elder care, the study authors reported online November 21 in the Annals of Internal Medicine. Nearly half of the spouses of male physicians stopped working professionally, versus 9% of spouses of female physicians.

“Although some might argue that the decision for women to stop working professionally, especially after having children, is volitional, I think it’s very hard to disentangle the influence of societal expectations from that ‘choice,’” said study author Dr. Dan Ly of Harvard Medical School in Boston, Massachusetts.

In earlier work, Ly and colleagues had found that the gender earnings gap among doctors has remained at about 20% for the past three decades. Furthermore, among physicians who teach at medical schools, women are less likely to obtain the highest rank of full professor.

“To try to explain some of these gender differences in pay and professional advancement among physicians, we have begun to look at home life,” Ly told Reuters Health by email.

Ly and colleagues looked at Census Bureau data between 2000-2015 to understand occupation, income, hours worked outside the home and graduate education status for 30,900 male doctors and 17,600 female doctors. They also looked at the number of children in families with a male doctor, a female doctor, or two doctor parents.

They found that 17% of male doctors were married to female doctors, whereas 31% of female doctors were married to male doctors.

Income, hours worked outside the home, and graduate education status differed greatly between female spouses of male doctors and male spouses of female doctors.

Overall, 52% of female doctors’ spouses had a graduate degree, compared to 40% of male doctors’ spouses. In couples with one doctor, the number of children was higher in families with a sole male physician versus a sole female physician. In addition, for all women, the average number of paid work hours decreased as the male spouse’s paid work hours increased.

“We think one possible reason for this is that societal expectations for women to reduce their professional hours to care for children exist, even for physicians,” Ly said.

Future studies will continue to look at the decisions that couples make about balancing each other’s careers and how having children factors into those decisions, he said.

“It’s important to understand why women in medicine and other professions might be facing unique challenges, even today,” Dr. Reshma Jagsi, director of the Center for Bioethics and Social Sciences in Medicine and the University of Michigan in Ann Arbor, told Reuters Health by phone.

“Those of us in Generation X were raised with expectations of the egalitarian division of labor at home and work, and we might not expect the findings seen in studies like these,” said Jagsi, who researches the gender pay gap and gender domestic differences in medicine but who wasn’t involved Ly’s study.

Jagsi and colleagues are monitoring several new programs that have been implemented to help doctors at work and home. The Doris Duke Charitable Foundation, for example, gave grants to 10 medical schools as the Fund to Retain Clinical Scientists to fund more mentorship and career development opportunities for early-career doctors, especially for those with extra caregiving burdens.

“Patients benefit when the medical workforce includes the most promising doctors in our society,” Jagsi said. “We need both women and men in the medical workforce, and we need to figure out ways society can alleviate the greater challenges faced by female physicians.”

Patients of female surgeons may have better outcomes: Study

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Patients treated by female surgeons are less likely to die in the first few weeks after operation than those treated by their male counterparts, a study claims.

Studies have shown that women and men practise medicine differently, although little researchexists on differences in learning styles, acquisition of skills, or outcomes for female and male surgeons.

Researchers led by Raj Satkunasivam from the University of Toronto in Canada compared outcomes for patients undergoing one of 25 surgical procedures by a female surgeon with patients undergoing the same operation by a male surgeon of the same age in the same hospital in Canada.

To ensure the two groups were well balanced, patients were matched for age, sex, presence of other conditions and income. Surgeons were matched for age, experience, volume and hospital.

The main outcome was a combined measure of death, readmission to hospital and complications 30 days after surgery, researchers said.

A total of 104,630 patients were treated by 3,314 surgeons (774 female and 2,540 male) over the study period (2007-2015).

The study published in The BMJ found that patients treated by female surgeons were slightly less likely to die within 30 days, but there was no significant difference in readmissions or complications.

There was also no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon, researchers.

Results remained largely unchanged after accounting for additional factors like case mix (differences in a patient’s condition), researchers said.

Possible reasons underlying better outcomes for patients treated by female surgeons are not clear, although it may be related to delivery of care that is more in line with guidelines, more patient centred, and involves better communication, they said.

“Our findings have important implications for supporting sex equality and diversity in a traditionally male dominated profession,” researchers said.

Doc, 31, kills self with drug injections

Varde’s residence; Friends recall him as a cheerful guy. Divorced two years ago, he was keen on remarrying

In an incident that has left the medical fraternity shocked, a 31- year-old orthopaedic surgeon at LG Hospital, Ahmedabad died of vecuronium overdose on Tuesday. While sources said Dr Mehul Varde is believed to have killed himself by injecting four times the normal dose of the muscle relaxant, which is used as part of general anaesthesia during surgeries, mystery shrouds the death as the doc did not show any signs of depression as per sources.

The alleged suicide took place between 2.30 pm and 7.30 pm at Varde’s fourth floor residence at Ishaan in Prahladnagar. According to the police, Mehul’s father Dr Ramesh Varde had been calling him on his cellphone repeatedly. Since he did not answer the calls, the worried father alerted Varde’s friend Neha Joshi to check on him. The door of his residence was broken into when Mehul did not answer the doorbell. He was rushed to Shalby Hospital where he was declared brought dead at 8.30 pm. What is intriguing is that Varde, an MS in Orthopaedics and a senior resident doctor in orthopaedic department, had attended the operation theatre at LG Hospital on Tuesday at 9 am, hours before the incident.

And according to his colleague, he did not seem depressed at all to take such a desperate step. “He was normal and like always he laughed and made others laugh. I could never have imagined that he could take such a step. He has always been jovial and a happy-golucky guy,” said a doctor on condition of anonymity. Apart from the fact that Varde got divorced two years ago and that his father runs a hospital in Deesa, his colleagues do not know much about his personal life. Fatesinh Pargi, PSI and investigating officer in the case, said, “Varde had divorced his wife two years ago. He was staying alone at his friend’s place and did not leave any suicide note behind. We will be investigating the cause of suicide. We will examine call details, scrutinise the postmortem report and question his friends and hospital staff to learn the exact cause of his death.”

‘Had placed a matrimonial ad’ 
A doctor at LG Hospital said the reasons certainly had to be personal. “He had already tendered his resignation and was set to join Zydus Hospital from July 26. He had also inserted a matrimonial advertisement in Ahmedabad Medico News, an Ahmedabad Medical Association bulletin, looking for a doctor pursuing post-graduation after MBBS.” It was understood that things were looking up for him before he suddenly decided to take the desperate step. LG’s Medical superintendent Dr Rajesh Shah said, “Dr Mehul Varde had joined LG on April 24, 2016 and had given his resignation on June 26, 2017.

He had given no hint of depression to his colleagues and friends at the hospital.” Deputy Superintendent (anaesthesia) Dr Charuben Pandya said, “He was an extremely good looking doctor who would have given any film star a run for his money. He studied at a University in Pune to become an orthopaedic surgeon and had worked at the VS Hospital before he joined LG. In fact, he and his mother had approached me and I had recommended his name for the post here.” Charuben said, “Vecuronium is given as muscle relaxant during the anaesthesia procedure that completely stiffens the muscles to keep your body still during the surgery. Normally, a dose of 1mg per kg of body weight is given to patients undergoing surgery.

It is a scheduled drug that is not available over the counter but it is not difficult for a doctor with his licence to procure it.” Judging from the ampoules found near the body, Dr Varde had injected four times the dose. Dr Kalrav Mistry, MD psychiatrist at Shalby Hospital, said, “Young doctors undergo a lot of stress much of which is work, financial, relationship or family pressure related that can cause depression. This appears more like a case of undiagnosed depression because of adjustment problem. There is tremendous stress in medical profession and stigma associated with psychiatry disorder. Divorce and marriage anxiety have a big impact and lead to depression. Also most common means of suicides by doctors are lethal medication overdoses.”

Sarkari Doctor’s Poetry

Image result for primary health centre

Guest article by Dr. Mayank

दुखांतिका

Paracetamol,
मैं थक गया;अब तू ही बोल।
कैसे करूँ तनहा तुझसे;PHC में हर बुखार control?
उधर amoxy ने आवाज दी,
डॉक्टर साहब अभी मैं stock में हूँ पड़ी।
पर चेतावनी है;ध्यान दें,
किसी भी मरीज को चार कैप्सूल से जादा न लिख दें।
मैनें फ़िज़ूल की उससे बहस की,
चार कैप्सूल से तुम्हारा कोर्स पूरा होगा नही।
amoxy हंसीं और साथ में septran भी,
लगता है इस डॉक्टर की PHC में पोस्टिंग है नई-नई।
बोला बगल में betadine का बोतल खड़ा,
महीनों से बिन ढक्कन पड़ा-
सुन लो ये डाक्टर बाबू,
अगर चाहते हो मरीज रहे काबू,
तो दवा का पूरा कोर्स भूल जाओ,
और मुझे तो बिन ढक्कन खोले ही घाव पर लगाओ।
तब तो एक बार के बजट में,पांच साल चलूँगा,
अपने अंदाज़ से ख़त्म किया तो साल भर खलूंगा।
अब पानी मिले savlon की बारी आई,
बोला वो मुझसे-भूल जा मेडिकल की पढाई।
तेरी पढाई के इलाज़ से,
नही कोई मेल सरकार के मिज़ाज़ से।
सरकार का सिर्फ एक काम ,
खोलो अस्पताल सरे-आम।
फिर दिए दिखाय,
जनता को सारे उपाय।
कि हमने PHC खोल दिया है,
डॉक्टर मौजूद रहे चौबीसो घंटा;ये बोल दिया है।
हॉस्पिटल में सारी सुविधा निःशुल्क उपलब्ध् कराई जायेगी,
dial करो 104/108;एम्बुलेंस घर पर दौड़ी चली आएगी।
पर ये नेता जी शायद भूल गए,
104/108 आये दिन रहती है garage में खड़े।
और बिन सुई-दवाई,
कैसे इलाज़ करे मेरा डॉक्टर भाई।
इतने में cotton और gauge ने अपना expiry date का लेवल खोला,
और पुरे antiseptic अंदाज़ में बोला-
इतना प्रवचन डॉक्टर साहब क्यों सुनते हो,
सरकार की कागज़ी बातों को क्यों चुनते हो?
कैसे सिमित दवाओँ से हर मर्ज दूर हो,
क्यों डॉक्टर स्टॉक के हिसाब से दवा लिखने को मज़बूर हो?
इतना तो kidney tray में पला बढ़ा,
बेचारा artery forcep;जो अब है जंग चढ़ा।
भी बता देगा,
कि अब मुझसे कोई काम न होगा।
फिर भी उस scissor से,
जाने कैसे-कैसे,
आप काम निकाल लेते हो।
और सरकारी आदेश में,
ढल जाते हो आप भी उसी परिवेश में।
कि हर पेट की बीमारी की दवा MTZ है,
ठीक हुआ तो हुआ;नही तो हम आपके कौन हैं?
अचानक गुस्सा हुआ R/L का bottle,
दिया जवाब in sum total,
क्या पूछते हो PHC के डॉक्टर से,
कभी पूछा उनसे;किस दर्द से हैं वो गुजरे?
DNS बोला intracath के साथ,
भाई N/S तुम्हें नही पता;क्या है बात।
D 5% बोल रहा था,
सारे सरकारी राज खोल रहा था।
कि नेताओं का ये फार्मूला है पुराना,
कैसे अपने area के पब्लिक को है उल्लू बनाना।
एक PHC हॉस्पिटल बिना किसी संसाधन के खोल दो,
उद्धघाटन करो और public को बोल दो।
आज से हर बीमारी का इलाज़ यहीं होगा,
जो डॉक्टर समय पर नही पहुंचें;मुझसे कहना होगा।
पर नेताजी अपने उद्धघाटन किये अस्पताल पे विश्वाश नही कर पाते हैं,
और अपनी सर्दी-जुखाम का भी इलाज़ करवाने;air ambulance से मेदांता से अमेरिका उड़े जातें हैं।
अब सिलाई का धागा,
कोने में पड़ा अभागा,
बोला-ऐ PHC के डॉक्टर,
मुझपे एक अहसान कर-
जिससे मेरी आत्मा तृप्त हो जाये,
जब भी कोई नेता चोट खाये,
अपने उद्धघाटन किये हुए अस्पताल में आये,
जहाँ तुझे दिए हुए है बिठाये,
मुझ से सी देना उसका जख्म;बिन xyolocaine लगाये।
डॉक्टर तू भविष्य है,
कैसे तुझ से कोई खेल पाये।
और deriphyllin dexona की कसम,
Omez Rantac के साथ पूछे तुझसे हम।
क्या बेरोजगारी इतनी भारी है,
की 5 1/2 साल की पढाई पे;5 साल की सरकार भारी है??????