Obit- Sornchai Looareesuwan

Follow the link:

http://www.thelancet.com/journals/lancet/article/PIIS0140673607613634/fulltext


The snake story is quite interesting!

More than 300 papers on malaria alone!! DRK wither thou?!
And we still have no resistance data on malaria in India!!

I had a tough time arguing with the folks here that malaria in Mumbai is chloroquine sensitive and you don't need mefloquine for prophylaxis.No data. No one trusts you.

Random

Some things in random order..no particular pattern ..as they occurred to me-

Yagnopavveta dharanam done. Cut some corners on specifics.Doesn't it sometimes feel reassuring that we choose to do that. I can still remember stuff from sandhyavandana that taatha taught us.Wonder if taatha's favorite disciple Denish remembers still.It ain't so reassuring that he is not around no more. There is a generation that shall not know...their inspiring moments, childhoods that they will remember shall be other ones. Life will go its random course, some will remember, some wont. And it really wont matter.

" Kahi karaycha aahe re, atta jidd aahe. Atta vel aahe, nahi kela tar kadhi karnaar. Mee nahi kela tar kon karnaar"

Shall be repeating residency here in the US. I am so thankful I did residency in India, at KEM. Just as I tell people at BJ, you wont know guys, nor can I tell you in so many words what an experience it was; I guess they are right in telling me the same about theirs; and so are people who will tell me about their residency here in the US. I also worked as a lecturer in BJ. I guess it never substitutes for the experience of residency. Of course there are mistakes I did during my tenure at KEM which I hope to improve upon here. I had emotional upheavals, I cringed at the futility of what we do after pati passed away. And I could never feel what it meant when tatha died within a year. Existentialist questions gnawed at my thought process.But I learnt one important thing.There will be another emerg day. There will be admissions again, some bad, some good. Some with less expressed emotion, some overwhelmed by it all.And if I am not up to my own questions how will I answer others questions.

I do not need to follow what is said, written or is common norm.I have to do what I have to do. And then live with it.

Remembered someone from the past(MS). 'Tee geli tevha rimjhim pauus ninadat hota.'
I don't know if I was wrong.But I have taken the right lessons from it all.


I have to decide on Jan to June. I need the money. But I shall never have the time again for MSF.

Will learn to play the sax some day.Like Kadri Gopalnath.

Life and career are different things. Repeat.Career and life are two different things.

Sriram is getting married today.On Raksha bandhan day!! I feel guilty for missing interacting with this group of my friends( except Gotya ).Wish you a happy married life dude.

Places you loafed around as a kid suddenly seem so small and different when you grow to 5 ft 10 and a few graduate degrees old. The Shiva temple at RP seemed so cramped for space when I visited the place after...so many years; the banyan tree not so big to grab a branch and swing on, the parapet wall not such an ordeal to scale, the gully too small for a decent cricket game except underarm one tappa out. Sriram would say that we should have never grown up. I don't know if he still says that.

Cute jhoot!

http://www.nytimes.com/2007/08/26/books/review/Chotiner-t.html?_r=1&ref=world&oref=slogin


Well, the review is interesting. But particularly interesting is the picture the NYT chose to caption this article with.See it. Fabulous image. Symbolic if you ponder about it.But who has the time really.Steve McCurry has some more fabulous images of India:
http://www.stevemccurry.com/main.php
but go through them...you realize what a color freak he is.And also who all have been 'inspired' by his images.

There's an image of a turbaned, mustachioed Indian peasant at the waiting lobby in St V's ID clinic. When I asked the attending why it is here- seemed more than a tad out of place- he remarked that it 'looks great.'And "we attract quite a diverse population of patients here" And finished by saying that he thought India was an interesting country.

Wonder what he exactly meant by that( or whether it was another one of those polite nothings that are part of the culture of this north east part of the US) and whatever cuteness that image might add to the St V waiting room, I wouldn't be wrong in saying that we seem to like this perceived image of ourselves.What do they think about us? Our colors, our clothes and whatever fancy pansy Boho( my granny calls that 'lambaadi')stuff we chose to make our exhibit with. Should we celebrate a cute image or our people, the emotion.Somebody chose the former as an election campaign and it was a disaster.

( Btw: See Sharbat Gula's image on the National Geographic website -shot some 20 years after the original snap became a similar cute wallpaper exhibit...looks monstrously stupid!!!)Another Steve McCurry ka curried offering!

A hurrah for Yousuf Hamied and Co

A Chennai court ruling quashed Novartis' patent protection case against generic antiretrovirals. As much as the right to patent what you have worked on and created is valid, hijacking the access to the drug from people who need it is ethically untenable.

Cipla and buddies have perfected reverse engineering to the hilt. We really don't know what amounts they make of the process- they monopolise the ART market in the sub Saharan African and Asian continents.They might not be the true champions of the cause, the altruistic saints we believe them to be - every person,group, company works on incentive right( Levitt/Dubner)But fact remains that prices of these generic drugs are a minuscule fraction of what the multinational drug companies sell them at.
Whatever their margin, the people who gain are the ill.Somebody has to play the dirty role.For the uninsured, daily wage earning laborer and his family for whom a trip to the ART center 350 km away means a couple of days' salary spent on travel besides no wages for that day,getting that bottle of pills for the month is all that matters.

The MOH/GOI has been overgenerous in providing free ART through its ART centers, and a substantial part of this is courtesy Mr Clinton, the Gates and PEPFAR.It would seem unlikely that this program would cover all infected patients in the country.There will be patients who choose to get treated outside the program, either due to concerns about stigma, drug resistance or even ignorance. The drugs being disbursed at the government ART centers are again the generic antiretrovirals made by Cipla, Alkem, Cytomed etc.Plus these guys sell them in the market. They have come out with cheaper versions of Tenofovir, Lopinavir/Ritonavir. And there is a Pepsi/Coke type battle here to get cheaper and cheaper( pun very intended)
Are we are being unfair here to Novartis and the lot?!

If the copycats are being allowed to sell to the GOI, they should not be allowed to market the drugs at the same rate.That dosen't seem fair.
I do not know how the specifics might work out. But it seem we would be sending the wrong signals going all ballistic against multinational drug companies.They are the guys who employ some of the best brains in the business and pump millions in sequencing genomes of bugs, then knocking them down, running trials. Its easy to copy. Its tough to be original.

Option two: Special categories of drugs including ARTs be put under less strict patent laws, shorter periods of patent protection.

Inequity will remain.It is a bitter reality. It is sad that the AIDS epidemic has just widened that chasm, given it that mai-baap giver taker angle. But it is also heartening that there are people ( Gates and the lot) who despite being in the better side of things are troubled by the inequity and choose to help.The ultimate beneficiary is the patient. Fortunately/unfortunately thats what matters.

Novartis will appeal.With the money they have, and some smart lobbying they might get some concession in the TRIPS case.But this is a good news for now. Lets savor it.

The day breaks
With it breaks my heart
For who knows this glorious morning
Might well be my last
.......................................Tagore, Gitanjali

Inky pinky ponky

How can you decide about something you want to do if you don't know anything about it till you actually do it?
Impulse?
Faith?
Inkypinkyponky?

Of quarters and middles-

I think there is no greater sadist oneupmanship than psychoanalysis. It gives you a big holier than thou pedestal to stand on and analyse emotion with a supreme sense of disconnected evolution. That every bit of gut tugging overwhelming angst be put into such discrete terminology like transference, defence mechanisms, learned helplessness, cognitive decentering and the like is disconcerting.I used to think that the psychoanalysis-know alls would be the most evolved beings on this planet...till my psy co-resident enlightened me that we are all the same gooey stuff 'up there'

This is a piece which has been floating around different blogs ....it was forwarded to me by my cousin some years back when I could claim membership to the twentysomething club. Now I have graduated to a twentymorethansomethings gluttonous club...well past a quarter century-but I think the ebbs and highs plague even the thirty or forty somethings just as much.

I am still to touch mid life.Which I think is a bit of a paradox- suppose I were to meet with an accident and die tomorrow- am I well past mid life then?Does a person in the developing countries with a lower life expectancy experience an earlier MLC. Huh?! It doesn't account for culture differences or the mutability of life or sensibilities.It is a lumper's theory...quite really.( Not of the likes who say " today is the first day of the rest of my life " na?)

Some choose to escape this MLC/QLC by being in perpetual college mode( Aamir Khan in RDB?),some change their paths( Arun Shourie?!),some glorify it( Scrubs, Wonder Years)...and well ...some just crumble ( Allen Ginsberg's Howl)Any one of them could be a 20, 30, 40 ...whatever you choose. The unifying concept is the crisis.The angst.Its a wasted emotion if you look at it with Freud's glasses. Productively nil.But again....thats the omniscient psychoanalyst's view. And there is no one walking on two legs by that name actually.

I tried to trace the original: can't really find out. If someone does- let me know.



They call it the “Quarter-life Crisis.” It is when you stop going along with the crowd and start realizing that there are many things about yourself that you didn’t know and may not like. You start feeling insecure and wonder where you will be in a year or two, but then get scared because you barely know where you are now.

You start realizing that people are selfish and that, maybe, those friends that you thought you were so close to aren’t exactly the greatest people you have ever met, and the people you have lost touch with are some of the most important ones. What you don’t recognize is that they are realizing that too, and aren’t really cold, catty, mean or insincere, but that they are as confused as you.

You look at your job… and it is not even close to what you thought you would be doing, or maybe you are looking for a job and realizing that you are going to have to start at the bottom and that scares you. Your opinions have gotten stronger. You see what others are doing and find yourself judging more than usual because suddenly you realize that you have certain boundaries in your life and are constantly adding things to your list of what is acceptable and what isn’t. One minute, you are insecure and then the next, secure. You laugh and cry with the greatest force of your life. You feel alone and scared and confused. Suddenly, change is the enemy and you try and cling on to the past with dear life, but soon realize that the past is drifting further and further away, and there is nothing to do but stay where you are or move forward. You get your heart broken and wonder how someone you loved could do such damage to you. Or you lie in bed and wonder why you can’t meet anyone decent enough that you want to get to know better. Or maybe you love someone but love someone else too and cannot figure out why you are doing this because you know that you aren’t a bad person.

One night stands and random hook ups start to look cheap. Getting wasted and acting like an idiot starts to look pathetic. You go through the same emotions and questions over and over, and talk with your friends about the same topics because you cannot seem to make a decision. You worry about loans, money, the future and making a life for yourself… and while winning the race would be great, right now you’d just like to be a contender!

What you may not realize is that everyone reading this relates to it. We are in our best of times and our worst of times, trying as hard as we can to figure this whole thing out...

HECklle TICkle

Has been a hectic schedule last few days. Leaving home at 6 am means waking at 5, washing, bowel cajoling, packing, throat packing in a hour; and pushing off unobtrusively while others snuggle at their sheets.A half hour ride to backbay, then an hour and twenty minutes to Worcester, ten minutes walk to St Vincent. Ta Da.Give another two hours to the evening- your day is very much spent looking at the insides of MBCR coaches or the same scenery playing on outside the windows - hell at the same time everyday as the sun downs at the lake at Westborough so predictably at the time I choose to look out. Its like listening to the same audio cassette again and again with stop and ffwd buttons jammed.

At the hospital I have been looking at the innards of the people of the USA- the poopy tubes and farty parts, bearing with the shitty bits and the turdy curds of the denizens of the Worcester with colonoscopes, sigscopes, OGD scopes; seeing consults with the fellow... the h/p mostly laced with bowel vowels and of the rectum spectrum; reading a bit of Sleisinger/Fordtran. I have also being lazing around the hospital atrium when the resident/fellow is not around since I may not see a patient without a resident with me and so I am at the mercy of their schedule.I have attended noon conferences which do not excite much- but thats the only chance U get to impress folks there- so hell be awake. The place has a lazy air to it- morning reports are held at noon.But I dont mind really. Gives me sonme time in the morning.

I realise- the most hectic part is not hectic at all.Its just that it occurs (fatalistic me!) over such a spread out time and distance schedule. I shal try and figure out some easier schedule next week. It really pains me to spend $27 a day for the travel part anyways.

Monday I start ID. Thats a subject close to heart. I hope to see some 'American' illnesses there- Lyme, babesiosis, ehrilichiosis and the sort.Wishful thinking you may say. But its tick season I guess. Or at least people going to the tick areas.So why not?!
Good for me.Not good for the patient I guess.But ...twill happen......U know....I am in a fatalistic bent of mood now.

Till then.....its a weekend!!!!!!! I am not going to think about monday.No way.

Loopin linearly

Just got the feeling while landing at Logan airport- to use a little kitsch, 'its all coming back to me'. I have seen this before, I have felt this gurgle in the tummy while the plane rough landed, that the Mecca of medicine was in my visual field, that I don't know how but I shall make it.That opportunity awaits me.

That was just how I felt I guess.This time new set pieces. Same me. New plans.I am at the Milliways, the restaurant at the end of things- time and space, and I am planning my journey back- only to come back to the present , in different coordinates.I have directions....how big I loop my loop is upto me.

Its funny, when U plan things big, U are actually going around in a circle of life( oh...Elton John, kitsch again)but things just seem linear - its just that you don't see it so.

Shinu, one of my classmates in Vincents in an answer to prove why the earth goes round the sun in an orbit wrote thus: the earth is circular, if you set it in motion it rolls . If you rotate it in a line, it will tend to revolve too like spin given to a thrown ball. As it continues to do so, it forms a circle.

Astra Castra Numen Lumen

ExCell !!

Thats a cell:On a tissue culture medium which has been layered with silicon nanowires which are loaded with DNA coloring dye. When imaged the cells light up with the dye taken up by the cellular DNA.We have needled 40 micron oocytes with ICSI.Maybe with this we can avoid the limitations with AAVs and retroviruses for nuclear transfection.