The wsj starts off with a good review on Thalidomide, but later cannot help itself...

 

Any sensible person who reads the wsj knows the publication is a double-edged sword at best. You mostly read it for the financial news and hope they are not lying through their teeth. And, like diamonds in the rough, or other undesirable places, every now and then, they do manage to write about things in a meaningful manner. 

It was with this sort of pleasant surprise that I started to read a review of the book titled "Frances Oldham Kelsey, the FDA, and the Battle Against Thalidomide". It is a poorly kept secret that the FDA was provided with ammunition at the most opportune of times, with which it prevented much death and dismemberment. It is also well-known that in today's political environment, such powers would be quite tough to come by, as this article linked below will demonstrate. 

The earlier part of the review

The earlier part of the review is pretty cool. Thalidomide, prescribed as a sleep aid, would have escaped review were it not for Frances Oldham-Kelsey's keen scientific eye and healthy apprehension for something that appeared too good to be true. Having worked on a drug that had a deleterious effect on fetii, she stepped up at the right time and required William S. Merrell Pharmaceuticals to provide more data. The ensuing saga, even in the short review, reads like a B-movie plot, and I leave all that up to you. I definitely recommend the review, and I personally put the book on my list of must-reads. 

The ignorant whiny part

Just when I was about to fool myself into thinking, "Wow, the wsj is about to become the WSJ in my eyes!", the review slipped into the well-branded, stereotypical, tone deaf part: "Ms. Warsh fails to discuss the tradeoffs of the glacial approval process"

You know what the tradeoff is? STAYING ALIVE and HEALTHY. It is remarkable that in the same review about a book that shows how one scientist stood in the way of unknown thousands of mutilated fetii and a good drug review process and created a revolution that now the world has started to embrace (with the EU pulling ahead of us), the review author irresponsibly caters to wsj's baser instincts. 

Conclusion: How to do approvals right

Drug and device approvals are quite tough to get right, even when the FDA is acting ethically, and not colluding with surgical supplies companies (I will link a post in which I touch upon the bad governance below), things slip by. Thus we end up with bad metal implants, knees, hips, you name it, questionable Azheimer's drugs and much more. 

Then, as with Aduhelm, (story below), the FDA realizes its mistakes, especially in bowing to political pressure from unscrupulous convicted felons, their friends, and others, and overclocks in the other direction. This then results in events like the one from last week, when MDMA was denied for PTSD treatment. Now it will take us forever to find out if the rejection was justified. 

Thus what we need are smarter, scientific reviews that don't arise from undue political pressure and self-destructive book reviews. At the end of the day, I am sure, Califf is not scanning unscrupulous publications for book reviews to worry about the pace at which his agency should approve drugs or devices. At least, I hope he has better things to read. 

Using machine learning techniques, better clinical data, honest reviews, dedicated panels of humans and other commonsense approaches, glacial or not, the FDA can strive to keep patients alive in the decades to come!  There will be plenty of time to discuss these techniques, and for now, I urge you to stick to the "glacial" timelines in an era where the glaciers are melting. 

References:

1. The self-destructive book review on wsj: https://www.wsj.com/arts-culture/books/frances-

oldham-kelsey-the-fda-and-the-battle-against-thalidomide-review-the-noble-bureaucrat-7f1fc379

2. The book:https://www.amazon.com/Frances-Oldham-Kelsey-against-Thalidomide/dp/0197632548

3. The FDA's aduhelm misadventure: https://www.nbcnews.com/health/health-news/fda-broke-protocols-approving-biogen-alzheimers-drug-congressional-rep-rcna63662

4. The FDA colludes with your favorite surgical device manufacturers: https://chaaraka.blogspot.com/2019/04/so-what-will-fdas-secret-hidden.html

5. The FDA's sudden repugnance for MDMA: https://www.nbcnews.com/health/health-news/fda-panel-rejects-first-mdma-treatment-deep-concerns-flawed-trials-rcna155325

6. The cover image for the blog post: https://www.pexels.com/photo/selective-focus-photo-of-pile-of-assorted-title-books-1148399/

World Health Day is here (April 07, 2024)

 

Every year, April 07 is World Health Day. The goal is to remind ourselves that human health is absolute to our species, and each year, one disease attains a specific focus. The area of focus is chosen by the WHO, and this year, is themed "My Health, My Right" and there is a detailed description available on the WHO site [2]. 2024 is special in that it is the 75th year that this day is being commemorated. 

The WHO reasons that there are significant threats to public health from various factors across the globe, especially climate change, conflicts, lack of service reach, expansiveness and more. 

Every human deserves care, clean air and water, hygiene in all aspects of life, access to mental health care, preventive services and more. By recognizing that health is a fundamental right, we can start thinking about widening the scope of how we provide care well beyond financial equations. We can design systems and delivery mechanisms that will be of an appropriate scale for this lofty goal. 

Fighting climate change, ensuring our air and waterways are clean, and our food comes from appropriate sources will amply put healthcare on a preventive path and ensure that at least the epigenetic factors that reduce disease and deteriorating health. 

All of us in healthcare, should seize this lofty goal and opportunity for everyone, and that includes ourselves! So, Happy World Health Day as you think about your own contributions. 

References: 

1. Cover Image: https://www.freepik.com/free-vector/gradient-world-health-day-horizontal-banners-set_23431745.htm#query=world%20health%20day%20banner&position=45&from_view=keyword&track=ais&uuid=576c9bcb-356b-45bc-a92e-e42403378620

2. WHO Declaration for 2024 World Health Day: https://www.who.int/campaigns/world-health-day/2024

On World Mosquito Day (August 20, 2023)

 

It might seem a bit crazy at first scan, to have a World Mosquito Day. That, in and of itself, is not surprising, given that most people are coached to alternatively hate or fear mosquitoes, cockroaches, other insects, lizards, scorpions, snakes, tigers, bears, lions.. you get the picture. 

Now, some fears are acceptable, but many are not. The fear of infection, disease and death are natural, but we have to be careful about taking things too far with any species, including humans, as displayed with the fear associated with many coronaviruses such as HIV and COVID-19. Both virus infections, especially the much-feared and maligned HIV, can be managed effectively with early diagnosis. 

However, mosquitoes do remain something to be worried about. They can spread the following viruses/infections:

1. Malaria
2. Dengue fever
3. Zika virus
4. Chikungunya virus
5. West Nile virus

In addition, mosquito bites hurt a lot, and they have become a nuisance across all the world, regardless of the underlying ecology. For instance, if you visited the Sierra Nevada mountains, or Alaska in summer, or decided to go to South America, Africa or Asia, you would find yourself relentlessly attacked by mosquitoes, except in the cold of the winter. 

In all, that is the purpose of World Mosquito Day. Stay aware of the presence of mosquitoes, not only in and around your work and home environment but also all the places you visit. 

The pregnant, the immunocompromised as well as those with special health circumstances need to be careful about exposure. 

It is also important to try and avoid or at least minimize the use of DEET compounds when trying to protect yourself from mosquitoes. 

Similarly, standing water is one of the main environments in which mosquitoes can thrive It is important to avoid allowing large quantities of unclean water to accumulate. 

Finally, keep up with the latest information such as the WHO malaria vaccine program, and other efforts that will help you and your loved ones. 

References: 

1. Cover Photo: https://www.pexels.com/photo/black-white-mosquito-86722/

2. WHO Malaria Vaccine Program: https://www.who.int/initiatives/malaria-vaccine-implementation-programme

April 24: World Lab Animal Day

 

April 24, annually is observed as World Day for Laboratory Animals. I am writing this post commemorating this. 

Laboratory animals do not get the respect they deserve in the service of biotechnology and medicine. I am not sure an approach that completely eliminates lab animal testing will work any time in the near future. Therefore, I wish to commemorate the day marking with due respect, the role they play in the advancement of science, from pediatrics all the way to geriatrics. 

Countless Animals and Dozens of Species

From monkeys to mice and cats to dogs, myriads of animals have sacrificed their lives in the service of science. This also includes species of near intelligence, such as Chimpanzees. We deserve to remember that not a single one of them had a choice in participating in studies. Countless humans will forever owe our lives to lab animals everywhere. As practitioners of science and engineering, we need to keep this foremost in our minds. 

Professing Humane Treatment of Lab Animals

1. Tests should go through IRBs. Only testing that is absolutely needed should be approved. 

2. Throughout the testing process, animals, regardless of species, be they naked mice or C. elegans, should be treated humanely. 

3. When a laboratory animal has the chance of being adopted or otherwise set free following an experiment or study, the animal should not be sacrificed. 

4. At the appropriate time, especially with acute studies, animals that cannot survive should be sacrificed. The same principles should apply to chronic studies. 

5. Study administrators, clinicians, and others should be examined. Animal cruelty in lab settings, above all, should not be tolerated and punishments must be swift and people convicted of cruelty in lab settings must not be permitted to engage in further studies or settings involving animals. 

6. Wherever possible alternates to animals should be used for studies. I have used a substrate myself and it was an excellent substitute for sacrificing a significant number of animals. Not only was the material effective, plant-based, and inexpensive, it also allowed for testing at a much larger scale than would be possible with animals in the midst. 

7. You may choose to sign this petition to end unnecessary lab studies: https://theanimalrescuesite.greatergood.com/clicktogive/ars/petition/animal-testing-ban?utm_campaign=animal-testing-ban&utm_medium=email&utm_term=20220424&utm_source=ars-ta-animals

8. Read, educate yourself and spread awareness through sites such as this, even if you don't agree with everything they may have to say: https://worlddayforlaboratoryanimals.org/

Conclusion:

Whether you are a medical doctor, a research scientist, an engineer, a lab tech, a clinician or a consumer, treat lab animals with the respect they deserve. 

Reference:

Cover Image, Courtesy Sipa, Pixabay: https://pixabay.com/photos/rat-cage-laboratory-domestic-animal-822288/

April 7th is World Health Day

 

Health. I wonder why that would be an important topic just about now? Well, I don't know if it is too soon for us to be laughing about this, but the coronavirus pandemic continues, and will continue to leave its mark on humanity for several years to come. It has also laid bare how humans act under such stressful conditions - and I don't mean just the negative news, but also the positive news, the many told and untold sacrifices of healthcare professionals and others. 

The World Health Day, is essentially the commemoration of the day in which the World Health Organization (WHO) was established, all the way back in 1948. 

The WHO, in conjunction with the UN has been setting various global societal goals, and has been providing direction, impetus and organization for countries and organizations. It is only fitting that this day be celebrated as World Health Day. 

On World Health Day, here are a few things to commit to:

1. Giving healthcare professionals their due respect. It is important to allow professionals in a given field to remain focused on their roles and help as many people as they can. 

2. Shun armchair fake "experts" trying to dole out unnecessary panic and misinformation. 

3. Trust science, support science and promote science. Educate friends and family as much as possible. 

4. Put your mental and physical health first! And remember the age-old aircraft safety advice - put your mask on before helping others. Care for yourself, and you will be able to care for your loved ones!

5. Celebrate life, and more importantly Healthcare Professionals - from the doctors and the nurses, to the orderlies and janitors! 

Until next time!

If you wish to add this for future reminders to yourself: 

Reference:

Cover Image: https://www.pexels.com/photo/white-and-blue-health-pill-and-tablet-letter-cutout-on-yellow-surface-806427/

Today (April 2nd) is World Autism Day!

I know it has been a while since I posted on this blog, but World Autism Day is too important to pass up, so here I am. 

World Autism Day should serve as a reminder to all of us of a few things about autism: 

1. The incidence and prevalence of Autism are NOT affected by any vaccines of any kind. 

2. Autism affects all ethnic and socioeconomic groups. 

3. Autism cannot be medically detected with current practices and technology. 

4. Autism is diagnosed more in biological males over biological females. 

5. Early intervention, as with most health conditions, is the best opportunity for a chance at a fruitful life for those living with autism. 

For more valuable statistics, you may go here: https://www.autismspeaks.org/autism-statistics-asd

What else can you do to observe World Autism Day?

First off, if you have a loved one in the spectrum, give them a big hug! For 10 more inspiring ideas go here: https://blog.stageslearning.com/blog/10-ways-to-celebrate-world-autism-day

Parting Thoughts: Autism is heavily misunderstood. We are also not anywhere near developing a good understanding of autism. It is important to support valid research and development for better diagnoses and therapies. Moreover, it is key that those who have conditions along the autism spectrum should be welcomed and integrated into society as well as possible. 

Should you wish to remind yourself of future recurrences of the World Autism Day, you can follow this link:

References:

1. Cover Image: pexels.com/photo/orange-green-and-yellow-puzzle-pieces-8386187/

2. Autism Awareness Day Image: https://pixabay.com/vectors/puzzle-autism-autistic-awareness-7085922/

Update: Newsom does say buck stops with him, as he points fingers outward...

 

This is a quick update to the post I wrote from this morning, regarding the resignation of Angell, California's Public Health Director late on Sunday. On that I mentioned, and I will quote here: 

For a true leader, the buck stops with you. Not a few levels below you! Especially not on scientists and public health officials. 

And of course, he then gave a press conference where he said the following:

“I’m governor, the buck stops with me.” 

Well that is good, and you can read about it in the link below, but here are still some unknowns and bothersome things:

1. Why did she have to resign? We still haven't heard what he has to say about that. 

2. If the state did inherit a bad database system, why did they not try to fix it till it was broken? And if the buck stops with you, then why bother passing it on again, in the same presser?

Conclusion

So, I don't know about you. I am still not impressed. You can't simply say the buck stops with you and then have a trained health professional resign. So, we are still where we were, except Newsom's questionable leadership stands a bit more exposed. 

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Did you enjoy this post? Please subscribe for more updates, using the sidebar. Have ideas or blog posts you'd like to see here? Contact me at yamanoor at gmail dot com.

References:

1. Title image, pixabay vai pexels: https://www.pexels.com/photo/1-us-bank-note-47344/

2. My original blog post from this AM: http://chaaraka.blogspot.com/2020/08/during-pandemics-we-need-honesty-not.html

3. On Newsom's presser: https://deadline.com/2020/08/california-coronavirus-update-governor-gavin-newsom-ethics-complaint-one-billion-dollars-1203009219/

During Pandemics, we need honesty, not resignations

 

California, my state of never-ending hubris, and chutzpah, is in the midst of a crisis. As with everything else, it is being handled rather poorly. Gavin Newsom, our governor is in a big fight to prove he is a better manager of the crisis than another, more inept leader. Ironically, this has only exposed Newsom's own lack of vision, leadership, and above all, patience. Since I am not beholden to political winds, I am happy to specify criticism every-where it is due! 

First, despite the warnings of Santa Clara County and others, waving evolving science in the face of everyone, the State was reopened in a maddening rush to nowhere. We all know how that has gone for us. 

Second, Newsom, still hasn't learned his lessons, and keeps looking for "outs", including going out and declaring a 21% drop in cases that simply was the result of a flaw in data gathering and analysis. Of course, the end result is, an otherwise capable enough Public Health Director, Sonia Angell, has resigned, as of Sunday evening, rather abruptly. 

The Problem

She is not without blame. Apparently her department knew there were data glitches (links below), and first reported them to the counties, rather than Newsom and State Health and Human Services Secretary Mark Ghaly. 

Hence it would appear Newsom had egg on his face, misreporting a drop in cases. Sure, but if you were he, wouldn't you ask yourself why the sudden drop? I would. Let me draw an analog. 

Tigers in India and Coronavirus in California

As the genius of some politicians in India was employed into feeding chickens to malnourished tigers in Indian zoos, WWF, an organization I grudgingly support, came out in full throated support of an extremely flawed Indian Government tiger census, a few years ago with a "study" that claimed the number of tigers in India had simply doubled! Now, even if Pfizer had dumped barrels of Sildenafil into all the watering holes in India's National Parks that are well poached, I suspected my ferocious feline friends wouldn't have had that much quick success. 

Back then, I was foolish enough to have a fraudbook account (facebook, for the uninitiated), I picked a rather friendly fight with WWF India about the government's count, seriously raising doubts. They assured me, they hadn't counted separate scat deposits, or double paws and what have you, and that this remarkable doubling had indeed happened. Utterly unconvinced, I simply gave up. 

Well, a few months after...

This is all Newsom had to do. Have a healthy dose of skepticism, or any at all. He didn't and now we have to lose an actual, educated officer from public service? 

Pressure in Public Service and Pandemics

It should be clear to anyone that Newsom made a huge mistake. The San Jose Mercury News just had
an editorial about what a mess our non-recovery, recovery has become. This is perhaps why, just as with publications in science, where people fake data to project success, Sonia Angell and her team, or just herself, or whoever she is covering for, probably hid the data problem. 

While Newsom is echelons above Ron DeSata..Desantis, who apparently, simply fired Florida's chief data wrangler for refusing to cook up data, the effect remains. 

1. We have lost an official with education and at least passable competence. If politicians get to keep their jobs, why shouldn't public health officials? In fact, I prefer the latter over the former. 

2. This has now created unwanted talking points for conspiracy nuts, with a view towards debunking the very existence of the pandemic. Sigh!

3. Continuity is VERY important. Yes, hiding data or data problems is bad. Hiding them from your boss is bad, but people should be given an opportunity to repent, express remorse and still do their jobs, which come with the backing of their scientific training. Especially, "at times like this," as cliched and painful as that has become!

Conclusion

In rushing to re-open a state that was not clearly anywhere near ready, and then playing an odd game of Mahjong with the various counties, Newsom ultimately bears the blame, not the officials who pre-date him. Yes, mistakes were made, and it is rather egregious of Angell to have hidden what happened, but Newsom would actually be demonstrating leadership, were he to disallow the resignation and let her continue to serve the public, with revived interest and earnestness. 

Newsom and Ghaly should ask themselves, what in their behavior has caused officials to hide the truth from them, that they were willing to share with the counties involved! 

Apply less pressure on public health officials and subordinates where you have failed, purposefully so. For a true leader, the buck stops with you. Not a few levels below you! Especially not on scientists and public health officials. Leave that to imbeciles like elon musk. 

Alas, that is not to be! A truly failed opportunity. 

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Did you enjoy this post? Please subscribe for more updates, using the sidebar. Have ideas or blog posts you'd like to see here? Contact me at yamanoor at gmail dot com.

Images, Courtesy of:

1. Cover Image: Kelsey Johnson via pexels: https://www.pexels.com/photo/golden-gate-bridge-2331573/

2. Tiger: George Desipris via pexels: https://www.pexels.com/photo/close-up-photography-of-tiger-792381/

3. Pipes and meters, pixabay via pexels: https://www.pexels.com/photo/metal-pipes-plumbing-pressure-372796/

References:

1. The resignation of Angell: https://www.politico.com/states/california/story/2020/08/10/california-public-health-director-abruptly-resigns-as-state-manages-data-snafu-9423839

2. The data flaw story: https://www.politico.com/states/california/story/2020/08/07/california-told-counties-about-data-flaw-before-newsom-ghaly-apparently-knew-1306033

3. The great India tiger discount: https://phys.org/news/2020-01-indian-authorities-flaws-tiger-criticism.html#:~:text=India%20is%20home%20to%20the,only%201%2C411%20tigers%20in%20India.&text=This%20was%20one%20third%20more,1%2C411%20animals%20reported%20in%202006.

India's uncontrolled and corrupt medical supply chain comes to bite back just in time for a pandemic

There is a strong yearning among many Indians, myself included, for our nation to reach the upper echelons, to considered as having arrived, and to be recognized as a developed nation. Sadly, political and societal will is lacking. This is not to be considered a negative post railing against India. I just want to state through at least one more recent story (linked below, Indian sites can drain your GPU through glaring graphics, so buyer beware), that I know adds to a large volume of anecdotes and press articles about the corruption that persists doggedly, at many levels of society, and alas, also in the medical supply chain. 

The Story

Recently, my father shared a story about Remdesivir being sold at approximately 4 times the regulated price in Tamil Nadu, India, our home state. You can say, a curiosity about healthcare runs in the family, so he does keep an eye out on local stories. As the story goes, even as supplies are sufficient, unscrupulous pharmaceutical "agents" are hogging supplies and then reselling them to desperate people at very high prices. There has of course been a complaint from the Medical Association to the local Government and as with all things, nothing tangible is happening.

Why? 

Simply put, the Indian government, while heavy-handed, has a very poor sense of direction or priorities.

They claim that Western companies engage in price gouging, so enforce really odd and incredible controls on the sale of drugs and devices originating from elsewhere (most Allopathic medicine in India originates elsewhere anyway). Despite innovations such as the Jaipur leg, this sort of regulation and control has done nothing to promote innovation at large scales from within India.

Yes, there are some really innovative solutions that come up, and there will be more as Indians realize their potential, but it is not owing to the really bizarre and ultimately useless regulatory environment set up. Why do I keep saying bizarre? Well, if you are an Abbott or a Medtronic for example, if you don't like the government's own price gouging, er, control, you have to apply even to withdraw a product from the market. I have blogged about this in the past. This is at the core of the problem. The real problem. 

The Real Problem

Yes, a significant portion of India still lives in poverty. Yet, list prices are not the problem. This is a

solvable issue. Even in a fair market, India could easily subsidize prices for customers who access public care, and of course, regulate ceiling prices. Instead, they control the prices and have done nothing to battle systemic corruption in every aspect of the healthcare chain. Therefore, hoarding and price gouging has just been transferred to criminals at large. This is now a systemic problem and affects every aspect of healthcare delivery like it has for decades, and the general public suffers. 

The Solution

I am not a free-market buff. I think a healthy dose of regulation is not a bad idea. However, the Indian

Government needs to federate pricing and manage this with maturity. Random, piecemeal pricing controls are not the solution, either. As I have written on this blog before, it destroys competitiveness and companies will shy away from introducing drugs and devices in India, medical tourism, or not. Protectionism can go both ways and really risk innovative products from India finding customers elsewhere in the future. The more urgent solution needs to be immediate control of the supply chain within India. Here are a few thoughts:

1. Prices for important drugs and devices, such as branded stents, or Remdesivir should be on a national database, available publicly, with a ceiling price clearly stated. 

2. If there is price gouging, there should be a separate hotline, that is then responded to when called upon, with swift punishments, which should include jail time. 

3. Modern tracking methods such as RFIDs and others should be used to track lots and quantities and where within the country shipments land. 

4. Suprise secret shoppers should visit online and brick-and-mortar stores and check out what is going on. I mean, it can be that simple, and the government has barely scratched the surface on such possibilities. 

Conclusion

It is clear that the Indian Government lacks the maturity to focus on the correct problems and the right solutions. I believe this transcends political parties as well. The medical profession and the public at large must insist on appropriate solutions that prevent injustices which will really push down the country's progress. India's pride and place in the world are at risk otherwise, as the coronavirus pandemic has shown. 

Subscribe and Support, Please! 

Did you enjoy this post? Please subscribe for more updates, using the sidebar. Have ideas or blog posts you'd like to see here? Contact me at yamanoor at gmail dot com.

References:

1. The Times of India Story (please be aware of the graphic-intensive nature of the web page): https://timesofindia.indiatimes.com/city/chennai/rs-3000/vial-remdesivir-sold-for-rs-12000-in-tn/articleshow/77271533.cms

2. An archival post I authored about the medical device market in India: https://chaaraka.blogspot.com/2017/04/indias-bizarre-medical-device-market.html

3. An archival post I authored about the status of Foreign Direct Investments (FDI) in India: https://chaaraka.blogspot.com/2012/08/indias-pharma-fdi-mess.html

Credits: 

1. Cover Image, courtesy Darshak Pandya via Pexels: https://www.pexels.com/photo/architecture-daylight-hand-india-574324/

2. Image of open book with glasses, courtesy Ugurlu via Pexels: https://www.pexels.com/photo/close-up-of-eyeglasses-on-book-336407/

3. Image of question mark, courtesy Pixabay via Pexels: https://www.pexels.com/photo/ask-blackboard-chalk-board-chalkboard-356079/

4. Image of lady with hands on her face, courtesy Kat Jayne via Pexels: https://www.pexels.com/photo/adult-alone-anxious-black-and-white-568027/

International Self-Care Day and what we should do amidst the pandemic

The International Self-Care Day is commemorated on July 24th, annually.

Why?

Well, if you are thinking about self-(health)care, you want to be engaged 24x7. Or, here in the "new" world, 7x24. Get it?

Now that we have that cuteness aside, let us talk about it a bit.

The Pandemic, Self-Care and You

So, dear reader, sorry, it is impossible to hide from the pandemic, or wish it away by the end of a random month in the future, unless you are a despot.

How are you?

Have you been caring for yourself? Self-care includes both physical and mental health care, as well as taking good care of your person. And as the title image postulates, it is not selfish! (Credits below).

I am hoping, even if you weren't doing so right now, with all the craziness going on, that you will, starting now. I am also hoping you would stay with me, as I lay out a personal, DIY, Maker experiment that my brother and I have been engaged in.

Some Self-Care Reminders

We all know these things. Yet, why do we have so much difficulty indulging in them? Well, stop the guilt and stop caring! For yourself. It will put you in a better place to care for others. That should take care of the guilt and be enough of an incentive. So here goes:

1. Grooming. I am very bad at this. I am now trying to improve. I hope you do too!

2. Walking. Yes, just pick yourself up and go for a walk. This is something I am good at.

3. Healthy Eating. I am doing better at this. Cut down gently on the stuff that needs to be eaten less, and start adding more of what needs to get in!

4. Meditation. Well, sigh, ADHD doesn't always allow me to do a good job of this. My daytime walking is also very focused on photography typically, and I tend to use visual and auditory cues as well as that "sixth sense". However, when I do the step-count catch-up at night, I play music and walk feverishly, on my block's sidewalk. Despite forming new friendships and gaining odd, new experiences, I have had the ability to meditate at night, without meaning to. I still suggest bringing a pen and paper because at some point, ideas start flowing!

5. Practice Zen. Having randomly picked Japanese as a language I would never learn, and therefore must, I extended my interest into a Zen class! And it was pleasantly, amazingly life changing and so different from what I thought it was. So read about emptying your mind, and using repetition to de-focus, so you may!

Healthcare Self-Care

For those with chronic health conditions such as diabetes, or the propensity towards diabetes, such as pre-diabetes, which I have self-care in the area of body health comes with some of those aforementioned activities such as walking and healthy eating. Generally speaking, more awareness and education is key. Knowing the important things to focus on is critical. Just about two years ago, for instance, I had my cholesterol tested. While my LDL (Low-Density Lipoproteins) level was low, which is generally considered a good thing, the HDL (High-Density Lipoproteins) level was low as well, and this is a problem. In East Indian men, a cohort I belong to as a cis-man, this is particularly a known issue.

Once I learned of that, I was able to start making dietary modifications to try and assist that process. I am a bit embarrassed to admit, I have not since gotten tested. The COVID-19 pandemic is a convenient excuse, but it does come with a grain of truth in that, I would rather testing resources as well as healthcare practitioners focus their energy on the sick, while giving themselves breathing room to recover. Then I know there is at least a touch of arthritis on my mother's side, and definite cardiovascular disease history on both sides.

The idea here is not to sit around and wait for things to come to me. I try to take, a middle path approach of taking enough care of myself. Of course, it would be very gratifying to do more, but I know that we live in rather contentious times and things will take time to turn in our favor, should they do. So, self-care should not become self-obsession or hypochondria. Of course, that is easier said than done. People who suffer from hypochondria can vouch for that.

This is where I think those who formally work in healthcare can endeavor to foment change.

Promoting Self-Care among the public

1. Keep it simple. The advice, the description of the health condition, the remedies, the consequences of inaction must all be laid out in the simplest terms. Heavy language tends to confuse and tune people out. Doctors should work with nurses, nutritional experts and other professionals to aid the public in a cohesive manner, with unified, simple messaging.

2. Awareness and Education must come with a cost-benefit analysis, laying out economic and familial benefits, as well as other areas where improvements can be beneficial. Painting a wholesome picture of how taking care of yourself helps you and those in your life has a very high chance of long-term success.

3. Update recommendations with care. Recently, blood pressure recommendations were updated to end up being rather confusing even to a trained mind. This is exactly what you want to avoid. Give people a couple of numbers, and a high/low binary classification and/or something simple. This is always the best way to go with these things. Throw in various permutations and combinations and you start losing people.

4. Repetition and reinforcement are key. It takes a while for messages to come through at times. Patience, repetition and reinforcement are important when creating awareness about healthcare in general and self-care in particular.

Our own experiments, Quantified selves and Self-Care

My brother, Sai Yamanoor and I are makers, besides being engineers. Faced with the travails of pre-diabetes the emergence of wearable watches and our own desire to help ourselves as others, we set out to brainstorm things we could do.

The end results are what we call Personal Health Dashboards 1 and 2, named for the first and second generation. Using LEDs, the first generation, PHD 1 highlights your progress towards your daily step goal, with the LEDs from left to right starting to glow, as you walk more, spanning from red to yellow to green.

This was a useful Proof-of-Concept and a prototype. With this, we were able to work on a next generation design and prototype. In this one, the Personal Health Dashboard (PHD) 2, or PHD2, we took our daily step goal, and started counting down the total steps to completion. So, if your daily goal is 10,000 steps and you have walked 2,000 so far, you will see 8,000 displayed and so on. This, another wild experiment in the Quantified Self milieu, turned out to be quite motivational and useful!

We continue to devise and build such tools. All designs are shared through publications and repositories online. We used to display these at Maker Faires in the hopes of inspiring other makers to engage in Self-Care, and of course the care of others.

Conclusion:

There are many forms of self-care. There are many ways to accomplish self-care. Pick your own adventure! Celebrate self-care day, every day, and not just on 7/24. If you wish to add the event to your calendar and remind yourself next year, you may do so!



Reference:

1. Cover Image, Courtesy, Madison Inouye: https://www.pexels.com/photo/self-care-isn-t-selfish-signage-2821823/

2. Some Information on International Self Care Day: https://self-management.eu/compareu-events/international-self-care-day-2020/#:~:text=Jul-,International%20Self%2DCare%20Day%202020,a%20vital%20foundation%20of%20health.

3. Detailed Instructions to construct PHD2: https://www.hackster.io/diychamps/personal-health-dashboard-7ee555

Observing World Health Day (April 7) in a momentous year

The World Health Organization has been promoting World Health Day, annually on April 7. In years past, one might have struggled to pick from various health conditions and issues, or cohorts to make observations. This year, we are in a unique position where the carelessness and sloppiness of many years has caught up with us, and here we are, with all of health, as potentially the issue to focus on. Here are a few thoughts on this day:

1. First, all healthcare and public health workers. All of humanity is indebted to you, from the First Responders and Police to Doctors and Nurses, Aides, Policy Makers, Public Health Leaders and Workers and many many more. There are many, many heartening and heartbreaking stories coming out, and many yet to be written whenever we can finally say this is done and over.

2. There has been a surprising lack of leadership across the globe, complemented by a surprising display of leadership to complement it. Leadership in crisis, especially a healthcare crisis deserves several blog posts on its own, and I will see if I can find time to write about this issue in detail. However, I will leave you with this. Don't "rally around a flag". That is useless. Hold elected officials to their tasks, and start acknowledging failures, and start punishing them at the polls. Otherwise, you are doing a disservice to yourself, setting bad examples for future generations and prolonging irresponsible responses to urgent situations.

3. It is incredible the amount of disinformation and ignorance that prevails, even among such danger. Just this Sunday, a neighbor was having a loud conversation with someone over the phone, proclaiming that the CVD was just the flu, and that you are supposed to get it and just power through it. For a good measure, he also threw in his apparent distrust of the news, because they were "trying to scare you". I am not about to start proselytizing willy-nilly, so I just let me jaw drop and started pondering exactly what it would take for humanity to overcome such wanton ignorance.

4. The emergence of idiots masquerading as "social scientists" and other nonsense. This includes Peter Navarro, Dr. Oz and a mix of quacks and other idiots. It is remarkable that such people still have influence, and even a pandemic is unable to stop this travesty. There has to be a forceful effort to prevent people from endangering the population.

5. The general lack of preparedness among many places across the world. This is very inexcusable, because we have recently had several smaller outbreaks such as the recent Ebola outbreak, the H1N1 outbreak and others, which have channeled the need to be better prepared. We have to do extensive analyses to understand how policy failures led to to such remarkable failures, and how they can be fixed going forward.

6. Several organizations have abdicated their responsibility. The WHO is suspect of kowtowing to China. The CDC is directionless. The FDA is approving tests at a questionable pace, and is allowing for unscientific experimentation to proceed, just to satisfy people looking for "quick fixes". This causes extensive damage to ongoing and future efforts without significant changes in leadership.


There are many, many more issues to be considered, and of course, they also have to be looked at with both breadth and depth. The message is clear. We slipped. And now, there is yet another opportunity to come out of this situation with a new perspective on things. The real question is, will we?

For now, stay home, stay safe and stay healthy!

Reference:

Image Source:

https://www.pexels.com/photo/fashion-man-people-sign-3952233/

Simple Innovations: What Comes After Coronavirus - Virtual Interactions

If you, like me are not a participant of the great toilet paper panic of 2020 (seriously, if you get sick, WHAT are you going to do with TP?), you are wondering what it is that we ought to do going forward.

Thinking of the future, one area of weakness that has opened up: virtual interactions

If you think about it, it is pretty ridiculous. Literally thousands of conferences on all manners of futuristic topics have been slow-boating their own toilet paper moment.

Conferences on the future which promise us all kinds of "solutions" are run in quite the old-school way. In reality, technology for virtual conferencing has been available for quite a while now. Greed has been the biggest roadblock up to this point.

Hopefully, when we are done with this, we push for more virtual interactions - virtual classes, virtual conferences and other means of interactions.

It is rather ironic to have to postulate basic steps, that everyone is aware of, but are not being taken!

Image Reference: https://www.pexels.com/photo/internet-technology-computer-pc-193349/

February is Heart Month

In the US, capitalizing on the spirit of Valentine's Day, February is commemorated as Heart Health Month.

So, get moving, get reading and get changing!

Photo Credit, etc. : https://www.pexels.com/photo/hands-heart-love-305530/

India: Tamil Nadu bans unnecessary intersex pediatric surgeries!

Note: I am from Coimbatore, Tamil Nadu, a very progressive city in a very progressive state. And so, I may not be as objective in writing this, even though, Diversity, LGBT and Women's rights are a top priority for me and I recognize that India has yet to make immense progress.

An Introduction

India is a country steeped in tradition and superstition, both of which cause immeasurable pain to those who don't "belong". And of course, infants have no power to fight the ills they are subjected to. I come from Tamil Nadu, where female infanticide has been a very sad and despicable crime, that the Governments have fought over several years. Female children are seen as a burden, because of the heinous observance of "dowry", which has to be presented to the male side during marriage. This, and the ongoing suppression of women, and other heinous acts against them, extends to transgender and other people who are not perceived as "normal".

In Tamil Nadu, one of the states that is somewhat progressive, right wing forces have yet to fully have an effect. In that environment, transgender folks have been getting some rights and attention in recent times. Hijra, as they are known in India, they are now offered the status of a third gender - a glimmer of hope, given the ostracization and crimes against them.There is an insightful video of transgender issues from Coimbatore, my hometown:

Unnecessary Intersex Surgeries in Children - A Global Problem

If you believe that unnecessary surgeries among intersex children is localized to developing nations, you need a bit of a refresher (See link below). Rest assured, right down from the US, such surgeries are a plague on children, and cause them severe, irreversible physical and emotional trauma. Much awareness, education and regulation is needed to reverse this trend. 

In that sense, this news that under the direction of the High Court, the Tamil Nadu Government has passed an executive order to ban such surgeries, except under conditions where the health of the child is endangered is heartening. They are also claiming to form a committee to prevent abuse of the health condition exception. 

The careful review of exceptions is critical. California knows this the best. Having passed a law to enforce vaccinations, the State learned that the provisions for exceptions are routinely and heavily abused by extremely irresponsible Doctors and Parents. 

The Future

One has to wait and see if future Governments in Tamil Nadu, as well as other Governments in other States, and some day, perhaps the National Government of India will follow this lead. It is very difficult to predict how things will go. Women, and minorities of every kind are in danger in India, and face discrimination and victimization routinely. Add to this caste based crimes, honor killings and other issues, the future is still grim. One can only hope that well-meaning courts and governments can act with care and prudence to help intersex children, transgender people, homosexual people, women and other minorities in India.

Reference:

1. News on the ban on intersex surgeries: https://www.reuters.com/article/india-lgbt-intersex/indian-state-bans-unnecessary-surgery-on-intersex-babies-idUSL5N25O22X
2. Unnecessary Intersex Surgeries in the US: https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us
3. California tries to deal with vaccination exemptions: https://www.apnews.com/e82739a3289647d39b0cf1c791628e17
4. Image, Courtesy, Pexels: https://www.pexels.com/photo/adorable-baby-baby-feet-beautiful-266011/