Author Archives: Trichur Hotel

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Not Fair!

Cosmetics
Cosmetics (Photo credit: My Sight, as You See.)

Should the cosmetic industry be regulated? Cosmetic industry historically is either not regulated or the regulations are minimal and ineffectual in most parts of the world. A topical pharmaceutical product takes years to reach the market after stringent safety and efficacy tests on humans and animal models. Still pharmaceutical products cannot advertise while the cosmetic industry can make horrendous claims like 2 shades lighter skin and “get your hair back in 15 days”!

English: Sun Spray, Nature Cosmetic, Sun Spray...
English: Sun Spray, Nature Cosmetic, Sun Spray from Germany Deutsch: Sonnenspray, Naturkosmetik, Deutsches Sonneschutzmittel (Photo credit: Wikipedia)

Ironically most consumers believe that cosmetic products have to substantiate their safety and efficacy to regulatory bodies before they make these claims. But the fact of the matter is, you can get away with normal clay packed in an attractive bottle as a fairness cream. If you have a good advertising team, you can make money too. Some claim “medical” benefits and call themselves cosmeceuticals!

Pharmaceutical products go through pre-clinical Phase I testing on animal models and clinical Phase II and Phase III testing to establish its pharmacokinetic and pharmacodynamic profile. Further monitoring and testing is done in Phase IV for which the gold standard is Randomised Controlled Trial (RCT). RCT is used to compare the product to placebo or the existing standard treatment. Though there is some merit in the argument that Phase I-III tests may not be required for cosmetics as only “products generally considered safe” are used in the manufacturing process, evidence collected through an appropriately conducted RCT is imperative to substantiate any advertisement claims that cosmetic manufacturers make. Manufacturers may not follow Good Manufacturing Practices (GMP) too.

It is high time for fairness creams to play fair!


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Gem: An Introduction.

Category : Gem

Gemini
Gemini (Photo credit: Justinsanity)

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Gem is my Gemini twin. We often engage in elaborate conversations. From philosophy to health informatics. From marketing to dermatology, we discuss everything.

 Knowing me is not knowing Gem. Gem is a believer and a communist at the same time, because Gem can live with contradictions. Gem is kiddish in some ways and believes that god can punish bad behaviour. At times Gem can be old and see death looming around every corner. Gem is opportunistic but pragmatic. Gem is shrewd and almost emotionless. You can never insult Gem. Gem is alone and happy to be so.

“So what should I discuss now?” Gem asks. “Should I teach you morality or should i teach you how to abstract health data?”

What is the relation between the two. I am confused.

“Let the unpredictable tomorrow decide the topic. But if I am in control, You see this symbol <>at the beginning. Otherwise you can discuss your mundane issues.”

“OK, Fine with me!”


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Pound foolish Vishu

Pounds Sterling
Pounds Sterling (Photo credit: 917press)
Today is Vishu, the malayalam new year. People wear new clothes and elders gift money to children called ‘vishukaineettam’. The latest TV advertisement of Kerala State Lottery shows this gifting ceremony. But there is a twist in the tale. What the person is gifting is not Indian rupee! It is a 2 pound sterling coin!! Time for introspection to all idolatrous Manglish speaking Mallus including me.
india kerala boat people
india kerala boat people (Photo credit: FriskoDude)
There are few hilarious TV ads in malayalam as well where Mohanlal buys, sells and does everything possible with gold. One hair oil ad rambles: “Why look at the face, everything is in the hair!!”  All the “kuri” ads try to be funny by emulating the comical Thrissur accent. Is it because all ‘kuri-companies’ are from Thrissur or is it because they (we) are the most gullible?

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Dr Who

Category : Medicine , Patient

A doctor examines a female patient.
A doctor examines a female patient. (Photo credit: Wikipedia)

Recently I was asked to find a solution to the following problem:

Dr Who is a popular doctor with lots of experience in treating a particular cosmetic condition. Dr Who has multiple clinics in different geographic locations. How do we scale up Dr Who’s experience to all the clinics?

This was my answer:

Dr Who uses 2 machines A & B and 2 products C & D.
Dr Who uses machine A with two settings A1 and A2 and B with 2 settings B1 and B2.
So you have several combinations and permutations of machine settings and products.

Dr Who extracts 3 information from a patient, X, Y, and Z. X and Y are captured by a machine and Z is noted by him.

Dr Who has 10000 patients with X,Y,Z known. He has data on what combination worked for whom and what did not.

We can correlate values of X,Y,Z for each patient with the combination (A1/A2/B1/B2/C/D) that worked for him. So when a patient comes to us, we measure X,Y,Z and propose the most likely combination to work for him. So our assessment will be based on Dr Who’s experience on 10000 patients.


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Airplane notes

Category : dermatology , Education

English: So called "New Matura" from...
Image via Wikipedia
No doubt, memories can be quite painful sometimes. But can memorizing something become cheating and outright illegal! Well, it seems possible. A CNN story alleges that doctors studying to become dermatologists have for years shared exam questions by memorizing and writing them down after the test. It seems radiologists also too share this vice. These memorised notes are called “airplane notes” as the memories are transferred to paper and shared in the plane on their return trips. The American Board of Dermatology has warned residents that the practice of using so-called “airplane notes” to cheat on certification exams is illegal! Dermatology and Radiology are the two medical specialities that rely mostly on visual cues and hence difficult to be ‘memorised’.
WELLINGTON, NEW ZEALAND - JUNE 29:  In this ha...
Image by Getty Images via @daylife
But this same ‘illegal’ practice is very common in our Indian medical/engineering entrance exams. Our entrance exams are mostly mcqs and a substantial percentage is repeated. Popular entrance coaching class owners relegate students to memorise a particular question so that the load is shared and they are able to get the entire question paper after the exams. Then they elucidate the pattern of certain commonly repeated questions and figure out work around to reach the answer without even having a basic understanding of the concepts. Ultimately these entrance exams fail to filter out intellectually capable prodigy from the millions who give this exams and unfairly select the ones who are resourceful enough to attend these entrance coaching classes. It is high time we called this illegal too! 

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My personal experience with KIRTADS healer

Traditional healer stand in an open market in ...
Image via Wikipedia
So on to my personal experience with a KIRTADS healer. I went inside one of the shacks (there were many, specialised in various segments perhaps) and met a dark, well built healer with a smooth-shaven face. (Not the features you expect for a traditional healer.) I told him that one of my friends has a thick skin condition like psoriasis. He immediately recognised psoriasis (may be it is a common complaint) and advised me that psoriasis requires exfoliation of thick skin from outside and purification of blood from inside and recommended concoctions for both. I realised that at a conceptual level, their approach is not very different from ours. Purification of blood is a very popular concept among traditional healers. It is a very appealing concept and has very high placebo value. Even if you go to a modern pharmacy in India and ask for “blood purification mix”, I am sure you will get something or the other OTC!!
Next I asked him whether he has any medicine for being fair. I sensed a qualm before he offered me “slim oil” for the same. May be he equated fair to beauty and by a complicated reasoning process – beauty to being slim. He did not offer me any further explanation. I feel “fairness creams” is a modern fad and never existed before. That brings me to certain ludicrous claims of Indian “fairness creams”. More on this in the next post.
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KIRTADS

KIRTADS – The Kerala Institute for Research, Training and Development of Scheduled Castes and Scheduled Tribes, is conducting a പൈത്രികൊല്സവം (culture festival, the translation may not be accurate) in Mala, Kerala from Jan 22nd 2012 to Jan 30th 2012. Since I am in Kerala now on vacation, I visited this festival a couple of days back. They had several stalls for traditional medicine. I will blog about my experience later. Today I will translate relevant parts of their brochure. Disclaimer: The translation may not be accurate. Read at your risk!!

Ethnomedicine (വംശീയവൈദ്യം): Every tribe has their own knowledge and treatment methods to deal with various diseases. Diseases that exist for several generations are treated with herbs and materials of animal origin. These practical knowledge evolved over several centuries and became a form of medicine called ethnomedicine. However this form of medicine is on the decline because of inefficient transfer of information through generations. Kirtands is trying to preserve this knowledge by encouraging ethnomedicine practitioners. Their core expertise is in psoriasis, piles, infertility, cancer, diseases of the nervous system, vitiligo, asthma, hair fall, abdominal diseases, cough, various arthritis and joint pains, eye diseases and tonsillitis. 

Medical Sauna: 

This is effective for skin diseases, respiratory diseases and arthritis and includes more than 60 herbal medicines. This treatment method is available in several centers in Kerala.

Research Initiatives in Ethanomedicine:

The main emphasis of our research division is on perpetuating the knowledge we have accumulated. We have initiated a 3 year course in ethanomedicine. Many of our practitioners who completed this course has become very popular in various districts of Kerala. We also conduct treatment camps in various places. We have even collaborated with Regional research center, Trivandrum on trials for diabetic medications. Our initiatives have helped in preserving our traditional treatment methods and to make it popular among the masses. 

In my next post I will describe my personal experience!


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Is there more to yoga than exercise?

Yoga at Wanderlust
Image by aquababe via Flickr
Today I read an article titled “jeevithayogam” about yoga in Malayala Manorama – Health. Though the title of this blog post may seem negative, I personally have no doubts about the many positive effects of yoga. In fact I have copied the title from an article published recently. We even provide yoga classes in our AestheticHoliday. I believe that Yoga is one of the most  intelligently contrived placebo treatment in the world. I must again stress that I am a strong supporter of the placebo effect and I don’t consider it an aberration that needs to be accounted for
However the focus of this article mentioned above is not about yoga itself. The author claims that the west has started to accept yoga by quoting few attractive names and studies. In fact it is little difficult to read these names in malayalam script. If cute names and studies can garner credibility, we may still be far behind acupuncture, and traditional chinese medicine. Here is what I found on pubmed.
1. Search for yoga  (779 results)
2. Search for acupuncture.  (8921 results)
3. Chinese Medicine (3069 results)
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Crazy Idea – II (Mobile Communication Network)

Category : Crazy Idea

English: Mobile phone evolution Русский: Эволю...
Image via Wikipedia

Here is another crazy idea!

In countries like India, even a relatively small event can have a large number of participants. During these events a large number of people will be clustered in a limited space for a certain amount of time. Any mobile communication between participants of these events will be carried by the service provider’s tower in the vicinity and will be charged according to the applicable rates. If small portable private mobile towers are available for organisers to buy or rent for such events, participants of such events can communicate with each other using the device, free of cost. In other words, a device that can aid communication of normal mobile phones in an intercom mode (without using service providers infrastructure) within a limited geographic area may be useful to cut cost for large event organisers and even big offices.

Creative Commons Licence
Mobile Communication by Bell Raj Eapen is licensed under a Creative Commons Attribution 3.0 Unported License.


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Diluting the Diagnosis

Psoriasis of the back.
Image via Wikipedia
Today I want to add another episode to the SCAM (Specialist in Complimentary and Alternative Medicine) series. This is a true story that happened about 2 years back. One of my patients with (not so severe) psoriasis had lower back ache. He was aware of the possibility of psoriatic spondylitis. I told him that lower back ache from psoriasis is relatively uncommon and the back-pain might not be related. He went to a homeopathic “physician” practising nearby and was promptly recommended x-ray of the spine. The homeopath diagnosed psoriatic spondylitis or its homeopathic equivalent and started treatment. I must admit that I lack his skills to promptly diagnose psoriatic spondylitis from x-ray. But why do these scams use the diagnostic tools of modern medicine. Hope they don’t dilute it to make it more potent.
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