Being Mortal in India

A peaceful, painless death is one of life's greatest blessings.

Atul Gawande's latest book is born out of experiences with those who, for most part, did not have this blessing. It discusses the way in which medical technology and social norms tend to mislead, dictate or overrule the options available to those who are terminally ill.

The book also brought back deeply disturbing memories of my father's last days at a hospital in Kerala. Much like a patient described in the book, he to was shuttling between hospitals and diagnostic labs, with an irreversible nervous system failure. Towards the end it was appalling to see somebody who stayed away from hospitals "drugged into oblivion and tubed in most natural orifices as well as a few artificial ones".

Gawande, with his focus on the prevailing healthcare system in USA, misses on some of the more disturbing aspects of what the urban elderly face in India. The fact that my father retired from the central government service prolonged his suffering in more ways than one. The first question they asked you at hospitals was - "He is fully insured under CGHS, isn't he?".

A comprehensive health insurance package seems to have prompted private hospital docs to prescribe drugs, diagnostics and procedures that were completely unnecessary. Towards the end, all the family members had to give a signed undertaking to get him out of the ICU, back into the pay-wards.

The priorities of the elderly, and the terminally ill in India may be the same as those in other countries -- to avoid suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others,

The challenge is trying to ensure that these priorities take precedence over those of the doctors, the healthcare service providers, pharma & diagnostic companies, as well as 'loving' family and friends.


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LINKS

Homepage - http://atulgawande.com/book/being-mortal/

Biotech Meets Nanotech

In India, Nano is the name adopted for a little car which was meant to be the most affordable car in the world.

On the other side of the globe, in USA, a scientist-entrepreneur of Indian origin is ready with something on a completely different scale. Dr. Anita Goel of Nanobiosym, has created a portable device called Gene-RADAR which, for the first time, can detect deadly diseases such as HIV/AIDS and tuberculosis in less than an hour, using just a drop of saliva or blood.

Incredible as this may sound, it is one of the many strides that being made with 'devices' that are no bigger than some molecules. In this case, Gene-RADAR uses nano-machines to detect specific DNA and RNA bio-markers in real time.

What are these nano-machines? A nano refers to a billionth measure (1/10^9). So a nanometer is a meter divided by 1000,000,000. It is a scale on which you can describe the size of molecules, parts of a living cell and the wavelength of visible light-spectrum.

Such devices are beginning to be used to detect the presence of viruses. As of now, the most accurate form of HIV viral load testing is  based on polymerase chain reaction technology,  a technique which amplifies a few copies of a piece of DNA to generate thousands or millions of a particular sequence for testing. In the U.S., the test costs about $200, and takes at least two weeks to get results, since the equipment used is large and not found in most hospitals.

At AIIMS in India, the premier, government-subsidized tertiary hospital in New Delhi, the same test costs about Rs.6000 (~ USD 100). Even then, it is way beyond the reach of regular patients.The is some hope that Nanobiosym's innovations will help bring down the cost of these tests.

Dr. Goel is  a pioneer in the emerging field of nanobiophysics, a new science at the convergence of physics, nanotechnology, and biomedicine. Her company aims to drastically cut the time and cost involved in diagnosing diseases, especially in parts of the world where it is difficult to install cumbersome lab equipment. Gene-RADARs are going to be field-tested in Rwanda next year, and possibly in India, later.

Under the current set of laws and regulations covering clinical trials, it is difficult to test the technology in India. It would be interesting to see how the device fares in Rwanda.

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REFERENCES & LINKS

* What to consider before a DNA test -- http://online.wsj.com/news/articles/SB10001424127887323308504579087103446161772

* Beikimpis, Victoria (2013) - Heal Thyself - http://mag.newsweek.com/2013/12/06/heal-thyself.html

* http://www.nanobiosym.com/our-team.html
- science & tech in society forum - http://www.stsforum.org/

* 23andMe - http://www.newsweek.com/fda-doesnt-want-you-unzip-your-genes-207358
- 23andMe - DIY genetic screening device - uses just a saliva swab
- Promised “health reports on 254 disease and conditions,” “carrier status,” “health risks” and “drug response” as a “first step in prevention…"

* http://venturebeat.com/2013/11/26/warning-letter-to-23andme-could-be-a-landmark-case-for-health-care/
- The FDA recently clamped down on a mobile medical app called uChek, pointing out that the company’s marketing was misleading.
-  Navigenics (a 23andMe rival that was acquired by Life Technologies for an unspecified sum)

* http://venturebeat.com/2012/08/13/using-a-few-drops-of-saliva-23andme-creates-a-song-out-of-your-dna/

* http://www.businessweek.com/articles/2013-11-25/a-portable-hiv-test-that-provides-results-in-minutes
- Gene-Radar uses nano-machines to detect specific DNA and RNA bio-markers in real time
- other lab-on-a-chip project - Theranos, for example, recently made its instant diagnosis technology available in some Walgreens (WAG) stores

* http://www.bizjournals.com/boston/blog/bioflash/2013/12/still-in-stealth-nanobiosym-sheds.html

* http://mag.newsweek.com/2013/10/18/cervical-cancer.html