Apr 26, 2010

Science or Conscience ?

There are few people whom I have met, who at most times smell of pain balms. They have a preconceived notion that only those balms could save them from headaches. In fact, in most cases they apply balms in anticipation of headache, even before actually starting to feel a headache. Those are the ones that inspired this blog. The fact about these counter-irritants lies in their names itself – "Counter-irritant". They act as a counter to the firing of neurons. The principle is simple. Will anyone care for a pimple on the nose when he accidentally cuts his finger when working with a knife? Will a man worry about not having shoes if he happens to lose his legs? The same is the matter with these balms.

So what do you do when you get a headache –
Take a pill? Rub a balm? Get out from your system for some fresh air? Have a short nap? Put all lights out and sit in the darkness? Listen to some light music? Or do nothing at all?

All these will relieve the headache in various degrees. What determines the effectiveness of a therapy? Science or conscience? Is it working really because of some complex chemical structure, bonding with our pain receptors? Or is it only a change in the perception of mind towards the pain? If the answer to the last question is No, then how does pranic healing work?

We all know that every drug that enters the market must pass through a series of clinical trials before being introduced. The volunteers are selected based on their pathological (disease) history and willingness. They sign in a form called as the “informed consent” form. They would be explained in detail, what the study team expects from them and what possible result is expected from the study. So the volunteers can guess about 10-40% of the drug’s effects. What if this “thought” clashes with the “performance” of the drug?

If a person with cancer knows that he is getting a probable cure for his ailment via clinical trials, and that the medicine may enhance his health, or that it may extend his deadline of life on earth, that very thought makes him euphoric. The euphoria is a condition of happiness, a state of active functioning of the neurons, making them transmit and receive neurotransmitters better than when we are at stress and depressed. The term also refers to the state of mind of drug addicts after taking their dose of schedule X drug. This temporary excited state about getting a treatment that is likely to alleviate all his sufferings and social isolation, will definitely make him less perceptible to pain.

Since a considerable part of the feedback questionnaire (that which is gathered from every volunteer after intake of drug) consists of subjective questions (like, do you feel better now?, has the pain subsided?, do you feel like puking?, etc.), the individual’s view of his body condition in euphoric state is different from the real condition. How would we know the distinction between the “real effect” and the “perceived effect” of the drug?

There has been a remedy devised to tackle this – to use “Placebo” drugs. In simpler language, dummy drugs. They do not have any medical effect in relation to the sickness under study. Empty capsules, sugar pills, vitamin supplements, etc. Placebos externally resemble trial drugs, but have no curing or preventing phenomena associated with them. They function as filters eliminating the noise (from conscience) and transmitting only the desired signal (of science). The patients in the study do not know if they are getting a placebo or an active drug. This is called a single-blind trial.

Then is it fine if the trial workers (those who administer the drug to the patient, collect samples and feedback) know who is receiving what medication? He is also a human with a conscience that might make him involuntarily mark an answer expected out of a patient on placebo therapy. A perfect trial should not let the study to be a prey to anyone’s conscience. Thus came into picture – double blind trials. Only the topmost executive of the study would know which patient is receiving placebo.

Finally, science or conscience?
After all knowing the power of conscience itself would not have been possible without science. So do not argue about the title. It’s just a catchy phrase. Human mind has a gift of imagining things. Let us use it for the good.

Apr 16, 2010

Delhi Metro

Leave apart the sunburns, mosquito bites, mouth sores and fever that Delhi gifted me, one of the enjoyable experiences in the whole tour was the few-minutes-travel in Delhi Metro train, the other being my interview, of course.

The National Capital Territory's road transport would thoroughly confuse a tourist with its baffling number of roundtanas. One thing appreciable was the low auto and cab fares. The drivers did not argue or bargain much though they did not practice using meters to measure distance-fare relation. Ever since we planned to go to Delhi, I decided to make it a point not to return without having a feel of the much-hyped-about-metro-rail. After all it was not without reason. Metro provides Delhiites with a cheap, rapid and comfortable travelling option.

The vending machine gives you a plastic coin (like namma ooru temple's slipper token) which we gotta retain till we reached our destination. There is frisking before entry and photos are not allowed. It is necessary to queue up before getting into the superfast carrier but not needed to do the same before getting out. Plus a crowded metro reminded me of haridwar at the time of kumbhmela.

The whole metro journey would not have lasted more than 5 minutes, but a memorable experience.

Apr 15, 2010

My UPSC Interview

CHAIRMAN (Ch): So, you have just completed your degree in Pharmaceutical Technology. What did you study in that degree?

Me: Sir, we studied the basics of drug formulation, tablet and capsule manufacture and how to design the medicine according to the disease.

Ch: Is it a very technical specialized course?

Me: Yes, Sir, it is a specialized course because it was previously available for study only after an undergraduation in biotechnology. Ours was the first batch to come out with such a degree in Anna University.

Ch: Have you ever considered pharmaceuticals for a career?

Me: I was considering that option also previously, Sir. I had the opportunity of being in NCC for three years. During that time, I came to know about civil service and the various national services. And even from my school days, my parents used to encourage me to become a collector.

Ch: So, you thought it was not a bad option to become an IAS, is it? (All start to laugh) OK, tell me what you learnt from NCC

Me: Sir, in NCC, I came to know about the power of working wonders with cooperation. We learnt the concept of unity and discipline there only. The importance of teamwork and organised work was realised.

Ch: Did you get any kind of weapon training in that? What else did you learn?

Me: Yes sir, we did get basic weapon introduction and training in SLRs. We were also taught how to dismantle and reassemble parts of the rifle. We had to write theory exam also for passing B and C certificates.

Ch: What thing that you learnt from NCC do you think will help you in civil service career?

Me: After NCC training, I can cooperate well with my colleagues. I can also able to manage my subordinates with ease. I have been a Corporal (my NCC rank) in NCC, Sir.

Ch: what is the one reason you would say for joining civil services?

Me: Sir, IAS, and for that matter all civil services, they demand the learning process throughout the period. The educative process is continuous. I can develop myself and in the process be of use to the nation also. It combines personal betterment with contribution to nation.

Ch: OK. You hail from Tamilnadu. Is there any social problem in your state. Definitely I accept that tamilnadu is performing very well in many indicators. But is there any problem you would like to mention? What is your view?

Me: (I forgot to note that he asked me “social problems”, so I started describing the more general river water problem) Sir, the delta regions are dependent on rivers for irrigation. Tamilnadu being a lower riparian state, the agriculture is affected when neighbouring states restrict river water supply to us. That is one of the problems.

Ch: Yes, that’s true. But, do you feel any sort of social problem that is prevalent in tamilnadu?

Me: Sir, I would not say that there are no social problems in tamilnadu. There have been some occurrences of suppression of lower caste people. (I was reminded of keezhavenmani and uthapuram incidents, he became interested when I said this)

Ch: So, are there areas where these seclusions are still there? What can be the role of administrators in dealing with this problem?

Me: There are some pockets in TN where these are still happening. (I believed that instead of saying there are no occurrences now and getting caught when he quotes some incidents, it was better to accept that such infirmities existed in the society). There were reports on existence of walls between the ‘Dalit’ nagar and the upper caste nagar. They had no access to public areas, water tanks,etc. But recently the wall was destroyed and now all have access to common areas. With regard to the role of administrators in the eradication of this problem, I would like to say that in this case, the initiative to demolish the wall was from a collector of that district. The administration has a great role in preventing such discrimination and it has been doing it well too.

Ch: OK. What else are your interests apart from your degree?

Me: I like to solve mathematical puzzles and riddles sir.

Ch: What is this Hindi Praveen that is mentioned in your biodata?

Me: It is the Hindi Prachar Sabha exams in TN sir.

Ch: So, you can speak in Hindi well, is it?

Me: I completed those exams some 10 years back sir, so I lost touch in speaking. But I can read and write hindi sir. I was not able to find anyone to talk to in hindi sir.

Ch: In your state, they would not appreciate people learning Hindi isn’t it?

Me: No, sir, that attitude is gradually coming down. People are taking Hindi exams with interest.
Ch: oh, that’s very good right?(he asks other members, they accept it) it helps you to get adapted to any state you are posted in India. Good..

Chairman asked member 1 to ask questions

M1: Since you are from pharmaceutical background, I wanted to ask you about one particular disease – malaria. There is a particular drug called Artemisinin. Have you heard about it ? (I said yes) There are two variants of this drug in the market (he told two names). Can you say what is the difference? I said I didn’t know and that we dealt with only generic drug names in our course. He asked me to guess. I said that the variation could have been due to different side chains attached to the chemical. There were more discussions on that between the members and chairman. They forgot my presence for about a minute. (This is a special kind of medicine from China, and it cannot be synthesised in the lab, must only be obtained from plants, chairman became very interested in this topic and asked M1 if it is available in the market, what its cost was and whether it is affordable). Finally he asked me what the importance of the drug was. I shook my head with a ‘No’. Then he said that it was the only drug that was available to deal with multiple-drug-resistant malaria. He comforted me by saying that no problem and it is just a discussion from where we all learn from each other. I thanked him.

M2: (lady member) What do you think about the patent process? Is it beneficial? Why patents are given?

Me: The product patent is more beneficial to the inventor. Process patent is more beneficial to the general public because it gives a cheaper medicine. Patents were given to encourage the inventor to do more research and to regain the money he spent to invent.

M2: what is the difference between product and process patent? Which is followed in India?

Me: the final product is patented in Product patent. In process patent, the process through which the product is arrived at is patented. We follow the process patent.

M2: What about amendments to the Patent act of India?

Me: We have suggested changes to convert to a product patent regime under the TRIPs. The process is going on. (M1 intervened to say that it has already been in force, I thanked him for the information)

(chairman rises to get some water to drink and then comes back)

M2: is India ready for the new change in patent system? What will be its implications?

Me: In the short term, there will be rise in drug prices, but in the long term it will vanish with the development of more drugs by R&D boost.

M2: is there any exception to the patent regime? Is it universal?

Me: No mam, it is not universal. Under the TRIPs itself provisions are there for excluding life-saving drugs, particularly AIDS, Tuberculosis, Malaria (I glanced at M1 for support, he agreed by a nod) and other epidemics from patent protection.

M2: Why product patent should be given?

Me: To encourage more new products invention. We opposed it because our drug companies only reverse-engineer established products of drugs abroad like U.S. very few new drugs come up

M2: But don’t you think this way helps our drug firms to invent cheaper process to produce a costly product?

Me: Mam, suppose a pest or microbe develops resistance to the drug, then producing the drug cheaply will be of no use. New drugs must be developed.

Ch: So, finally, do you think patents should be given or not?

Me: I think patents must be restricted to creative things only, and must not cover life-saving drugs and things that directly affect the general public (all were satisfied with the reply and gave convincing head-shakes and smiles. Chairman asks M3 to ask questions)

M3: Well, if you are posted in north India like Punjab, rajasthan, haryana. There are these so-called khap panchayats which regulate their own business and give inhuman judgements. So what will be your role in such cases? How can you control them along with your district S.P.? (This is the first and last question asked by M3. he was very much an observer and not much involved in the board)

Me: I will take the cooperation of S.P. to take legal action against them if they give brutal judgements to the people

Ch: What if the S.P. doesn’t cooperate with you, if he refuses to comply?

Me: (I waited for two seconds, looked between two members to collect my senses) sir, at this stage I do not know how the relationship between a collector and S.P. will work. May be after joining the service and knowing the intricacies I would be better able to answer this question. (chairman was all smiles and taken aback for a moment, he said ‘I think this is a very nice way to answer this question’ and laughed out. All joined. Me too. Then he asked M4 to start)

M4: (This member looked like an anglo-indian and I had to listen intently to understand his accent) you were saying something about rivers in tamilnadu. There are rivers which have different names in different areas of its flow. Do you know some rivers like that? Tell me the names of brahmaputra in different areas.

Me: it is called as the Dihang sir.

M4: (I could not understand his expression whether my answer is right or wrong but he continued) it is called as the Tsangpo in Tibet as the Chinese would like to call it. Do you know the European river which has two capital cities situated on it?

Me: (I was in deep thought, felt it was something to do with France.)

M4: It has been famously talked about in literature. Can you guess?

Me: is it thames, Sir?

M4: No. it is not

Ch: thames runs in an island nation, so it cannot have two capitals located in it. Try some more

Me: sir, is it anywere near France?

M4: No, it is the famous Danube, can you say the names of capitals atleast? (then seeing my blank expression, he himself said the answer as Budapest and one more city. Well someday you need to come out of tamilnadu and India, so you have to know these things, that is why I asked this. OK. We have this male dominated society. They don’t care for women, they do not respect women. When you are posted in such an area and if men are behaving like this, how do you think you can cope with it?

Me: I can definitely command the respect I ought to receive, sir. I am a civil servant and a representative of the government. And it does not matter whether I am a male or female in this regard.

Ch: How will you get respect from the people of your district?

Me: Sir, I strongly believe that if I do my duties properly and sincerely, I can get accolades from my seniors and people (all satisfied with reply. Shook their heads as if they expected this reply only)

M4: being a graduate from pharmaceutical sciences, what would you like to say about this drug- Nimesulide? What effect does it have on children?

Me: Nimesulide causes liver damage sir (he accepted it with a yes) though all countries have banned it, it is still available in the open market in India.

M4: what do you think can be done to prevent such occurrences?

Me: (happy to receive the same question I discussed with a fellow-candidate a few minutes back) Sir, I think the intervention should not be made in the drug sales period. This must have been more carefully monitored in the drug licensing stage itself. (all supported with headshakes) even today there was a case of ethical violation in a vaccination trial. (M1 shook his head heavily signifying that he had read that article)

M1: Can you elaborate on that issue?

Me: sir, should I tell about the nimesulide issue or this vaccination trials sir?

M1: tell in general. (Then he changed) OK. tell about today’s vaccination issue. I think four girls have died due to it.

Me: Yes Sir, why I wanted to make it clear is because both cases are different. Nimesulide case is a curative medicine. But vaccines are preventive medicines. In case of curatives, there are several phases in which the drug has to be tested. First it has to be used on normal healthy volunteers, not on sick people directly. The sick must be included in the study only after checking the safety in Phase I. Then comes the issue of effectiveness of the drug.
But in the case of preventive medicines like vaccines, the trials are first done in labs, then in animals, and then in the targeted population. In animals, they are first vaccinated and then cancer is induced using certain chemicals to check how well the vaccine prevent the occurrence. But it is unethical to do the same in humans. Even if the vaccines are meant for children, they must be given first to adults only in the trial stage. So there must be stricter practices to protect ethics.

M4: so do you think the ethical committee has failed in this case?

Me: sir, the ethical committee is a body that has to decide on the number of people in the trial, the duration of the trial and about the protocols. I cannot understand how they permitted such a trial without proper considerations. So this I would say is a clear-cut failure on the part of the ethics committee. (I was emboldened by the cordial board and took a bold stand)

Ch: what are your service preferences? Have you opted only for IAS?

Me: I have given IAS, IFS, IAAS, IRS, Information service, postal service Sir.

Ch: So if you get IFS will you consider going abroad or go only into IAS and serve the nation?

Me: I will be very happy to serve in either case Sir. I would definitely join IFS and go abroad to serve.

Ch: Why?

Me: Sir, I have always liked to represent my country and so I will be proud of joining IFS.

Ch: what is the order in which you have given cadre preference? Will you like to serve in Tamilnadu only, or any other state also?

Me: I will be ready to serve any state in India sir.

M4: I have been observing many candidates in these interviews. I like to note their body language and how they use their hands, head, eye and all. Because even I was noted of my body language when I was interviewed by many people. (Laughs) particularly girls from Tamilnadu, the way you shake your head, it is very nice to look at (he shakes his head in an attempt to imitate me) (all join laughter club) How do you do it? How does it come to you?

Me: (I was smiling and even while listening to the above question did not change my mannerism and shook head in the same way as before) Sir, it is just a sign of acceptance. And it is a symbol of involvement in the conversation. (All members supported the view, though I was looking at the chairman only)

M4: Oh, and it shows that you are not stiff-headed also! (he poses a stiff-head and all start to laugh again) very good..

Chairman looked at all members for agreement to end the interview and thanked me for spending time with them. I reciprocated, got up from the chair and strode towards the door confidently and shut the door behind me silently. I was very happy to have completed the interview and had a certain level of confidence.