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Archive for March, 2019

Poverty is the cruelest  disease of mankind , the infective vector is not any deadly HINI or retro virus , but mostly the fellow humans themselves ! This is why WHO has included poverty in the ICD code (Z59.5 ) as a disease .

I used to wonder , as a member of Noble profession , should we fight against this disease or be happy to  spend my entire life time cleaning the coronary arteries of affluent human-beings and earn few bucks !

Can growth of money eliminate poverty ? 

We may think so  . . .  but it  doesn’t most times .Of course affluence can get more jobs to poor and logically reduce it . Its not that easy concept to understand . But we have robust evidence for affluence can aggregates poverty .

If poverty is a disease , and if  uncontrolled affluence elsewhere is an Indirect cause for it  , then affluence also becomes a  potential disease , Is in’t ? Will WHO include it in ICD listing ?

May I  propose Z59.5A to be called  Uncontrolled &  manic desire for affluence made at the cost of  fellow humans to be clubbed with poverty as a worrisome disease. Once its included in the ICD manual , I guess it will be unethical to ignore this disease. 

We all aim for growth in life .Nothing wrong in that .There are many facets of life that requires growth. Unfortunately , for most  homo-sapiens ,  growth is synonymous with  multiplication of money . . . nothing else seems to matter ! Money when it grows unregulated ,  begins to control you and hijack your  body and mind .

One more issue to  comprehend is , rapid growth of money is possible only at the cost of something else – Akin to cancer cachexia ,it depletes the body (Earth ) of it’s resources ( Nature abuse ,  extreme poverty , inequality ,  Third world exploitation , wars, etc ) For the  medical professionals  it is all the more important that growth shouldn’t mean money , as it has a direct and conflicting  impact on some one else’s life  !

mitosis of money 003

Just Imagine ,  if the all car companies combine together , aim for a rapid  growth from the current  4 %  to 25 % by 2030  , manage to  achieve it by any means ! . . . This planet will sink in the combined weight of automobile Junk !

It is obvious , uncontrolled growth in any form requires vigorous regulation and  Intervention and will eventually require a radical surgery if the growth goes unabated  !

Final message

If extreme poverty is a disease my guess would be forces that make poverty sustain is also a disease.  I know in my country people sell their life time assets for crucial health care .(Of course universal health care insurance is just beginning to come in. Here again insurance based health care has inflated the actual costs and threatening to impose inappropriate therapies .As a medical professional we should aim for the cheapest  and best form* of treatment to our patients . Artificially inflating the cost of therapy by worthless drugs, devices, procedures and disseminating them invariably leads to pathological  growth of science.

*If any one thinks “cheap and quality” doesn’t go together in medical care it is ignorance ! Most problems has simple and effective solution.

Counter point

It is foolish to link growing money and wealth  equivalent to cancer. Unlike cancer cells , money multiplied can be put into use for those in need .It is the principle of charity .But the reality is , human beings who are rabidly after money rarely have this mind set.In contrary the haven’ts have it in plenty. In my opinion, excess money has a dubious  capacity  to  contaminate  human values  ! (Why should some rich and elite opposes affordable health care  to poor ?)

Let us amass wealth and help others . Microsoft  is able to do it . Apple may do it later. What is the need for big companies social responsibility and philanthropy ? If the business worlds  motive and end product  promotes equality and goodness , sans exploitation , the question of charity at a later date never  arises.

 

Please note

Diseases that occur to  affluent population  is entirely different topic . Can be found elsewhere

Disease of affluence

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One popular definition of Intelligence goes something like this  “It’s a global capacity  of a living organism  to deal effectively with environment and live peacefully”

When myocytes are confronted with acute ischemia , they  don’t always  jitter . It expresses many behavioral pattern.The damage inflicted is variable as  the molecular mechanism of ischemic tolerance appears to be a virtue ! This might make  much revered time window of myocyte ischemia irrelevant .Each cell has got a unique capacity to survive or die . In chronic ischemia this myocyte intelligence and intention to survive is glaringly evident. How about this phenomenon in ACS ?

myocardial intelligence myocyte memory

Art of  survival 

Why some cells die instantly , some fully recover and few go for hibernation  and others  are just stunned . While apoptosis is programmed cell death with intact cell membrane , hibernation can be termed as programmed cell survival .We don’t know how many intermediate forms of cell surviving mechanisms exists.

One of the famous questions is does the myocyte need blood or fuel for survival* ?

It is a fine balance of various cell  surviving (Anti ) mechanism.How energy is utilised with available ATP molecules is a different  science altogether .It’s  possible like brain,  heart too has  myocardial intelligence  , which does  some independent thinking aided by  fuzzy logic and problem solving algorithms  built within.

Ignorance based ACS care 

While we slog with metals inside the large coronary arteries , the response of the micro vascular territory is at the mercy of God . mRNA instructed DNA codes determine acute mitochondrial  respiratory sensitization.Finally ,the successful reversal of ischemic injury depends upon the cell repair molecule’s crisis management skills !

How else one can explain , some broken hearts recover so well from a major ischemic injury others sink with first insult !

The concepts of pre and post ischemic conditioning  are related phenomenon which can be pharmacologically  mimicked .They  are the major areas of research in myocyte  revascularisation.

Final message 

What is written above  is pure non academic fantasy . Now, read the following article by Dr Kloner which describe the molecular mechanism of  ischemia modification and its impact on clinical cardiology.

Reference 

1.Robert A. Kloner, Shereif H. Rezkalla; Preconditioning, postconditioning and their application to clinical cardiology, Cardiovascular Research, Volume 70, Issue 2, 1 May 2006, Pages 297–307,

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