I agree. Let me tell you a personal story.
1983. My youngest uncle (dad's brother) in his 40s had a stroke, went into coma & died in a week.
I was a 2nd yr med student at KEM Mumbai & insisted he was Rx at KEM. Best in the business..then as well as now...1/n

https://twitter.com/DrJoyeeta/status/1738847385126912248

Prof of Medicine Rxing my uncle asked me to get all his surviving siblings for a blood test. I can't recall why, but none of the siblings actually came for a test except my father..2/n

A thread on the generic vs patented medicines debate for those not from a medical background. Hence I am simplifying some concepts. Experts please excuse.
Here we go!

Medicines are generally discovered/invented by Pharma companies. The company which first discovers/invents...+ the drug gets a patent (monopoly) to sell the drug for a fixed period of time (usually 15-20 yrs). This is referred to as the patented drug.
Once this period lapses, the patent expires & other companies can now make and sell this drug. These are called as generics...++

Telling kids not to worry and giving examples of how we may have coped with exam related stress will not ↓ children's suicides. We had 10,000+ suicides in 2021.
There are structural issues we need to address. Do you know that exam related suicides only account for...1/n for 10-15% of children's suicides. The single largest cause of children's suicides according to NCRB is 'family problems'.
This is not to absolve our education system. During the Covid pandemic (2020) since exams were cancelled, exam related suicides ↓28%, but before you...2/n

Short thread on a recent patient interaction: Why I am tired & have given up trying anymore.
Mrs X is about 30 yrs old. Middle class couple from town 200 kms from Pune.
I have known her for ~8 yrs now. I first saw her 6 months after her first baby, as she was depressed..1/n Had post partum depression & was suicidal. With treatment she recovered in about 3 months & about 1 yr after, we discussed and gradually tapered & stopped her medicines.
I also discussed with the couple about risk of post partum depression if they planned another pregnancy..2/n

This thread reminds me of a personal story. Not my diabetes, but actually something even more worrying when my younger son was 6 yrs old.
Short thread. +/

https://twitter.com/KunalBauvaa/status/1531296683656908800

When he was 6 he once had the usual flu/cough/cold that 6 yr olds routinely catch in nursery school. Since my wife & I are Drs we usually do nothing & wait for a week or so. Usually it gets better & that's the end of that. But on this occasion, his mother decided to consult +/

So why does the disabled community insist on being called 'disabled persons' and reject all alternative terminologies? Short thread.
This is not just about language, but is more fundamental than that. It goes into how you conceptualize & understand disability.
Intrigued?... For centuries, society has understood disability using the using the 'Medical Model' of disability. What does this mean?
Medical model locates the disability inside the individual. So a blind person is disabled bcoz they cannot see for example..

Saw a 35 yr old yesterday. Had schizophrenia since 18, multiple Drs. By the time I saw him at 25, he had dropped out of college, poor self care. Parents middle management professionals. Over the past 10 yrs, we have managed not only symptom improvement, but also functional ..+/ improvement. He completed a course & now holds a semi-skilled job. During this time he has attempted stopping his meds twice & relapsed after 2+3 months with disastrous results. Parents keen for him to get married & aim for a managerial job. I am unable to convince them that +/

This case raises many Qs. This appears like a miscarriage of justice. Here is what the head of department (HOD) of KEM hospital’s psychiatry, under whom Parmar had undergone treatment for post-partum depression after her daughter died said...1/n
google.com/amp/s/indianex… Psychiatrist said the woman had post-partum disorder & had not eaten, slept or rested properly since the birth of her twins. She said that Parmar & her husband, who suffered from leprosy, were living in poverty and the medical condition of their twins had stressed them out. 2/n

I grew up in 70s Mumbai. Remember my parents putting their money in FDs @ 15% interest & very pleased with it. Also remember we could never move out of our 1 bed flat bcoz the prices always kept ahead of my father's earnings & my parents would be horrified if you suggested..1/n taking a housing loan. Mind you in the 70s, there was hardly anyone giving a housing loan. HDFC came in 1980.
My father was a lawyer & had a client who was a small time business-man. He would keep saying to my father, that he made money bcoz ppl like him put money in FDs..2/n

As a medical Dr living with diabetes for ~ 15 yrs (pre-diabetes & diabetes) I have learnt:
1. Diabetes is not a disease as conventionally understood but a system malfunction.
2. Wt reduction helps even in normal wt ppl. 7 kg wt loss in one study in normal wt patients ..1/n reversed diabetes.
3. Cut the carbs. For me reducing bread/chapatis/rice to minimum & ↑ proteins (meat, fish) works well.
4. Anti-diabetic medications. I rarely miss my doses & take whatever is prescribed by my physician (who is a close friend - so trust him totally)...2/n

For all those who think caste discrimination is eliminated once someone benefits from reservations:
Had a classmate who got admission to MBBS through SC reservation.
Did well & got into Surgery PG in open category. Did MS (Gen Surgery) at 1st attempt....1/n I lost touch as I went abroad and returned after 10 yrs. Accidentally met him after nearly 15 yrs. Was practising as a Gen Surgeon in a Mumbai suburb.
The most noticeable thing was that he had changed his family name. I asked him what happened?
His words...2/n

Thread: On cults
Janja Lallich (American sociologist) & Michael Lampone (American psychologist) came up with this list of defining characteristics of cults
1. The group has a polarized, us-versus-them mentality, which may cause conflict with the wider society. 1/n 2. The group displays an excessively zealous and unquestioning commitment to its leader, and (whether he is alive or dead) regards his belief system, ideology, and practices as the Truth, as law. 2/n

Thread: Does increasing incomes improve mental health?
Intriguing Q and we now have some good research to answer it.
Interested? Read below.
Some of the findings will surprise you!..
#WMHD2021
1/n In 1999, UK Govt implemented a minimum wage law ↑sing wages to £3.5/hr. This created 3 groups.
1. Whose wages ↑sed
2. Group whose wages did not increase bcoz were 100-110% of the eligibility threshold
3. Group whose firms did not increase their wages to meet eligibility..2/n

Thread: #SuicidePrevention
I promised to tell you abt research on a new treatment which ↓suicides by 60%.
It's from Brazil & Indonesia, 2 countries ~ similar to India in development indicators. India has ~250k suicides /yr so ↓ 60% could save 150,000 lives.
Brazil first ..1/n The Brazil study covers 50% of the population with information on 114 million ppl followed up for 12 yrs. Impressive, isn't it?
About half, 69 million received the new treatment & rest were controls. Those receiving the treatment had 61% lower suicide rate than controls ....2/n

Short story of the impact of pandemic on ordinary people who are not on Twitter.
A few days back, Arjun (name changed) called my wife & asked to come & meet her.
Arjun is someone I have known for ~ 2 decade. An owner driver, I have used him for my frequent travels..1/n to Mumbai & nearby places. He is honest, hardworking guy who my family & I trust a lot. He has ferried my kids when they were as small as 5-10 yrs old to Mumbai to my sister's place all alone with no adults in tow.
A devout God fearing man. Over the yrs, he got married..2/n

Thread: Indian understanding of quality & effectiveness of medicines.
Many moons ago, I was contacted by a father from Bihar for his 35 yr old son. Had schizophrenia for nearly 15 years & not getting better since many years. Had seen many Drs but no benefit. He had heard ++ of me from a relative in Pune. "Can I please get my son to see you" he sounded desperate. I normally dissuade people from making such long journeys esp when they have already seen so many Drs + chronic illness. Don't want to raise their hopes. In this case, the father ++

THREAD: My personal experience working in India's public health system.
Regular readers of this timeline will know I am a supporter of a public healthcare system.
So naturally I get asked, why don't you work in the public health system, if you think it is so good?
Here's why ++ I trained in a public medical school Seth GS Medical College & KEM Hospital 1982-91 & left in 1991 to go to UK having completed a MD (Psychiatry).
I worked in the NHS in UK from 1991-1999, when I returned to India.
During my time in UK, I got to see first hand & closely ++

Thread: I tweeted about Ekalavya & this Assistant Prof Savitribai Phule Pune University tweeted the reply below.
So let me tell you my own experience. I think 1st person accounts are important.
Disclaimer: I am not a savarna nor am I a Dalit. Honestly, I don't know my caste ++

https://twitter.com/tulidey_TBL/status/1373620155054399492

I grew up in Mumbai in 70-80s studied medicine at G S Medical College (KEM Hospital). Proudly got in there with "merit". Reservations & caste really did not impinge on my life except occasionally when savarna classmates said I had "wasted" a seat by not taking admission++

Thread: This is a long thread about my wife's grand-father: Vinayak Apte.
Born, brought up & lived in Pune. Aptewada, Sadashiv Peth. Qualified as an engineer in 1920s or so. Married around same time.
I promise you this is worth reading, so settle down with your cup of tea....1/n Around 1921, young Vinayak writes to Mahatma Gandhi expressing his desire to join Bapu & work for freedom struggle.
Bapu writes back saying sending money for the ticket (₹5) & get your backside up here (not exactly these words, but you know what I mean!).
Bapu adds a PS...2/n

I find ppl have difficulty understanding #evidencebasedmedicine (EBM) & how Science works.
EBM doesn't try to "prove" anything but is focused on REFUTATION. Let's say u have a new medicine which you believe works better than previous medicine/no medicine. Thats your theory...1/n #EBM sets out to refute this theory. Hence all trials start with a null hypothesis: New Treatment A is no better than placebo/treatment B.
You then use statistics to find out whether the difference between the two was likely to happen by chance. P < 0.05 only means that...2/n

THREAD: for academics & researchers wanting to influence policy makers. Mostly India specific advice. Based on my reading & experience of doing this stuff for > decade now.
At the end, I have also given a link to a very useful Nature paper on this subject
So let's begin..1/n Rule 1: Policy makers are smart people, smarter than researchers/academics/clinicians. In most countries, its harder to become a senior civil servant than get admission to medical college or a proffesorship. Don't be fooled by the dumb look. That's training. So respect them..2/n