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Showing posts from 2020

The Art of Setting Up Success

What makes a great surgeon? Do they have long fingers? Or steady hands? Or the heart of a lion? I think it is the preparation they do right before they make the incision. In VMH, I would be assisting various surgeons, especially Dr MR Seetharam in orthopedic surgeries. MRS is very methodical in preparation for a surgery. Every surgery is different. One might require an expensive equipment, or a team of skilled surgeons. The patient might have severe comorbidities that make post-surgical management difficult. The economics might not work out. Functional recovery maybe more important. There are many factors that go into choosing the right kind of surgery for the right kind of patient. MRS will be thinking of all these as soon as becoming aware of someone who has an issue. But that's not the preparation I'm talking about. Inside the operation theater, with the patient and others eagerly waiting, there's a final and crucial step of preparation that MRS does. The X-rays are put

Science is Broken Because Scientists Can't Think Rationally

Scihub is being sued in Indian courts by the journal industry. There are some people worried about it. But it is funny how our knowledge system works. Take this tweet for example: Scientific publishing sure is rigged & broken. But hoping that the very bandicoots that are getting fat from the status quo will take hints and improve the system is beyond naive. The telling lack of collective resistance from scientists too enables this perverse model to thrive. — M D Madhusudan (@mdmadhusudan) December 24, 2020 The reason why journals charge exorbitantly and still get away with it is because almost all academicians publish only in those journals. And why do academicians publish in those journals? Here comes the greatest hypocrisy/logical fallacy of academicians. They think that publishing in "prestigious" journals bring "prestige". They even have a way of measuring prestige without making it sound like it's an emotional thing - impact fa

Lumbar Puncture and HIV

Lumbar puncture is a fascinating procedure. It is cheap, it can be done in relatively remote places, and it can be learnt easily given access to enough people who need it. LP has an incredible role in the management of many complications related to HIV. I've heard stories about how there used to be 5 LPs done every day in VMH during the time when HIV was causing rampant destruction in Karnataka and India. When I was there, we would do about 5 in two weeks. Nevertheless, when a colleague asked on Twitter about CSF analysis, I thought I should write down some of the things I believe to know about Lumbar Puncture itself, especially in relation to its use in management of complications of HIV. The first many LPs I saw were all done for spinal anesthesia in KR Hospital. Till then all I knew about spinal anaesthesia was a friend's description of the back ache he had post a "cool" hernia surgery because they had "poked many times for anaesthesia". I think I hadn&#

Public Lives of Doctors?

Social media has made our private life public. Facebook, Instagram, even WhatsApp (through stories) thrive on users generating engaging content. Often this content is snaps from daily life. A picture is worth a thousand words, yet can be generated in a second. Image centered social media platforms rely on this to keep themselves going. What about doctors (and other professionals) on social media? Is it any different for them? Should it be any different? This post has been triggered by the #MedBikini hashtag. Here's one tweet that reveals what happened: This journal article considers social media posts where MDs hold alcohol, wear inappropriate attire, and give opinion on controversial social topics as “potentially unprofessional.” How would any of these adversely affect the care we give to patients? 😳 #MedBikini — Ronnie Baticulon (@ronibats) July 24, 2020 I will not spend a lot of time discussing this particular paper or the twitter response to it.

What to Make of Itolizumab?

It is the worst of times . Science is suffering an identity crisis. The world is in dire need of science. Science isn't used to being rushed. "It is a giant and slow churn", said a friend once, "and spews a breakthrough once in a while". Is it possible to make the process faster? That's what everyone is wondering. And praying. And waiting, eagerly. Science isn't used to getting this attention. "Coronil is 100% effective", said Patanjali folks. "Favipiravir is 88% effective", said Glenmark folks. How to know the truth? Seeking truth has never been easy. Never has it been easy for journalists, scientists, or the common person. In some sciences there are multiple truths . Is medicine one of those sciences? Can there be a single truth in medicine? I won't use words like epistemology and ontology in this post. (Because I still can't remember which is which). But the question is essentially two: 1. Is there a single truth? 2. Is th