Can Ayurveda initiate a paradigm shift? A response to Patwardhan.

Professor Kishor Patwardhan's paper [1] has elicited a great deal of interest as the several comments and criticisms demonstrate. It is clear that he is a highly respected teacher and physician, and my comments as a person who fully believes in the Western system of medicine and has never used Ayurveda are perhaps bordering on insolence. Yet, I feel the need to make them in order to draw attention to some framing aspects of contemporary medicine.

Intention, perception and trust: comment on "Challenges of informed consent during a political crisis" by Mishra and Gaitonde.

This note explores the relevance of the ethics requirement of having a "study-independent observer/impartial witness" signing off on the informed consent procedure when the community under study is unwilling to do so. It shows how the community's distrust of the researcher as an agent of a malevolent government (expressed in a refusal to sign the consent form) is reflected in the researcher's objective links to government through education and advanced academic research. Arguing that research ethics rather than blindly following rules, means thinking about context, it reverses the question of relevance of the ethics protocol, to questioning the relevance of the research to the community. It suggests that thinking this through will clarify the position of the researcher and contribute to research ethics. Keywords: informed consent, impartial witness, public health research ethics, Citizenship Amendment Act, National Register of Citizens.

On the absence of a doctor's dilemma in India: Reflections on impatient violence.

On June 10, 2019, Mohammed Sayeed, a 75-year-old patient was admitted to the Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal (1). He died that night due to a cardiac arrest and this led to a scuffle between the patient's family and duty doctors. In retaliation, the doctors refused to discharge the body, asserting that since the family claimed it was a suspicious death, a post-mortem was required. A mob arrived, and in the confrontation, a doctor was injured. The medicos struck work. Doctors and medical associations across the country have voiced unanimous support for the doctors, and called for protective legislation against the violence of the public. As a consequence of these nationwide doctors' protests, the Supreme Court has now proposed a law that protects doctors by severely punishing those who attack them (2). Meanwhile, it does seem as if such attacks are increasing.

Hepatic and Renal Biochemical Markers as Predictors of Mortality Among Critically Ill Systemic Inflammatory Response Syndrome Patients.

Systemic inflammatory response syndrome (SIRS) is a frequently encountered complication seen in intensive care unit patients and remains a common cause of mortality. Assessing prognosis of those becomes a priority and indeed we have various efficient scoring systems for the same. However they use enormous data and involve complex calculations for scoring. We intended to find a simple, inexpensive, accurate diagnostic tool of certain markers to predict mortality outcome among critically ill SIRS patients and to evaluate their efficiency in comparison to Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Eighty-seven patients were selected and general hepatic, renal and urinary investigations were done for them at 24 h of admission and were followed up for a period of 4 weeks from admission date to classify them as survivors and non-survivors. Twenty-one percent patients had succumbed to death during study period. Urine albumin-creatinine ratio, alanineaminotransferase, aspartate aminotransferase and prothrombin time/International Normalized Ratio were found to be correlating with APACHE II scores and mortality significantly. Specific individual cut-offs were found for these parameters and were combined to form combined predictors which showed good discrimination (AUC = 0.715) and good calibration (p = 0.811) with specificity of 98.6% in predicting mortality. SIRS patients falling above combined predictor's cutoff are 54 times more likely to have an unfavorable outcome compared to the ones below. Overall predictive accuracy of first day combined predictors was such that within 24 h of ICU admission 87% of ICU SIRS admissions could be given a risk estimate for hospital death.

Storm in a teacup? General implications of the Cochrane crisis.

The crisis that has emerged around the expulsion of Peter Gøtzsche from the Cochrane Board seems at first sight to be the outcome of a typical power play. However, the structural issues that have led to the crisis have emerged in a more technical criticism. These include lack of transparency, lack of cooperation of the pharma industry and hostility of institutions. Thus, the watchdog institution for efficacy and effectiveness of pharmaceutical drugs has itself now been hobbled by inefficacy and lack of effectiveness in its operation. What the confrontation shows us is how little control or understanding we (ordinary people) have over what we are given as curative and preventive biomedicine. It demonstrates how we are ignorant about the treatment of our sick bodies by expertise, pharmaceutical industry and medical institutions. The problem is not one of a particular evil actor. It is a problem of our medical culture. While we struggle to find our way through this overall historical situation, we need to listen to ethical experts like Peter Gøtzsche who are willing to stick their necks out and speak the truth.

Integrative Analysis of Normal Long Intergenic Non-Coding RNAs in Prostate Cancer.

Recently, large numbers of normal human tissues have been profiled for non-coding RNAs and more than fourteen thousand long intergenic non-coding RNAs (lincRNAs) are found expressed in normal human tissues. The functional roles of these normal lincRNAs (nlincRNAs) in the regulation of protein coding genes in normal and disease biology are yet to be established. Here, we have profiled two RNA-seq datasets including cancer and matched non-neoplastic tissues from 12 individuals from diverse demography for both coding genes and nlincRNAs. We find 130 nlincRNAs significantly regulated in cancer, with 127 regulated in the same direction in the two datasets. Interestingly, according to Illumina Body Map, significant numbers of these nlincRNAs display baseline null expression in normal prostate tissues but are specific to other tissues such as thyroid, kidney, liver and testis. A number of the regulated nlincRNAs share loci with coding genes, which are either co-regulated or oppositely regulated in all cancer samples studied here. For example, in all cancer samples i) the nlincRNA, TCONS_00029157, and a neighboring tumor suppressor factor, SIK1, are both down regulated; ii) several thyroid-specific nlincRNAs in the neighborhood of the thyroid-specific gene TPO, are both up-regulated; and iii) the TCONS_00010581, an isoform of HEIH, is down-regulated while the neighboring EZH2 gene is up-regulated in cancer. Several nlincRNAs from a prostate cancer associated chromosomal locus, 8q24, are up-regulated in cancer along with other known prostate cancer associated genes including PCAT-1, PVT1, and PCAT-92. We observe that there is significant bias towards up-regulation of nlincRNAs with as high as 118 out of 127 up-regulated in cancer, even though regulation of coding genes is skewed towards down-regulation. Considering that all reported cancer associated lincRNAs (clincRNAs) are biased towards up-regulation, we conclude that this bias may be functionally relevant.

Reflections on discrimination and health in India.

This is a speculative paper on the structure of caste-based discrimination in India. It sketches the field by a) proposing four empirical and historical examples of discrimination in different medical situations; b) suggesting an analytical framework composed of domain, register, temporality and intensity of discrimination; c) proposing that in the Indian historical context, discrimination masks itself, hiding its character behind the veneer of secular ideas; d) arguing that discrimination is not some unfortunate residue of backwardness in modern society that will go away, but is the force of social hierarchy transforming itself into a fully modern capitalist culture. The paper then arrives at the understanding that discrimination is pandemic across India. The conclusion suggests that in India today, we need proposals, hypotheses and arguments that help us establish the ethical framework for meaningful empirical research that sociological studies of medical ethics and the epidemiology of discrimination can pursue. Its method is that of logical and speculative argument based on experience, with examples of different forms of discrimination to clarify the point being made. No specific research was undertaken for this purpose since the paper is not empirically based.