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2022 has just come to an end, and so will we. Given our mortality, it's astonishing
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that we are such an arrogant species. We behave at an individual and collective level as if
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we are immortal. We know almost nothing about the vast and complex universe around us, but
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we have full conviction in the stories we tell ourselves about it. And we are just beginning
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to get to grips with our own bodies. For most of human history, we knew so little about
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the flesh and bones that we are made of. Not long ago, we even thought the brain was a
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part of the heart. Now, while our arrogance remains as unjustified as before, we have
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more reason to hope. Science has brought us to a place where we understand our bodies
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better. We understand our different organs, the way nature reacts upon us, the origin
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of diseases. And sure, there's still a lot to figure out, but we know the methods and
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the mindset we need to keep progressing. The method is scientific, where everything must
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be evidence-based and open to falsification. The mindset is humble, curious, skeptical.
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Now, sure, we can't live forever, but we can live the lives that we do live longer and
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better. And to do this, to keep progressing, we need to embrace science and put aside superstition.
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Welcome to The Scene and the Unseen, our weekly podcast on economics, politics and behavioral
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science. Please welcome your host, Amit Verma.
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Welcome to The Scene and the Unseen. My guest today is the outstanding doctor-scientist
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Abby Phillips. I first heard of Abby from Dinesh Thakur, who recorded a memorable episode
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with me called The Dark Side of Indian Pharma. Abby is known as the liver doctor on Twitter,
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and he is a fearless rationalist. For years now, he has been debunking different kinds
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of quackery that calls itself alternative medicine. The term is a misnomer. Modern medicine
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is evidence-based medicine, and the so-called alternative medicine systems are not evidence-based,
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they're not medicine at all. Abby has been attacked both by big corporations peddling
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nonsense products and by the Ministry of Ayush, but he continues his crusade because it is
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important. As a liver doctor, he has seen countless patients whose livers have been
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damaged because they popped what they thought was a harmless herbal supplement or an Ayurvedic
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medicine etc. etc. The myths around these are many, but lives are at stake and those
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myths must be fought. I have admired the way in which Abby has done that, and I have written
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various articles about the dangers of homeopathy and Ayurveda as well. I'll link them all from
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the show notes as well as some excellent books on the subject by the likes of Ben Goldacre
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and Simon Singh. Abby flew down to Mumbai a few weeks ago to record this episode, and
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we only spoke about quackery in the second half. In the first half, we spoke about Abby's
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journey, what the medical ecosystem in India is like, the incentives doctors deal with,
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the trade-offs they face, the ethical dilemmas they encounter, and why Abby chose not just
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to be a doctor but to be a scientist as well. He's published 165 papers and done pioneering
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work in reversing liver cirrhosis. There is much wisdom in this episode, and it's an important
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episode that can affect lives. So please do listen to it and please share widely, not
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just among doctors and medical students, but among all of us. I mean, we all have bodies,
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and we should all embrace science and shun dangerous dogma.
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One of the ways in which I've changed my life is that I try to understand my body better,
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and science has brought us to a place where we can finally begin to understand our own
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programming. This episode is sponsored by MapMyGenome, a path-breaking company that
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gives you different kinds of insight about your own body. And I'm specifically interested
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That's right, for 25% off, use the discount code Unseen at MapMyGenome.in. Know your genome,
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Abhi, welcome to the scene on The Unseen. Such a pleasure to have you on the show.
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Thank you for having me. I mean, the pleasure is all mine.
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So you know, before we kind of get started by talking about current times, the current
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state of medicine and all the sort of quackery that we are surrounded with in different contexts,
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I want to know more about you. Tell me a bit about, you know, what was your childhood like,
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where did you grow up and so on.
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Oh, yeah, I mean, and this is going to be very nostalgic for me because I miss those
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days actually. I was actually born in a small town called Kutatugulam. That's in Kottayam
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in Kerala. And my dad is a doctor. He's a senior gastroenterologist. And my mom is a
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housewife. So I'm the third of four. I have an elder brother, an elder sister and a younger
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sister. And most of my childhood, I mean, till the fourth grade, I spent in Chungam,
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in a place called Chungam. And my father used to work in this hospital called Devamada Hospital
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in Kottayam, in Devamada Kutatugulam. And he used to visit us maybe twice a week. He
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used to stay there and work there. And a lot of my childhood was actually seeing my father's
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work, the doctors that come to our houses. I mean, he never used to bring his work home.
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That was something my father did. But he was always very passionate. So a lot of my childhood
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was actually with my siblings. You know, we had a very good time. It was those times where,
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you know, sip ups were the greatest thing. I mean, you have these frozen orange drinks
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and you suck it out of that. You know, it's not a sip up during those times. I think it's
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obsolete now. You don't get it. It's extinct now. So those are our little, little joys.
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So I was born in Kottayam. And then we moved to Cochin in 1992 when my dad joined this
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hospital called SPVS Hospital. And further from there onwards, we've been in Cochin.
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And since 92, I've joined, I did my schooling in this place called Chinmaya Vidyalaya. So
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I've done my schooling, everything in a Hindu school where we used, we had to learn Sanskrit
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and you know, we used to do the Vishnu Sahasranama every Thursday. And my schooling till 12th
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was there. Fantastic place. I just loved it. And post 12th, I actually tried for medicine
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because my brother directly jumped into computer engineering and he left the country and he's
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now currently settled in the US. His name is Augustine. My sister became an artist.
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So after her master's in art, she moved to the US and now she's in LA and she runs an
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independent art installation services there. And my younger sister, she became a musician
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and left the country. So I was the, I was the medicinal engineering scapegoat who was
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in, who stayed back. So then I tried getting into MBBS after my 12th, but I did not get
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through. A lot of my classmates got through, which was devastating for me because we all
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went to the same coaching center. So at that time there was, there were no major coaching
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centers like we have now. We have Cerebellum, Praplada, Marrow, a lot of stuff happening
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now. But at that time we just had one place called as PC Thomas coaching classes in Trissur,
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another town in another city in Kerala. And we used to go there every Sunday, attend the
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classes and come back. And unfortunately I did not get through through the first time.
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I think I did not study well. I was not, I was not very serious about studies at that
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time. And, but then when I saw that, my friends actually went into the next phase in their
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life and I was still stuck there. I joined PC Thomas coaching classes as a full-time
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student. And I studied for about a year there, staying in their hostel. That hostel was like
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a military hostel. And I think it actually helped me realize, you know, the importance
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of discipline in life. So that is where I actually started spending time reading. And
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through that, I got through, after two years of attempts, I got through for MBBS at St.
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John's Medical College in Bangalore. And I completed my MBBS in 2007 from St. John's.
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And again, it's again, I mean, the whole aspect of Indian medicine is, I mean, Indian medical
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system is to, you know, you have to keep studying, keep studying because you're not going to
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do well with a basic degree. So the next was to go for MD in internal medicine because
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I never liked surgery. I can't stand the sight of blood and I cannot stand for long hours
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and do work. So I was going to go for medical field, not a surgical field. So I again, and
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it's all about again, sitting and attempting, you know, again, a competitive examination.
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Like what we have neat now, we had AI PJMT at that time, All India Postgraduate Entrance
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Test. And I gave it, did not get through the first time, gave a second time, did not get
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through. And ultimately, I think on my third attempt, I got through in general medicine
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at Nirulatham Sarkar Medical College through the government merit and I started my MD in
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general medicine there. So I did three years in Calcutta. And after three years, it's again,
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you know, you have to do something super specialization. You're not going to do really well in your
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life with just a MBBS or an MD degree. So then I was totally lost. I did not know what
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to do. So I mean, my dad was, he's a gastroenterologist. So he, I mean, he is very important for me
#
because what he tells me through my, I mean, at each and every important phase of my life
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where I wanted to make a decision, I think his words actually was the most important.
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So he actually told me to, you know, if you get into a government medical college, take
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it. So that is how I ended up in Calcutta. And I think Calcutta was the most important
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phase of my life. That is where I actually understood what diseases can do to families
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and what poverty is and how it is to work with minimal or no resources for people. And
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that is where I understood that it's not just medicine or prescriptions, but a kind
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of good deed, a pat on the shoulder, a hug, all these matter for patients and the family.
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And that actually changed everything. And my professors were so, I mean, I think they
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are like a dying breed. You don't get professors and teachers like that anymore. They never
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let us do any unnecessary investigations or tests. In my three years in Calcutta, only
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thing I think I've probably done about three or four MRI of the brain. That's it. Otherwise
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it's just clinical examination and identifying where exactly the problem is in the brain.
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And that is how they teach you. So all of this happened in Calcutta. And when my dad,
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I mean, I was very, very happy that I, I mean, it was very difficult for me to actually cope
#
with the life in Calcutta initially, because the, when I did my MBBS, it was all very nice
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because St. John's Medical College is very cool, very beautiful campus and things are
#
so nice there for students. So when I went into a government medical college, initially,
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I mean, we were like four of us in a room along with the rats and cats and everything
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around. And it was so difficult for me, but then I had to adjust to it. And when I adjusted
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to it, I understood that, you know, these things are not at all important. Your work
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and your, your profession, your career, the way you think and help people out in need
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is more important. So all of that actually, you know, came to a very nice climax. It was
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not an anticlimax in Calcutta. So after that, when I was thinking of doing my DM, that is
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a super speciality in gastroenterology, my dad told me, you know, please don't do gastroenterology.
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But I said, you know, you are a gastroenterologist. It's like, you know, I have to be a gastroenterologist.
#
So he said, no, absolutely not. Because gastroenterology is now going to get very soon going to get
#
saturated like cardiology is because now everybody is going to split out into cardiology. Like
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there is some, there are super special, super specialties inside cardiology now, like you have people
#
taking care of only arrhythmias and rate problem, heart and rhythm problems, people looking
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into surgeries, people who are only into intervention and things like that. So he said that gastroenterology
#
is going to get saturated. So please go for hepatology. So after my MD, what happened
#
was that, I mean, I mean, just before my MD, I mean, just after my MBBS, while I was just
#
loafing around, not getting in anywhere, my dad actually sent me to Delhi. And he said,
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there is this person called Professor Shiv Sarin at GB panth hospital. He is one of the
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top guys in gastroenterology and hepatology. Actually, he is actually one of the pillars
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of hepatology in the country. Please go and be with him, talk to him and work under him
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and see how you like hepatology. So I went there as a junior research fellow, sir, I mean,
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very, very charismatic man. He took me in and he made me a JRF, a junior research fellow.
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And I started working under him in basic sciences. So there was no clinical exposure at all.
#
But what happened was that because it was all basic sciences and I was never, never
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interested in basic sciences, I used to actually hate basic sciences subjects in my MBBS. And
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you know, during preparation for my MD, I actually went into depression there. So I
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was staying alone in some place in Karol Bagh. And I was alone at the this room was very
#
close to the terrace attached to the terrace. And when it rains, my room used to get flooded.
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And I had to keep cleaning my room. And I did that for about three months. And I got
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very depressed. I stopped eating. And that was the first time I actually understood what
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depression was, because I did not want to go to GB panth. I did not want to work there.
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I just hated the whole thing. But I said, you know, but my dad said, you know, if if
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you actually go and start taking interest in what process Irene was going to teach you,
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maybe you will find something good out of it. So I tried for another month, but then
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I was really losing it. So one day I told my dad and mom, you know, I think I'm really
#
going into depression. I don't I can't actually get myself up out of the bed to go out in
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the morning. And I started taking sedatives myself to go to sleep and things like that,
#
because it was really tough for me. So he my dad came there. And the moment I said that
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I'm not getting things in the right sense. He came there the next day. He took me got
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a flight and took me back to Cochin. And then he said, OK, you do something. Joined for
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coaching in, you know, in Trissur, there is this Trissur Medical College, alumni association.
#
They do a coaching for post graduates, like for MD exams. So I joined there. And very,
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I mean, surprisingly, and I was very happy that one of my colleagues, my batch mates
#
from MBBS actually was also coming there. So we both got a room and we started studying
#
together. And I spent about nine to 11 months there in Trissur. I mean, the first time I
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spent was it was a PC Thomas for MBBS. And again, I went back to Trissur to study for
#
my MD also. And I spent about 11 months there. And both of us wrote the exam. And that is
#
when I cracked the exam and got into Calcutta, the Nithyananda Sarkar Medical College. Now,
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the best part is when I left Delhi as a research fellow, I told my sir, sir, I don't think
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this is for me. I want to do I want to be a clinical doctor and not get stuck in basic
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sciences. Sir told me, you know, I want you to come back to me because it's like the whole
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aspect of gastroenterology and hepatology is not about just clinical practice or skill.
#
If you know and if you love basic sciences, then you can actually make a difference for
#
your patients. He just told me that and said, I'm always here. If you want to do this, please
#
come back to me. So after the MD exams got over, and I was looking at taking up gastroenterology
#
and my dad said, you know, no, you take up hepatology. And he said, you know, Professor
#
Sarin has now moved out of GBPant. And he started this new he became the director and
#
started under the government a new institute known as Institute of Liver and Biliary Sciences
#
ILBS at Vasanth Kunj in Delhi. So he said, they have a DM hepatology program now. And
#
go there and be with him and see what he what he has for you. So I went to ILBS and I again
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met with Professor Sarin. So he said, see, I have paths have come again and crossed again.
#
So what I did was that I joined as a senior resident there. That is post MD. You are a
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non-academic resident. You actually work like in a salaried position, but you are not part
#
of the academic program yet. And I worked there for a whole year and I just fell in
#
love with hepatology because the stuff that they were doing there was something so different
#
from what I have been seeing in MBBS or MD. The kind of research work, the kind of work
#
that actually changes perspectives in patient management, cutting edge work was being done
#
there. Small animal experiments, cellular tissue based experiments, pure clinical research
#
experiments. I mean, this was like completely different form of clinical medicine that I
#
have experienced. And then and there I decided, you know, hepatology is the place because
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hepatology is one of the most extreme forms of internal medicine. If you take general
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medicine, hepatology is the most extreme format because you have to know about every system
#
to actually practice hepatology. And what I did was I at that time gave them in, they
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have an entrance exam. So they, I gave the entrance exam for the, for ILBS Institute
#
and also I gave entrance exam for All India Institute, AIMS. That I had to give because
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everybody is giving it. You know, it's like you are, you know, you have to give AIMS.
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If you don't give AIMS, that means you are not deserving. So I gave AIMS just like that.
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But I got into ILBS and then I did my DM, super specialty in ILBS. And I completed that
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in 2016, 2015, 2016. And in 2016, I came back home and started working as a counselor in
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hepatology in Kutchin. So this is my journey from a small town in Kottayam and back to
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Kutchin, then to Bangalore, Calcutta, Delhi and back to Kutchin.
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It's such a fascinating story. And there are many things I want to double click on.
#
I want to sort of take you back in a sense to your childhood, but the theme that I want
#
to ask you on kind of plays across. I want to ask you about as a doctor, where does one
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get one's values from? And not just as a doctor. I think in any profession, we see that there
#
are people who are just going through the motions. It's a career for them. They have
#
ladders to rise up. And you know, you can actually lose all engagement with what you
#
are really doing, which in your case is human beings, I guess, in a sense. And you can lose
#
that engagement and go through the motions and climb that path. But there are others
#
who have this deeper conviction that there is a greater meaning to what I am doing. And
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you can see this in journalism, where most journalists might be going through the motions,
#
but a few will be no, it is a higher calling. Perhaps you can see it in the law. You can
#
definitely see it in medicine, you know. So we'll hear about how, for example, these
#
days the incentives are tailored in such a way that doctors are asking for test after
#
test after test because, you know, they get more money and so on and so forth. But as
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you pointed out in Calcutta, when you were learning that was discouraged. And what I
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see from, you know, first time we've met, but from what I see from following you on
#
Twitter and elsewhere, is that there's a deep engagement with your work. You really care
#
about the thing that you're doing. Right. So tell me a little bit about where you think
#
this comes from. Like, how much did your father have to do with this? Tell me a bit about
#
your father. What, you know, what kind of values would you grow up with just outside
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of the medical context also, you know? Right. Yeah. I mean, I think we can have a whole
#
episode on my dad. Let's do it. Yeah. So my dad, his name is Philip Augustine. He is actually,
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I'm actually searching for words, you know, because he's such a complex man in the sense
#
that, you know, he's dedicated his life completely to medicine and people. And what I have actually
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seen him do is that, I mean, I don't think I can be like him ever because he's him and
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I cannot be like him. People actually can't expect me to be like him also because he is
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him. What happened? I mean, when I look at him and his work, he's actually one of the
#
first gastroenterologists in the country and actually one of the first gastroenterologists
#
to actually went into interventional gastroenterology, doing endoscopies and procedures like endoscopies
#
and procedures like ERCPs first time in the state, doing very, very expert procedures
#
like transjugular liver biopsies. That is where you actually go through a vein, a vessel
#
and go into the liver and take a tissue of the liver and then come out through the same
#
vessel out. So these kinds of extreme liver biopsies, extreme procedures, he was actually
#
the first to do it in the state. And he's one of the founding fathers of gastroenterology
#
in the country. He's also a Padma award winner. And all of that is because of the quality
#
and the dedication that he has actually shown to his work. So what I have seen him do is
#
that he brings, when I, when I initially said that he does not bring his work home, it's
#
in the sense that he does not bring his burden of work home, but he is always available for
#
his patients at all times. I have actually seen him pick up phone calls at 2am and 3am
#
in between his sleep and talking to patients, patient families, bystanders and telling them
#
what needs to be done. And he's always available 24x7 on that phone. When I, if I do that now,
#
make myself available 24x7, I mean, I think I just have to be in the hospital. I mean,
#
I can't do that at home because people will keep calling me and you know, but for him,
#
that's not a burden. He actually takes it as a duty, something that he's bound to do
#
and which he enjoys. And he, I mean, I have seen him always helping out. He never says
#
no to a phone call from a patient or, or, I mean, I've actually seen him take calls
#
and from total strangers and give them advice on the phone saying that, you know, you need
#
to do this test and do that and then come back to me and then we'll take a decision
#
on it. You know, I see an unknown number. I don't pick it up. I mean, that's, that's
#
a normal behavior, but not for him because he feels that that number he has to pick up
#
because they want some help or they're in need and he has to do it. So that's, that,
#
that's the kind of person my father is. So I think that compassion part comes from him
#
because deep inside I've seen him help people and how satisfied he is with his life. My
#
dad has actually, I mean, if you look at from the point of my dad's story is actually quite
#
bittersweet and he was actually a pure academician at one point. I had one of the best publications
#
ever at that time. It's not, not so easy. Like we do publications now here. We just
#
upload electronically and then they send us revisions and we do everything through the
#
computer. But at that time there was no computer. There was everything was a typewriter. So
#
he used to actually type everything, all his publications and then send it to the journal
#
as a hard copy. Then after months, they correct and send it back. Then again, he makes corrections
#
and then sends it back. So publication used to take months and months and months at that
#
time. And it's all in type through the typewriters. And he used to be dedicated in that. And what
#
happened was that once he moved to Cochin and he started and his practice actually started
#
flourishing because he, he's a, he's a people's doctor. And obviously other doctors don't
#
actually refer to him much. The first time I've actually seen that in my life is patients
#
referring other patients. So his patients, when they're satisfied, they go back and they
#
bring more patients for him. So that was a patient to patient ruffle. And it was like,
#
it was like, that was a peak of his game at the time when he used to see about 120 patients
#
a day. He still does by the way, without any complaints. And what, what happened was that
#
at that point he started talking, thinking about entrepreneurship. So he wanted to create
#
an environment where healthcare was going to be affordable and it was going to be lightning
#
quick. So that is when he created this through a lot of, I mean, he actually went to a lot
#
of places, to a lot of people, got a lot of people in, they funded, it was a public funded
#
company and he made a Lakeshore hospital. It was one of the top, I mean, it, it's still,
#
it is still there. It was a top hospital in Cochin Lakeshore hospital research center
#
limited and he, he was a director, a managing director of the hospital for a very long time,
#
more than 10, 12 years. And it was flourishing like anything. So I was actually doing my
#
MBB as an MD at the time. And what happened was that when something actually becomes really
#
good and really big, somebody has to ruin it. So this, a company, a conglomerate from
#
the UAE came in and they did a lot of work behind my dad and they actually got the hospital
#
under them. And he was actually chucked out of the position of managing director and somebody
#
else was instilled above him. And they brought in that, that old style corporate kind of
#
work into the hospital where he was, I mean, during his time, that was unheard of the corporate
#
kind of work in Lakeshore hospital. But they came in, they slowly moved him around and
#
without, and this, this was like a coop, a complete coop without his knowledge, all of
#
these things happened. And this is just when I was finishing my DM. And what happened was
#
that that, that hospital was his baby and he quit. He just quit. And what he did was
#
he, he was like a fish out of water then because he was, because that was his home and that
#
was his, that was everything for him. I wanted to work more in Delhi with process
#
serine and I wanted to actually do some fellowships and training and get to do more of basic science
#
work and research fellowships in basic sciences out of the country, probably in the U S or
#
Europe. So that was my plan because I was actually speaking at the moment from basic
#
sciences work at ILBS. One, at that time, my dad had to get out of Lakeshore. He had
#
to quit and once he quit, he was alone. So I had to go back to him. So what he planned
#
was he was, he, he made a company, a consultancy group known as Phillip Augustine associates.
#
And it was just the two of us, me and my dad. And my mom is also there. I mean, she's very
#
helpful with everything that we do and every decision my dad makes. I think my mom is the
#
silent person who actually tells him, yes, this is the right thing to do, not just my
#
dad. So it's both of them. And ultimately we made this consultancy group and I came
#
back and I asked him what, what should we do now because we have nowhere to go. So initially
#
when we, he came to Kochin from Kottayam, he was working in this place called PBS hospital.
#
That was also in Kochin. And he had asked them if they would like, I mean, they asked
#
him if he would come back to them because that hospital was doing very bad at that time,
#
because once he left from there to Lakeshore, it was crumbling. So, I mean, we had nowhere
#
else to go. He said, okay, we'll, we'll come there, but then you'll have to give us the,
#
the chance and the opportunity like we were doing in Lakeshore and we'll get it done.
#
But things did not work out in PBS also. I was also, I also worked there and that was
#
the time when I actually faced a lot of professional harassment in the sense that professional enmity.
#
I mean, I never knew doctors could become really bad to other doctors because what happened
#
was that I was a hepatologist. So I was the second hepatologist in the state. Before me,
#
there was another hepatologist who's trained from PJ Chandigarh and he was working in the,
#
in a hospital in Alua and, but he was doing both gastroenterology and hepatology, but
#
I was a core hepatologist. I used to do only hepatology work and my work was actually well
#
known also at the time before I came down to Kochin. And once this happened, a lot of
#
liver patients actually started coming towards me and a lot of liver patients started getting
#
out of the other gastroenterologists who were working as liver specialists there. A lot
#
of them did not like it. So they made my life hell there. And ultimately even that hospital,
#
it was not, not, I mean, for us, it was not a good environment to work with, even though
#
they did everything for us. The management was very considerate, but it was not going
#
to be a long-term thing. So we got out of that place and again, we were like, like fish
#
out of water. And that is when this, a small setup called Ernakulam Medical Center, they
#
said they wanted to improve on their activities. So they wanted us, our consultancy group to
#
completely take over gastroenterology and hepatology work there. So a lot of the work
#
that we did in the last four years, a lot of my research work, clinical work, everything
#
happened in Ernakulam Medical Center. So me and my dad, we went there and we started working
#
there and we worked there for about three and a half to four years and it became saturated
#
because I was not able to do more of my work and dad wanted me to actually increase my
#
output from a research point of view and that was not happening there. And that is when
#
we moved to Rajagiri Hospital, which we are in now currently. So coming back to that question,
#
everything that I have done is somewhere or the other related to what my dad has been
#
directly telling me or indirectly telling me. And that compassion, the, the, the reason
#
why I developed a strong bonding with the kind of, with my profession, that is hepatology
#
is because he has shown me that working for patients and their families actually may not
#
get me the money that, you know, other, my friends and all are getting in other professions,
#
but it actually helps me sleep well at night. You know, it's very satisfying to come back
#
home when you do that kind of work. I mean, like, imagine you're, you're helping out somebody
#
who's really in need. Even if you cannot help that patient, patient might die. It's not
#
up to you. I mean, you are not, we are not gods to save everybody. People die. And, but
#
the process that the journey that the patient and the family is on, and if you can become
#
part of that journey and there is nothing more satisfying than that in the medical profession.
#
So medical profession is not about seeing 120, 200 patients a day or doing 500 colonoscopies
#
and 300 endoscopies a day, or, you know, getting a first car or, I mean, I still haven't bought
#
my first car. The car that I drive now is partly funded by my father-in-law and partly
#
by my father. I still can't buy myself a car, but I'm happy because I'm able to come back
#
home and have a peaceful sleep. I mean, I get maybe four hours of sleep only per day,
#
but it's good sleep. So that kind of compassionate work actually gave me that important aspect
#
in life that when you are in a profession, the core values of that profession is what
#
drives you. It's nothing else. That is, that is why I don't lose focus. And my dad has
#
actually shown me, even my dad, he, and he's very well to do after this, after 65 years
#
of age, I think, you know, he actually became comfortable in life, monitorily also, I think
#
beyond 65 years of age, but he was always a happy man. And that is purely because of
#
the kind of work that he was doing. And he was satisfied with that kind of work. And
#
that actually is what fuels me also to do, to actually commit myself to in depth, that
#
compassion and care that we, that I want to show towards my patients and family. So yes,
#
my dad's story and his work definitely has helped. My professors who has taught me in
#
my master's degree has definitely helped. And definitely my main teacher is my mentor
#
is Professor Shiv Sarin. And his approach to patient care is, I mean, it's something
#
so different, where he actually puts in, applies new thoughts and new research opportunities
#
to make things better. So he was like, you know, you, you are doing something, you're
#
following guidelines, you have an option to follow the guidelines, you have an option
#
to change the guidelines for the better. So changing the guidelines for the better is
#
more satisfactory. So that is why we do a lot of, that is, that is how I fell in love
#
with clinical research also. And falling in love with clinical research is actually one
#
of the most important aspects of compassionate care for the patient, because you do, you
#
think out of the box for the patient and family, not for yourself or your work. So when you
#
say clinical research, people say that what is there in clinical research? But I think
#
clinical research is one of the most compassionate and core aspects of medical science.
#
Fascinating. Lots of what to double click on. But before, you know, we go further, tell
#
me and my listeners, what is hepatology precisely? Like, yes, okay. Hepatology is basically study
#
and management of diseases associated with the liver. So you have the liver, you have
#
everything to do around the liver. So for example, you have the gallbladder, you have
#
the bile ducts inside the liver that makes bile and the gallbladder stores it. Then when
#
you eat food, the gallbladder propels the bile into the small intestine and that's
#
how digestion happens. So anything to do with the biliary system, that is the gallbladder
#
and bile ducts and everything, plus the liver as an organ is what hepatology is all about.
#
And it's just one organ. My brother, you say, why are you so stressed out in your life?
#
It's just one organ. You have so many other organs. I tell him that this is the most complicated
#
of all organs. The largest organ in the body is skin. But and the second largest solid
#
organ, I mean, the largest solid organ could be is definitely the liver. And it's such
#
a complex organ and has to do with everything. So your immunity, the proteins that you make
#
in your body, the hormones that you metabolize, the hormones that you convert in your body,
#
you know, your digestion, your metabolic, everything happens. I mean, everything is
#
controlled by the liver. You definitely need a beating heart to survive. But ultimately,
#
what keeps you going is the liver. So this is what hepatology is all about. And hepatology
#
is also an additional point is that there is something more to it than from gastroenterology
#
point of view and that is transplantation. So you have transplant medicine also coming
#
in other than directly management of patients with liver disease. So there is transplant
#
medicine, post transplantation also in as part of core practice in hepatology.
#
So you know, let's go back to values and continue down that road. One of the things you mentioned
#
about Calcutta is how you were kind of one living four to a room as far as your personal
#
circumstances were concerned that the facilities given to you and two, you spoke about how
#
people were so desperately poor and you came face to face with poverty and all of that.
#
And you know, what part did that play in, you know, developing sort of empathy in you?
#
And the other broader question there is that I think a danger for all people, not just
#
doctors is that you tend to forget other people are people in the sense that you are the head
#
chief character in a play inside your head. Everybody else is a prop for your amusement.
#
Everybody, everything else is instrumental, right? And you have to keep reminding yourself
#
that other people are people too, and to relate to them as human beings and all of that. And
#
I think we often fall into a default mode where, you know, people are instrumental and
#
I would imagine that for a doctor, this is even a greater danger because you're always
#
thinking of the body and the organ and the processes and your inner sense, you're dehumanizing
#
all of those and you know, those become things that you study. And you know, when a patient
#
is with you, it could be tempting that that patient becomes a sum of their charts and
#
their ailments and whatever is happening inside their body. But there is a person there who
#
might be anxious, who might be terrified, who might be perhaps even reacting with aggression
#
towards you simply because they're confused and they don't know how to navigate this shit.
#
So and you mentioned that Calcutta was important for you for your kind of coming to terms with
#
all of that. So take me a little bit through your journey, thinking about these things
#
and sort of avoiding those traps in yourself as it were.
#
I think this this part is, I think, most important when it comes to me as a doctor and taking
#
responsibility for my patients and their family. In Calcutta, what happened was that, I mean,
#
I mean, it was general medicine. So we used to get all kinds of cases there from snake
#
bites to, you know, uncontrolled diabetes, infections, I mean, strokes, anything you
#
say, anything you can actually think of. Although all the old world diseases also we have seen
#
there, rabies, tetanus, you name it. And what was striking was that there was this particular
#
patient who came with uncontrolled diabetes. And when you have, I so clearly remember this,
#
when you have very high levels of sugar glucose in your body, you go into a particular condition
#
known as diabetic ketoacidosis, which is life threatening. And that is usually associated
#
with an infection. So you have very high amounts of sugar in your body that gets converted
#
to ketones. And that ketones starts harming you and you start having organ failures. So
#
you have to treat that quickly with insulin, bring down the sugars and make sure that patient
#
does not go into organ failures. At one point, we did not have, I mean, at one point patients
#
were so poor, the patients that with diabetic ketoacidosis that I actually admitted in the
#
night, that patient was so poor that they could not afford, I mean, they could not even
#
afford a simple gas medicine. You know, I mean, there are some medicines which are not
#
in stock in government hospitals and you ask these people to actually go and buy it. Unfortunately
#
on that day, we did not have insulin in the hospital and we asked them to buy a vial of
#
insulin from outside. They did not have money for that. And without insulin, this man was
#
going to die. And it's not easy to be in that situation because you know that without that
#
particular drug that patient is going to die. And there was no other means for us to get
#
insulin for them because it's a government setup. And so what we do is we hydrate these
#
patients immensely, bring down the ketosis with good fluid therapy and things like that.
#
But at one point, you know that this patient is going to die without insulin. So I still
#
remember me running around the female general ward, male general wards, the chronic wards
#
and we have chronic and acute wards there looking at other people who would share their
#
insulin. And at some point, I actually got a little bit of insulin for us to use for
#
this patient. And ultimately, we gave him insulin. He was there. The ICUs were full.
#
So we managed him in the ward. And a couple of days later, he died. And we did everything
#
that we could. They did everything they could. But so poor, they could not even afford basic
#
medicines. But we did keep him alive for two days with just the minimal resources that
#
we had. At one point, I was actually angry at them because I was like, why don't they
#
have money? You know, they should find money. If they don't have money, they should find
#
money. People do that all the time. You find stuff. Then I realized that they don't have
#
that luxury to even find money. No help, nothing. There are people like that. And the best that
#
you could do for them is to tell them that you are doing everything that you can for
#
this patient. No stones are left unturned. You have come to the right place. We are the
#
right people. And we are also helping you, supporting you. That's like a closure for
#
them because it's not like they have not done anything for the patient. And when I spoke
#
to them about this part, when that man died, I can actually see they were from a Muslim
#
community and they were actually from Murshidabad. I spoke to them and I told the son that,
#
you know, you have done everything that you could and we did everything we could. He was
#
actually happy to hear it from me. You know, even though it ended with his father dying,
#
he was actually happy that, you know, they did something that everybody is supposed to
#
do. They did not do anything that is off charts. It's not like it's not their fault. So I told
#
them, it's not your fault. So that is when I understood that, you know, money plays such
#
an important part in India, in management of patients. Those who have money, they can
#
go to any extent, but those who don't have money, they cannot afford to save somebody
#
in their family. So I took the, I mean, and that's just not one episode, multiple episodes
#
like that happened throughout my studies in MD. And when I actually came back and started
#
working in, I mean, when I saw, I mean, in Delhi, it was a different scenario because
#
a lot of people who used to come there were affluent. They could afford, very few who
#
could not. And Delhi has a very good policy where the below poverty line patients used
#
to get free treatment and free transplant. So things were okay. There was a machinery
#
moving around and things were fine. But when I came back here and I'm working in a private
#
setup, a lot of these people don't, patients don't have any medical claim or insurance
#
and they have to pay out of pocket. What I did initially was that the first patient I
#
sent for a liver transplant was a young man. He was an alcoholic. No, we don't call them
#
as alcoholic. It's alcohol associated or alcohol misuse because it's stigma associated with
#
it. So he was actually an alcohol associated liver disease patient and deep jaundice and
#
he was actually going to die within a few months if they did not get a new liver. I
#
did not bother asking the family about their deep into their financial status. I just told
#
the wife, she had two small children. I mean, they had two small children and I told them
#
that without a transplant, he's going to die. For them, that is the point that strikes.
#
You need a transplant. Only a transplant can save that man. And I did not know how this
#
was done, but what happened was that they actually had no money at all. So they took
#
a bank loan and there was a little bit of land that this man had saved up and they actually
#
put that land as mortgage for the bank for the loan. And they did the transplant and
#
the transplant and he was so sick during the transplant and because they took a long time
#
to get that money, everything done. And by the time this patient was so sick and ideally
#
I told them that, you know, this time that we decided to do a transplant earlier and
#
the time for transplant now, that's a lot of difference. You know, the benefits are
#
going to come going to be less, but they said, sir, we tried so much. We have come this far.
#
We want to do the transplant. So they did the transplant. It was somewhere around 18
#
to 19 lakhs at that time. And he was doing fine for the first one week. From the second
#
week onwards, he started getting infections because he was already having so many infections
#
before transplant. That is a very high risk factor for infections after transplant. And
#
the infections that he actually got after transplants were quite bad because you actually
#
see a lot of weird and strange organisms infecting an immunosuppressed individual and it was
#
fungus infection and he died. And post transplant for us to actually keep him alive for the
#
for about a couple of weeks, they had to spend another four to five lakhs. And by the time
#
everything was done, he died. They took his body and a couple of weeks or maybe three
#
weeks later, one of the neighbors came back for some documents from me. So I said, how
#
are they doing? How's the wife and kids doing? They said, sir, the whole family is now completely
#
in a mess because they borrowed so much of money and this patient died and they actually
#
overshot the bank loan. They lost the land. And that land was actually the only thing
#
the father had kept for the two female, I mean, the girl, the girl children. It's all
#
lost there. And I think, I mean, he told me that, you know, they actually moved to their
#
parents or grandparents someplace and they're trying to make ends meet there. And this was
#
like a shocker to me because I did not know that there is this aspect of treatment from
#
that time onwards. Every time I have to decide on an advanced treatment option for the patient,
#
I look at the family. I look at the family status. I talk to them in depth about everything.
#
How many children? How are they studying? What is your financial status? What about
#
their education? I look at everything together and I make a calculation in my mind that,
#
you know, if these patients, if I take them for a surgery, advise them for an advanced
#
procedure like a transplant or something else, and if they can't afford it and if they overshoot
#
it, if that is going to affect them as a family after this man, I mean, you have, you can't
#
guarantee anybody's life after procedure. I mean, you have that few risks here and there.
#
Somebody can die. Some patients can actually have complications that you don't even expect
#
to happen. So if I feel that, you know, they cannot afford and they're actually going to
#
do something out of something that that is going to stress them out for that financial
#
aspect, I tell them, don't do it because see, whatever we can do, we'll do it medically.
#
If you are comfortable with getting finances and if you are comfortable getting finances
#
that you'll even take care of complications, then yes, let us do it because otherwise you
#
will lose the patient and you will lose your life. You will lose the future of your children.
#
You will lose your land. You will lose your house. You will lose everything. It should
#
not be like that. So make sure that financial stability is there. Make sure they can afford
#
it. Otherwise, take them through that journey where ultimately the patient might die, but
#
then they will have that, that, that feeling that they have done everything medically for
#
that patient. And we have also done everything medically for that patient, but ultimately
#
we could not do much, but there is no financial burden on them and there is no extra stress
#
on that family. So once I started doing this for my patients, I found out that they were
#
more satisfied with that kind of treatment rather than me telling them, do this, do that,
#
do this, like exactly what you said. You are sitting there and giving orders, not thinking
#
about things other than that particular organ. Like for example, if I just think about the
#
liver and saving the liver, it's always a transplant. You know, I just keep pushing
#
patients for transplant, make sure, I mean, I don't care about how they're going to do
#
it. They will do it somehow. It's good money for the hospital. They will let them do it.
#
And because I want the transplants to be done, that is medically what is right. No, you cannot
#
think like that as a doctor. You actually have to think beyond that. If the transplant
#
is going to get them into a trouble, much more than that they bargained for with just
#
the disease. I think it's always good to openly discuss this with the family and the
#
bystander and say that, you know, these are the risks. You're going to be financially
#
struggling after this if something happens. If you want to take that risk, please do.
#
Some of them say, yes, sir, we will do that. We will take that risk. Financially, if whatever
#
happens, we have to sell our land, we have to sell our homes. We don't mind. We'll do
#
it. And for such patients, I say, okay, fine. That's your decision. Others will actually
#
come and tell me that, sir, because you have told us this, we do not know how to do it.
#
And if we do this, we know we are going to get into a lot of trouble. And we know that
#
this patient can also have a lot of complications. He might die also without doing it. But then
#
there is no way that we can do it. And because you told us this openly, we can make the decision
#
clearly. So if I don't talk to them about that particular aspect that, you know, it
#
is okay to not take the best option, which is given to you because you cannot afford
#
it. It is okay. It is fine. It's not like you have to do a transplant, spend that much
#
amount of money to save that patient for you to have some success. It's not like that.
#
Sometimes the best decisions may not be the best decision, best option for the patient,
#
but it's definitely the best decision in the interest of the patient and the family.
#
And this is what I have been doing in the last many, many years. And actually, my patients
#
have been actually doing quite well with that. And a lot of my patients have been improving
#
also medically when I treat because what happens is that some doctors will say that, you know,
#
do a transplant. They'll say that, sir, we cannot afford a transplant. So for that doctor,
#
that's the end of it. So this guy is not going to do a transplant. So he's going to die.
#
So just treat him like that. Give him something here and there. Anyway, he's going to die.
#
So they don't actually bother treating them to their best efforts. This guy is anyway
#
going to die. They know it. I know it. So why bother? But when you actually say that,
#
you know, both all of us know that he is going to die because they cannot afford the best
#
option, it makes you do much more for the patient medically. And when that medical effort
#
comes in really at that particular really good level, that that actually improves the
#
patient also better. So somebody who's going to die without a transplant in six months
#
have seen them survive for more than two and a half to three years on medical management
#
alone. So that extra three years for that family is like, it's a great thing. It's
#
a great thing. So some patients tell me that, sir, you told us that without a transplant
#
he's going to die in six months, but medically you have given us another two and a half years.
#
That is enough for us. So that is where this aspect of what I studied in Calcutta was extrapolated
#
to my current work here. Wow. So how would you have handled that original case differently?
#
That original case, I mean, if I look back, see, I have a lot of regrets in during my
#
initial part of my profession because I was, I was, I was just a young graduate. I mean,
#
I just got out of hepatology and I never knew what real life is going to be because I was
#
always under the umbrella of my institute. So we have professors, our professors, they
#
make decisions. We just have to tell, I mean, we just have to listen to what they want us
#
to do. That's it. And you're not responsible. The whole Institute is responsible. So we
#
don't get into trouble. But when you practice alone, your responsibility is much, much different
#
from the responsibility that you actually face in your training. And in that sense,
#
I have a lot of regrets. And one of that is that sometimes I overdo a lot of things for
#
my patients. Initially, a lot of things I used to overdo because I was scared as a doctor.
#
Usually I was not very good on confidence. And I used to do a lot of things for my patients
#
from both investigation point of view and medical treatment point of view, thinking
#
that something will hit somewhere. And if somebody comes and accuses me, so initially
#
the kind of practice that I used to do was to save myself, not the patient. I'll do everything
#
that I can. And I'll say that if the patient dies, I'll say that I've done everything.
#
I actually done things that I should not have even done. So that was a kind of practice
#
that initially I did. And that is that is why even the transplant happened, because
#
I wanted them to do the transplant and they did the transplant. But then I would also
#
want to blame them because it was their decision. They did the transplant and they knew that
#
the patient can also die with the transplant. So it's like basically like gaslighting. And
#
I used to gaslight my patients initially, and it was it was bad. And I learned from
#
it because when I when my when when this patient actually was a young man, I still remember
#
his face. And when he died and I knew that they lost a lot of money, they lost everything
#
that actually changed the way I actually practice medicine. So if I wanted to change anything
#
from that particular patient, I would not have let them do the transplant. I would have
#
actually done more for him medically, instead of just pushing them into transplant and making
#
them waste that money. I would have actually told them that, you know, we'll try medically
#
as much as possible, which is low on finances for you. But maybe very good on the patient
#
because medical management is not an inferior management. I mean, you look at transplant,
#
some patients do do well. And that would have actually I think probably given them another
#
maybe two years. But instead of that, he died in six months. It was exactly the opposite
#
what I had planned for them. So he died earlier than we expected him to. And he died in a
#
way. I mean, he died increasing the financial burden on that family, the debt burden on
#
that family. So I would not have transplanted him in the state that he was actually going
#
in for transplant. I would have actually told them not to do it because I would I would
#
know I now know that taking a patient like that for a transplant is a very high risk
#
transplant. And there is no need to take that risk because every risk is associated with
#
financial burden also. If they had a medical claim or medical insurance, fine, it's fine.
#
They can do it. But not not like this, not putting everything else into trouble. Right.
#
So that I would have done definitely different. And I don't think I have done a single I've
#
made a single wrong decision. I mean, is what I feel I have not because this is what I get.
#
I mean, I get feedbacks from my patients and families also, though, even the ones who die,
#
the ones who survive, I do get feedbacks from everyone. And what I feel is that I've been
#
doing right by them. You know, I may not be able to save a lot of my patients without
#
a transplant, but ultimately we are all on the same page. And people are happy. Patients
#
are happy. The families are happy. When I tell them black and white that, you know,
#
I'm sorry, but I feel that this is not going to work out and this is going to end up badly
#
for you. And I don't want that to happen to you, even though this is going to end up badly
#
for the patient. You know, it had to compromise somewhere. You either compromise on your future
#
stability or you compromise on your patient right now. That is up to you. And when that
#
openness happens from doctors point from the doctor's side, I think patients actually
#
love that from doctors. The problem comes when doctors are not so open because see,
#
I have fears. I have I have doubts. And when I tell about my fears and my doubts to my
#
patients and their family, we are all on the same page. And that is when patients and families,
#
they don't get violent towards you. I have had two episodes of violence against me from
#
patient families. But other than that, in my last seven years, never I've ever have
#
I faced a bad episode from a patient family because I've been very open to them. And
#
the two violence, I think maybe we can talk about it later on. The two violent episodes
#
that I faced actually was because of poor communication. And I completely blame myself
#
for that and not the patient. And how I mean, I'm trying to put myself in the shoes of that
#
patient and just thinking that, you know, how do those patients react when you tell
#
them that, look, you know, a transplant can save you, but you can't afford it. So you
#
have to make a choice for your family's future and all of that. How do patients respond?
#
How do families respond? Because even his family must be then feeling incredibly guilty
#
at having to make a choice like that. The patient himself must feel incredibly conflicted.
#
So what I do is that whatever decisions that we make in the open or whatever things that
#
I want to tell them openly, I don't do that much with the patient. I want my patient to
#
be happy. So a lot of the complex decisions that I take is only with the family. And we
#
don't have to tell the patient everything. You know, I mean, he does not need to know
#
that he's going to die in six months. It's absolutely wasted information for him. Why
#
should somebody know that they're going to die? Absolutely not needed. So what we do
#
is that the families, of course, families, I mean, there are in my clinical practice,
#
what I have found out is that within the family, there is an alpha, you know, it can be the
#
wife, it can be the mother, it could be a nephew, it can be a cousin, could be the daughter,
#
but there is an alpha personality who actually understands and imbibes everything and helps
#
others take decisions. So I always look out for the alpha when I talk, because when I
#
make, when I discuss in depth, I don't discuss with one person. No, I don't say that call
#
the wife and just talk to the wife. I'll call the wife, she'll come with her sister, the
#
mother. So there'll be a group of people who I talk to. It makes things easier for everybody
#
to, you know, it's supportive for them also. I never separately call the patients bystander
#
and say that, you know, he's going to die and these things we have to make a decision.
#
I never do that. That's that's like harassment. It's like torture for them. So it's always
#
in a group. So I always look at who the alpha is, because when I talk to them in a group,
#
there'll be one person who will be asking me a lot of questions to make a decision.
#
And when that happens, what they do is they, as a group, they try to diffuse that tension
#
within themselves. And ultimately, it's difficult for them to come to terms. I mean, I understand
#
that. I mean, I cannot actually imagine. I mean, if you put me in that patient, patient
#
wife or a family's position, I don't know what I will be, what my thinking will be.
#
It's not going to be easy. But what they do is they ultimately make a decision in such
#
a way that it is not a single person making the decision. So that is the importance of
#
talking to a group of people in the family. So it'll be a collective decision. And once
#
that happens, a single person does not feel guilty. And it's a collective decision. Everybody
#
is on board. It's a family. It's we are all on the same page. And the patient does not
#
need to know about all of that. So what we tell the patient is that, see, we have made
#
a collective decision for you. And this is what we are going to do. We are going to try
#
medical management for you at the highest level possible. Keep your hopes up. We are
#
keeping our hopes up. We'll hope everything goes well. We give him a good life. We take
#
him on that journey. I mean, it is towards his death, but we make sure that journey is
#
worth it for him. And I think this works out well. So when you have a happy patient and
#
when you have a collective decision making within the family, I don't think there is
#
any guilt associated with it. And how do you manage how much to tell the patient and all
#
of that? Because if I was a patient, I would be like, hey, I'm mature enough to handle
#
it. I need to know. I don't want to get things kept from me. I've had patients actually ask
#
me separately what is going to happen to me. So I tell them in a way that I feel for them.
#
I feel with them in a sense. For example, I don't tell them that actually we decided
#
that, you know, we'll go with medicine because you don't have much money. And ultimately
#
without a transfer, you're going to die. You know, it's not like that. He'll ask me directly,
#
but I will diffuse the situation and provide him with more compassionate and caring words.
#
And he'll forget about the actual question. So I confuse a lot of my patients like that
#
when they ask me directly. But there are patients who are very adamant who wants to know what
#
is going to happen to them. For example, patients with cancers, liver cancers, because they
#
know it's liver cancer and they really want to know what is going to happen to them. So
#
I tell them, so I tell them from an evidence point of view. So we have a lot of these studies
#
on liver cancer. We have stages of liver cancer. We actually know how much, how long a patient
#
is going to survive at each stage. And I show him the statistics and I tell him that, see,
#
these are statistics. And I tell examples from my own personal treatment choices that
#
I made for my patients. I tell them, let's see, there is this patient who had exactly
#
your stage of cancer. And I told him that, you know, he'll survive for only two months,
#
but he survived for two years. There was another guy who I said will survive for two years,
#
but then he survived for only two days. So we are not going to talk about when you're
#
going to die because I'm not God. I don't know if I'm going to sit on this chair tomorrow.
#
I don't know if I'm going to die of an accident today. I don't know. So who am I to tell
#
you when you're going to die? I'm nobody. So let us not ask that question to each other.
#
So I just let it rest there. So they don't, they don't bother about asking me such questions
#
after that. And they're happy with the treatment that I give them.
#
So you mentioned that one of the sort of good things about having a system of values and
#
caring about people is that you go home and sleep well at night. But even then, if you're
#
dealing with cases like this all the time, I don't know how I would sleep at night because
#
at some level you're going to feel a connection for these people. You know, at some level
#
you're going to feel bad when someone goes at some level. It can't be nice that somebody's
#
come for a particular visit and they're looking a particular way and the next time they come,
#
it's visible, the deterioration. You kind of, you can, so how do you deal with that
#
I think this is such an important question. My quality of sleep threshold is actually
#
quite low now. I mean, when I say quality of sleep for a normal person, that's really
#
bad sleep. But for me, it's good sleep in the sense that, you know, uh, I want to sleep
#
for eight hours continuously without any breaks and without any thoughts, but that is not
#
going to happen. But when I say a good sleep, it's, it's not like, you know, I sleep deeply
#
without any, any thoughts about my patients. I do think about them, especially patients
#
who are, you know, who patients who are fighting chance to survive and we have to give them,
#
we have to take that fight to them. Those are the patients who make me actually lose
#
my sleep at night and I keep thinking about them. But even then, if you ask me, that is
#
actually a good quality sleep for me because I'm not wasting any time there sleeping. I'm
#
lying down and I'm thinking about what to do for that person next day. And if that works
#
out well, I'm happy. I mean, two hours of sleep, I get one hour of planning that I did
#
and that worked out for that patient. That's good quality sleep for me. So it's not about
#
the hours of sleep. It's, it's, it's, it's, it's much more than that. So my good quality
#
sleep actually threshold is very low, which for a normal person is really bad sleep.
#
This is great book, which I'll recommend to all my listeners and links from the show notes
#
called why we sleep by Matthew Walker. And as a doctor, you know, that lack of sleep
#
does hurt you, right? Increase cortisol levels and all the other things. So, you know, how
#
do you, I mean, I am, I mean, if you ask me, are you healthy? I'm not, I'm not healthy.
#
I have, I am depressed. I am stressed. I lack a good sleep. I have put on a little bit of
#
weight. I think the last few months, there is no good exercise. I mean, even though I've
#
started hitting the gym in the last one month. So if, I mean, that is, I mean, what you said
#
is perfectly true. And I think doctors are the ones who are the most unhealthy among
#
the lot. I would say that actually by quoting a study, which the Indian medical association
#
did in Kerala, where they found out that when you compare doctor population to general population,
#
doctors died 10 years before the general population. Wow. Yeah. A decade before. So somebody has
#
a life expectancy of about 72. If you look at from the doctor's population in that same
#
with the same characteristics, doctors are dying at 62. So this is very true. Doctors
#
die much younger because of a lot of factors and definitely sleep and even the food patterns.
#
And I have two meals a day. I have an early breakfast and an early dinner and I drink
#
loads of coffee in between. That is the only thing that I have in between. But if you look
#
at from common man's or a lay person's perspective, that's really, uh, unhealthy eating habit,
#
you know, but I'm going on with that. And it's been there for a long, long time. So
#
I've got adjusted to it. My body's got adjusted to it. So it's, it's, it's very difficult.
#
I mean, a doctor's life, I don't think if somebody asked me, I mean, right out there,
#
I mean, if they don't have a good family presence of doctors and they have some support to become
#
a doctor and if somebody right off the bat is interested in going for medicine, I would
#
discourage them. If you ask me, I would discourage them because either you have to be compassionate
#
and you have to be like a burning candle. You know, your whole life is going to be like
#
that. You have to just keep burning and you'll melt and go away. That is how it is going
#
to be for you. It's not going to be all floral. It's going to be a tough life. So if you want
#
that kind of life, yes, be a doctor, but otherwise I don't think this is the profession that
#
you should actually jumpstart from a fresh perspective. It's tough. Do you wish that
#
someone had given you this advice when you were much younger? A lot of people gave me
#
this advice, including my father's professor. So at that point, see, I mean, we don't know
#
what is happening when it comes to real practice of medicine, right? So I was so astonished
#
and I actually tweeted about this once, I think probably about six months back. There
#
was this very senior professor from Delhi and he was my father's teacher. My father
#
took me after my 12th grade when I did not get through. There were a few months we had,
#
I was free from studies. He took me to I think Delhi for some medical conference, a gastroenterology
#
conference to help me get a feel of what gastroenterology conference is. So I went there and then he
#
introduced me to this elderly man and he said, what are you planning to do? I said, I'm trying
#
for my MBBS. I'm going to start my coaching. Then he just told me, young man, this is the
#
biggest mistake you're going to do in your life. Don't do it. I just looked at my dad.
#
My dad is like poker faced and I looked at him and he was like really serious. I thought
#
he was joking. No, he was very serious. I was like, my God, this guy is so dumb. I want
#
to become a doctor and he's discouraging me. I thought about it at that moment like that.
#
But right now I'm saying if somebody comes and asks me, I'll say, never, never, never
#
become a doctor. Do you regret it? Absolutely not. I love it. So tell me about a particular
#
kind of trade off that I see here that you've pointed out how it's important to look at
#
all your patients as human beings, right? Where you try to figure out their circumstances,
#
their mentality to the extent that within a family you're looking for an alpha and so
#
on and so forth. And therefore you have to give them time. Therefore it seems that you
#
cannot then have a cookie cutter approach to the thing. Whereas what we find in modern
#
medicine, what many people, including doctors often complain about is that they don't have
#
a choice, that you have to maximize for the number of patients you see because there is
#
so much pressure and therefore you minimize on the time that you give them. And therefore
#
you're basically using what economists would call fast and frugal heuristics with each
#
patient where you're not really going deep. You're kind of whatever patterns you discern
#
based on that you're saying, okay, this medicine, this test law and all of that. And that's
#
not necessarily a bad approach in the sense that you're seeing more people and therefore
#
helping more people, but giving them less time. And therefore the quality of the treatment
#
suffers because of that. And somewhere in the middle, there is some line which is perfection,
#
but basically as a doctor, you constantly then have to deal with the trade off that
#
either the quality for each patient will be good, but you'll see less patients or the
#
other way around. So is this sort of a fair characterization and would it also be fair
#
to say that the natural rational tendency for a doctor is to see as many people as possible
#
because that's how you make the most money? I mean, in our community, I mean, if you look
#
at India, I mean the whole country, like you said, there are, there are these two kinds
#
of doctors. One is the doctors who are seeing a lot of patients, but just superficially
#
scratching the surface. And the second is doctors who actually see very few patients,
#
but they see them thoroughly. They may not be able to accommodate every patient in need
#
at that time. The whole point is that if you look at India per se, a lot of good quality
#
medical, you know, work is done in the private sector. You know, if you look at liver transplants
#
in Kerala, only the private hospitals do it, not a single government hospital does it.
#
So when the quality of work is actually more in the private sector, what happens is that
#
patients actually rush more into the private. It's not like government hospitals don't
#
have patients. They do have patients, a lot of patients, but the problem is that if they
#
want a different level of treatment, they all rush into the private sector. So doctors
#
are actually completely stressed with this huge patient load in hospitals and doctors
#
can't take a decision on how many patients they're going to see because it's not their
#
hospital somebody else is running it. So this is the corporate thinking that you have to
#
actually maximize on the patient load and these doctors are made to see. So I don't
#
think any doctor wants to actually see a hundred patients a day because it's tiring for them.
#
I don't. I see 25 patients a day and I have fixed it. I am talking from a privileged position
#
because I don't, even though I work at Rajagiri hospital, it is our consultancy group that
#
is giving the service. So we don't, we are just affiliated Rajagiri. They don't employ
#
us so we can make our rules. So what we have done is my dad wants to see a hundred patients
#
because otherwise he'll go into withdrawal. He's that kind of a person. So he sees a hundred
#
patients. He'll see the first patient and the hundredth patient the same way with the
#
same energy. He does that because he knows how to do that. Me on the other hand, if I
#
see a 26th or a 28th patient, I'm half dead. My fuel is out. My battery is out by 4.35
#
o'clock. I can't see more than that, but I'm drained out because I spend a lot of time
#
with these patients. So somebody sees 200 patients and me seeing 25 patients is actually
#
equal when it comes to the energy spent on it. But everybody, every doctor cannot be
#
like me in the sense that they cannot make decisions like me and they work in setups.
#
For example, in a government hospital, you have to see every patient that comes to you.
#
You cannot say, no, I'm not going to see that patient. You have to see it's part of the
#
part of the whole job profile. So I think doctors are not rationally made to actually
#
see many patients and maximize on it. I think doctors really want to take it easy and see
#
patients to their heart's content. But that is not happening here because of multiple
#
factors. One is the patient burden, the doctor to patient ratio, the kind of services that
#
is available in the public and private sectors, and also the demand from patient community.
#
For example, I see a lot of patients come to hospital unnecessary. They don't need to
#
come to the hospital. Some of them just come because they are over concerned. A lot of
#
them have various other problems and it's not like they really need treatment. They
#
just need a little bit of counseling and they're all fine. So I think if you can, if people
#
are actually informed a little more about when to actually go to a hospital, get proper
#
treatment and checkups done, that level of burden actually on the doctors can also reduce.
#
For example, I'll tell you a classical example where I had this patient from this place called
#
Malappuram. It's North Kerala, a huge Muslim population area. And he came to me because
#
his brother was having cirrhosis. Actually his cousin brother, so they're all in the
#
same family. So his cousin brother has cirrhosis. So he came to me and asked me that, please
#
check me up. Even I think I have cirrhosis. He has no problems, no symptoms, nothing.
#
He just came to me and said, okay, let us check. And he came, I did an ultrasound. I
#
did some specific tests for him and he actually did have cirrhosis. So he had chronic liver
#
disease, but he was okay because he was very obese and he had a diabetes that was undiagnosed.
#
So we diagnosed it. We diagnosed liver disease and fatty liver disease, everything. And then
#
I gave him all the treatments and I sent him home. The next few days, you won't believe
#
the whole family, about 28 to 29 of them landed up on the OPT doorstep for health evaluation.
#
And none of them had any problem. So that is a huge burden on my OP practice because
#
they're all okay. They're fine because this guy had an unexpected cirrhosis diagnosis
#
and his brother already had cirrhosis. They were all, I mean, people are health conscious
#
obviously, but that kind of approach and attitude towards healthcare services is very much predominant
#
in our country because people want to get checked up even if they don't have any issues.
#
They just want to visit a doctor and increase the patient burden in the hospitals. So I
#
think that is one small aspect of increased work from a doctor's point of view. And also
#
because doctors are not owners of the hospital and their job profile warrants them to see
#
more patients. And then that is classical corporate tactics. You see more patients,
#
it's more business for the hospital. And is there also a problem that there's an
#
undersupply of doctors? Like I'd run an episode a long time back about the Medical Council
#
of India, which I think no longer exists or the rules have changed or whatever. This was,
#
I think, one of the first episodes I did six years ago. But my guest there, Pawan Srinath,
#
spoke about how the Medical Council of India would restrict supply of doctors by, you know,
#
only certain hospitals, only certain, certain number of colleges, certain number of whatever.
#
So it's an artificial restriction on the supply of doctors. And then that would inevitably
#
result in this where you're flooded with patients.
#
Yeah, I mean, definitely there is a big skew in the number of doctors that we actually
#
need and to cater to a particular patient population. There is a definitely big skew.
#
And a lot of that is happening because a lot of people are going out of the country. So
#
if you, if I look at my batch, MBBS batch, I think just a handful of us are here in India.
#
Majority of them are in the US and UK. And because of which a lot, I mean, even after
#
this neat PG fiasco and everything is happening, a lot of students are going out of the country.
#
And I think not just limited seats that are available. So the MBBS seats have been increasing,
#
but the MD and DM seats are not fully increasing. So you have a huge number of doctors who are
#
trained at the basic level only. You don't have doctors above that. You don't have specialists
#
and super specialists. And they are the ones who will actually cater to quality patients
#
at some point. And that is not happening. And because of that, we have stagnant doctors
#
who, who can, you know, see patients, manage them superficially, but they're not going
#
to cater to the real needs of a patient. And that is actually causing a lot of trouble.
#
So definitely we have a problem with doctor patient ratio, even if, even though the government
#
would not, I think, because the last time the government actually brought out a statistic
#
and said that now we have reached the WHO level of definition of good doctor to patient
#
ratio, they actually include all the Ayush practitioners also in that.
#
We'll talk about that later as well.
#
Yeah. So that is how they got that particular value in, but I don't think we, I still think
#
we have a problem with the doctor patient ratio.
#
So you know, one of the things I wanted to double click on at the start when you were
#
talking about, you know, your early years is also how one's interests develop in the
#
sense that, you know, some people will go in for a career like medicine or engineering
#
because it's expected, maybe the parents are in it. It seems a respectable thing to do.
#
They go in, but they're not truly interested, not truly committed. Some people will have
#
interests, but one, they might find out when they begin to do it that those, you know,
#
the subject they thought they were interested in is really not that interesting. Their interest
#
lies elsewhere. And then gradually over a period of time, your interests can develop
#
in different directions for different reasons. Like you pointed out how you were not interested
#
in like that basic science aspect of it. And elsewhere, I think you mentioned how initially
#
you were not interested in statistics, but over time you got interested in both of those
#
because you know, something else happened. You got a, you got a different view of why
#
they are important and the difference that they can make. Give me a mapping of your sort
#
of interests. Like, you know, I find your Instagram page really refreshing because it
#
has nothing to do with medicine. You know, you're crazily into food. It's got beautiful
#
photographs of food. You're enjoying yourself with your family, which is so charming. You're
#
taking photographs of Kochi at night, or you went to Istanbul and you took pictures there.
#
And I've also been there. So I was also looking for familiar things there. And so, you know,
#
so what are your other interests like? What were, how did your interests within medicine
#
bringing you to hepatology? How did that kind of evolve? And how do you maintain a balance?
#
Like just a couple of days ago, somebody I forget who apologies was talking about how
#
one advice they always give people is that in life, whatever your work is, always have
#
a hobby, always have a hobby that you go deeply into because that is what, you know, keeps
#
you alive in a different kind of way. So tell me a little bit more about your interests
#
both within and outside of medicine.
#
Yeah. So within medicine, like you said, I mean, when do we actually decide on what we
#
want to do within medicine? Right. So I think that actually comes up comes in internship.
#
So you finish your MBBS training, and then you have a compulsory one year internship
#
rotation in all the departments, you know, and you can actually have internship rotations
#
in specific optional areas also, like for example, forensic medicine, somebody likes
#
forensic medicine, they can opt for that for an internship rotation there. So in internship,
#
what I found out was that from my my own personal perspective, is that I did not like any of
#
the surgical subjects, you know, long time standing, you know, it was so stressful surgery
#
when you look at being a physician, and I immediately lost my interest in surgery. I
#
mean, I did not like general surgery, I did not like transplant surgery. At that time,
#
I was posted in a kidney transplant unit. And it was so scary, because the surgery takes
#
many, many hours. And after the surgery, the surgeon has to rest. So he goes home and then
#
he puts me in the with the patient to monitor the patient. And every time I have to see
#
how much of urine is coming out because they have put in a new kidney. And the most important
#
aspect is that the urine should come out properly. So every hour I'll sit there and look at the
#
urine how much ml is coming and I message him this much ml has come. So I found that
#
that does it's too stressful for me the surgical the surgical part. And so I fell in love with
#
the medical part. And in in within medicine, I liked to work with adult medicine, instead
#
of pediatrics, because in pediatrics, it's kind of it's I mean, I mean, I don't know
#
how best to put it, but it's kind of like like in veterinary medicine, you know, the
#
dogs, the cats, they don't they can't tell you their complaints. Same with these little
#
kids, they just either cry, or they don't. It's so scary, there is nothing in between
#
either they cry, or they're like, flabby, and they don't they don't respond. And and
#
you have to figure out what the hell is happening to them. And all you have are the parents.
#
And the parents are so stressed out there. I mean, I must give it to pediatricians. I
#
mean, I have, I just salute them, pediatricians and neonatologist, the ones with which who
#
work with the littlest neonates and and other children, I mean, I don't know how they do
#
it. Because I can't, it's too much. And because of that, I wanted more interaction with my
#
patients and the family, I fell in love with the adult medicine part. And in adult medicine,
#
the what I found out was that you need to have variety, you know, and that's that's
#
how you know, dermatology and psychiatry and everything went off because it's it's it's
#
more focused into a particular aspect. So general medicine was the best option for me
#
because general medicine, you see everything, you know, you see psychiatric patients, you
#
see dermatology, you see stroke, you see cardiac, everything you see, you have the whole bunch
#
mixed back there. So it's very, very exciting and very interesting, challenging to because
#
you'll not know what you're going to see next day. So it's always exciting to work. So that
#
is why I took internal medicine. And once I finished internal medicine, then the rest
#
of the decisions on as to which is the best for me or which particular aspect of medicine
#
I will I will appreciate all my life. That was not singularly my decision. Like I said,
#
it was a lot to do with my father's advice also, because he wanted me to do something
#
more than just being a doctor nine to five. So, you know, he was like, he's like a nine
#
to five doctor, he goes and sees maximum number of patients, spends time with them and he's
#
fine with that. But he knew that there was another part of me where I wanted to do or
#
understand new things about my patients. And that is where clinical research comes in.
#
So that is why exactly why he wanted me to and get a get a feel of hepatology. And that
#
is how I understood the importance of hepatology and its practice, because I found out that
#
I loved adult medicine. I loved internal medicine. Hepatology is the most extreme form of internal
#
medicine. And plus, it has a lot of clinical research opportunities. This is how I I went
#
into hepatology in that sense. But I have had a lot of my friends who actually enter
#
into one particular stream. For example, they do general surgery and they've actually dropped
#
it because they could not go on with it and then tried for another. And many of them,
#
there are a lot of them who actually completely dropped becoming clinical doctors that is
#
after MBBS or part right through MD and MS. They have stopped studying or stopped that
#
particular training and they have gone and done MBA and hospital administration and gone
#
into entrepreneurship and things like that. There are a lot of my friends who do that.
#
So I think it's it's not easy. It's not like black and white, which everybody can say that,
#
you know, I want this at some point. I think it's a process. So you have to journey through
#
that phase like MBBS. Absolute confusion. What is happening? MD, you understand that
#
now you actually are a doctor. You know, after you don't feel like a doctor in MD, you actually
#
feel like, yeah, I think I am a doctor. And when it comes to DM, you'll say that, yeah,
#
now I'm a doctor and I'm confidently I'm going to work for my patients. So I think everybody
#
should go through that and ultimately decide there will be a point where you it strikes
#
you that, you know, this is what I like. There are very few people who actually say that,
#
you know, this is what I want, because they have a lot of that kind of, for example, I
#
know a person whose family is full of cardiologists. So he has his brother as a cardiologist, his
#
brother-in-law is a cardiologist, he's a cardiologist, his dad is a cardiologist, his mom is a cardiologist.
#
So they do cardiology. So that I mean, there are there are there are families like that.
#
So that that decision already made, it'll never go away. But for me, and I think for
#
the for a person who starts off with medicine as a career, I think the journey will take
#
the person to the destination. And nothing is predetermined. Everything comes in its
#
own pace and time. And tell me about the importance of statistics, which you said you sort of
#
realize later. Statistics. And I would I would definitely want every young doctor to learn
#
statistics, because there is this subject called community medicine. And community medicine
#
is where you actually learn statistics in MBBS. And that is the chapter which nobody
#
bothers about. And if I find a I mean, when in my MBBS exams, when I find a statistic
#
question, I just leave it. I know I can make it up in some other question. I don't want
#
to bother about statistics. But what I found out is that if you are going to be a clinical
#
researcher, a large part of research is on analysis, you have to analyze data. Without
#
analyzing the data, you have no results and no outputs. And you have no conclusions to
#
your study. And analysis is purely statistics. And it was not like before. Now we have very
#
good softwares that actually help you do analysis so easy from scratch. You don't actually have
#
to sit and study statistics, you just need to know how to operate the software and which
#
particular statistic to apply at which point. For example, if you're doing two group analysis
#
or a single group analysis, you have specific sets of analytical scores that you should
#
apply and you just need to know that. So it's very easy. But even that people are not interested
#
in. But they should be if they actually want to take up a career as a clinician scientist.
#
So there are clinicians who will purely work on the ground like doctors nine to five, there
#
are scientists who have no exposure to patients, but they will work with data only and bring
#
out basic science work. And there are clinician scientists, which is actually very rare breed,
#
which my service, Professor Shiv Sarin is a clinician scientist and he trained me to
#
be one. And I think every doctor should strive to be a clinician scientist. And to become
#
a good clinician scientist, you have to know statistics. There is no other way. And what
#
I say is why I say that is see, there are two ways to it. If you're working in a big
#
university, you'll have a statistician there. He'll help you out. But the problem is that
#
you have something in your mind that you want to do for your patients or analyze. And it's
#
not going to be so easy for you to make that person understand what you want. But if you
#
know statistics, it's so easy for you. It's it's it won't waste your time. You can directly
#
jump into it and get your results done. So you will be like self. It's like a self contained
#
unit. If you know statistics and clinical research becomes part of you. So that is why
#
I say statistics is is very important. And coming to that second part of the question
#
out of medicine, I think everybody if you ask me, I mean, go back and ask me that what
#
do you actually wanted to become? That question never came. I would say that I wanted to I
#
actually wanted to become a screenwriter. Wow. Yeah, I love the media. I love the movies.
#
I wanted to become a graphic novelist. Wow. Yeah, because I don't read big, big books.
#
If you see my library, it's all graphic novels. And that is the only medium that I love to
#
read. And I wanted to become a graphic novelist and a screen and a screenwriter. And that
#
was my initial love. But then it went down the drain and somewhere in the line, somewhere
#
down the, you know, the hectic aspect of studies and everything. I think it just got lost.
#
But I think it's coming back, you know, in the sense that now that writing part the giving
#
life to data through research and publications is something that I really love because I
#
love writing to start off with. So I think it's catching up with me. So out of medicine,
#
this is what I actually loved. And as a hobby, I love writing. So I used to write for my
#
college. I used to. Now I'm writing for some media houses also. And now I'm going to write
#
a book also. I've got a good deal. And so all that is now coming back to me. And I don't
#
think everybody, you actually lose what you love. It will definitely come back to you
#
in some other form and you'll be satisfied with it. And I make it a point that, you know,
#
I don't bring my work home, which is why I have a totally different profile altogether
#
on Instagram. And out of my medicine, three things I love is that I love to travel on
#
weekends hunting for new food places in and around Cochin. That is why you see a lot of
#
new food photos every weekend. And the second thing is I love to catch up on some movies
#
and I don't see mainstream theater movies. I want to see some unique kind of movies.
#
So I'll I'll I am a big fan of Korean movies. So that is something I love. I see a lot of
#
Korean movies. And the third aspect is photography. So I'm not a professional photographer, but
#
I love to take a picture of something good. And it's almost always food. And these things,
#
these three things actually keep me alive out of medicine. And obviously this is all
#
with family. So that gives it extra sweetness. You cook also? No, I don't cook. But I think
#
I used to I used to love cooking, but I don't cook. But if you give me an opportunity, I'll
#
definitely cook. But my wife doesn't give me that because she wants everything to be
#
done by her style. And I love it because her food is like the best. So I let her cook.
#
I don't want to ruin that. So and you're also a gamer apparently. Yeah, that is that is
#
actually my stress busting part. So what I do is it's not every time, but usually mostly
#
on the weekends, I'm an avid PC gamer. So I have a custom built PC at home and in my
#
studio. And I usually I don't have a console. So I'm like, no, I'm not for a console gamer.
#
And sometimes I play a lot of first person shooters, because it's very it's stress busting,
#
you know, and that that happens maybe once or twice a week. And it's really enjoyable
#
because you just go into another world and it's totally, totally distressing. And I do
#
that maybe for an hour, not more than that. And you aim for the liver. So what also struck
#
me when I went to your Google Scholar page is the remarkable number of papers you've
#
written, which I'm sure makes your dad very proud. I think more than 60 papers you've
#
written 165 165 papers. Oh, my God. So you know, what is and I'm guessing you would call
#
yourself a clinical scientist as well, right? Yeah, right. Yeah, because I do a lot of basic
#
science work and I publish in basic sciences, which is why that term sticks. It's not purely
#
patient oriented papers. It's I do a lot of basic science work with respect to gut microbiome,
#
the bacteria inside our body, genetic studies, these things I've done and we have published
#
also and I have I have good backup lab and facilities who helped me do that kind of work.
#
So the paper publications actually happened because I have a very good team that supports
#
me and help me in data collection. And would you say that all clinicians and all scientists
#
should be clinic clinician scientists? Because, you know, if you are a clinician, if you are
#
a practicing doctor, understanding the basic science helps you in your work. And equally,
#
if you are doing basic science sciences that interface with real life and real patients
#
also helps you think better about the fundamental problems. It does. I think if you know basic
#
sciences, you you you are able to simplify things. So, for example, I mean, if you look
#
at my professor, Professor Shiv Sareen, I mean, he's he's been working on hepatitis B
#
and I mean, a lot of liver diseases from basic aspects to clinical aspects for decades. And
#
I would expect that if I sit in his talk of his, I'm not going to understand anything
#
because he's such a big person and he knows so much about basic stuff. But if you actually
#
sit in his talk, he'll tell you stuff like like you're going to read Amarchitrakatha.
#
It is going to be that simple. He can simplify such complex matters because he knows basic
#
science stuff. And that is exactly what he's taught me also. And that is exactly why I'm
#
able to talk about diseases, management and prognosis in very simplified terms to my patients
#
and their family. I don't use any medical terms when I talk to them at all. And I make
#
it a point that I don't use any medical terms, no scientific jargons. And without using medical
#
terms and scientific jargons, my patients understand the same level of stuff that I
#
understand about the disease equally. So if I know something about alcoholic liver disease
#
to the highest extent, the same thing my patient will also know. I make sure we are all on
#
the same page. And he will know because I have simplified it for him. And why why could
#
I simplify that? Because I have I because I love the basic science part of it. And this
#
is the only way that you can simplify medicine for patients if you know basic science. If
#
you know basic science, that means you know the subject. Yeah. And that's a great point
#
and that you know ties in with another point I often tell my writing students that if you
#
force yourself to write clearly, you will become a better thinker because you can only
#
write clearly if you're thinking clearly. So just trying to write like if you have to
#
explain in layman's language to a patient who might not have the same level of education
#
as you do, if you're you're only able to do that, if you really know the subject inside
#
exactly, because when I had to take my child for a particular disease management, when
#
I spoke to the pediatrician, because I'm a doctor, I could understand what my pediatrician
#
was telling me. But my wife, she did not understand anything. And she was so stressed out because
#
she was she was she thought that this person was actually telling me a lot of bad stuff.
#
And you know, things are very bad for it was nothing. It was just an allergy thing. And
#
but the way they spoke with a lot of scientific terms, my wife got so stressed out. And she
#
came home and she was like, what what were they saying? And I said, no, no, it's just
#
simple stuff. It is it is this this this. That's it. So I from that point, I know, I
#
mean, I always strive to think. I mean, like you said, you can only think clearly if you
#
know that stuff at the at the most clear part. I mean, at the basic level of that particular
#
disease progression and even genetic diseases, the toughest to explain to people. Even that
#
we can very easily explain in layman's terms to people. I mean, when there is this is called
#
Wilson's disease, which is because of copper overload in the in the liver. And that is
#
a genetic condition. And all of my Wilson's disease patients, they exactly know even which
#
gene is affected. They'll tell you which gene is affected. They know the whole pathway,
#
everything, because we have been discussing it so clearly in our routine follow visits.
#
And that's you. But is that a failing in many other doctors? I do feel so. Yes, because a
#
lot of doctors. One thing is a lot of doctors don't spend enough time discussing with the
#
patient or their family and the time that they actually spend discussing. They maybe
#
use a lot of scientific terms because when you use a lot of scientific terms, patients
#
and family get put off. They'll say, okay, fine, and they'll just go. But if you actually
#
start telling them nicely, they'll sit and hear you out and ask you questions. So this
#
is one of my litmus test. So if a patient listens to me, or a family listens to me,
#
and they have a lot of questions for me, that means it's worked. That means they want to
#
know more about it and they're getting a feel of it. They understand what I'm trying to
#
tell them. But if I say something and they just look at me blankly and they just get
#
up and go, that means I failed. And a lot of patients who actually come to me for second
#
opinion come to me because of this. They just want to know what they have. The doctor has
#
given them the right medications and everything, but they have no clue what they have. Yeah,
#
so I explained to them and then they stick with me. Wow. The only previous doctor I've
#
had on the show practicing medical doctors, Lancelot Pinto, you must have heard of him.
#
Yeah, wonderful guy. And he even treated me for COVID after we recorded when I happened
#
to get it. And one of the things that I found impressive about him, which is also true of
#
you obviously, is that he made this effort to keep himself up to date with the latest
#
research on his subject. And one of the things that I notice about many doctors otherwise
#
is that fine, they've got their medical education whenever they got it, 90s, 80s, whenever,
#
and they did well and they were good students, but they don't, after that it's a daily grind
#
and they're not really keeping themselves up to date as much as they should, which is
#
a problem because A, the science is changing in many fields like nutrition, for example,
#
where the conventional wisdom of the 90s is like almost the opposite of today. And B,
#
you know, when something new comes about like COVID, your traditional knowledge, you know,
#
you have to all stay on top of it. Look at the latest research, look at the latest numbers
#
and use your, you know, statistical mind there as well. So when you look around you at the
#
profession, I mean, you've written 165 papers, obviously you make an effort to keep in touch,
#
but how intentional is the effort in terms of how much time do you think a good doctor
#
should give to looking at the latest research in her field, say every week or whatever.
#
And I know it will differ from area to area, you know, and do you find that too many doctors
#
don't do this? I think a majority of doctors don't do this. They don't read, they apply
#
what they have been taught and they just follow the guidelines and some of them actually don't
#
even follow the updated guidelines. So that's, that's even worse. What I do is that I read
#
every day an hour. I spend one hour on, I mean, because we have so many journals and
#
every journal has different, different contents. I mean, in hepatology itself, we have multiple
#
journals and every journal will have some good content in it. It's not going to be easy
#
for you to, you know, read every journal towards a weekend. So what I do is I target, I take
#
one journal a day, go through the latest additions on the, in their online new issue, and I read
#
one paper from that every day. If I don't find anything interesting and that day is
#
free for me, I don't do anything, but I still look for new data every day. And I have trained
#
myself to do that. And which is why I can help. I mean, I can get updated much faster
#
and easier instead of waiting for somebody to update me. Another way of getting updated
#
is to attend conferences and that to really good academic conferences. For example, I'm
#
yet to actually see a very good academic conference in India because in India medical conferences
#
are, it's like a Bollywood song. It's just, you know, people partying and all that. And
#
I mean, if you look at conferences from the liver societies that is done from outside
#
from Europe and the US, they're just, they just stick to academic work. They just want
#
to get updated and they, they provide and produce the latest stuff there. And I always,
#
I mean, before the COVID came, every year I used to go for the American liver meeting
#
and the international liver Congress, that is the Europe one and get myself updated there.
#
But it's not easy to travel now every year. So I have started doing this journal reading
#
stuff now, but what doctors who cannot do that can do is to attend such academic conferences
#
because that's like one short updation for everything. And you have annual conferences,
#
maybe once or twice for some institutes. I mean, for some societies, they have double
#
conferences and all. I mean, specific single topic conferences and annual conferences,
#
which gets you very good updated data, but doctors don't even do that. You know, they
#
go for conferences to have a good time. If you actually see Indian comics, so funny,
#
they'll you'll have academic sessions going on, but there'll be some boat cruise and some
#
dance happening. People are all there. Nobody's in the, in the hall. And I think that that
#
kind of environment within the Indian Academy must change, you know, you don't have to
#
make all conferences very Bollywood style. You can actually focus on good academic input
#
so that people actually get good academic outputs for their patients. And that is what
#
we should strive for. And the third aspect is that doctors actually, they overwork.
#
I mean, like I said, somebody who sees 120 patients a day, I don't think he has, he
#
has any energy left to come and read. And people work here on Saturdays also. And Saturday
#
is just like any other weekday for a lot of doctors. They see patients from nine to five,
#
come home at seven or eight. And Sunday is just the one day. And I don't think any doctor
#
is going to sit and read on a Sunday because they've been working from Monday to Saturday.
#
So I think the work profile also matters regarding the updation part. A lot of general practitioners
#
and super specialists, they're all working day in and day out. So they forget to update
#
themselves. And I see that some of them do update themselves when they actually are faced
#
with a crisis. So you have a patient who actually is challenging you with a diagnosis or a management.
#
Then I think many doctors go back and read and see what they can do for that. So there
#
are doctors who update from that point of view also. For example, in, in my practice
#
also, when I started seeing a lot of different types of causes for acute hepatitis, I went
#
back and started reading differently on those issues. So that kind of updation can also
#
happen, which is case by case based. But otherwise a protocol based, daily based updation for
#
updation sake, I don't think Indian doctors are doing it much.
#
And can you think of a concrete way in which that helped you in the sense that, that something
#
you read recently actually helped you treat somebody which otherwise you may not have
#
known of or thought about?
#
I think classical example, I think most classical example is that I had, I mean, if you look
#
at, I tweeted about this and I had a lot of backlash. So I had a tweet which went really
#
viral. I had like six K likes on it. And I tweeted a few points. And one of the point
#
in that was that tweet had multiple points. And one of the point was that cirrhosis is
#
reversible. It can be reversed. So I just mentioned that a lot of doctors actually wrote
#
as a response under that saying that what nonsense are you speaking? Go open your textbooks
#
and see what is the definition of cirrhosis. The definition of cirrhosis is a structural
#
change to the liver. That is structural means both vascular, that is your blood vessel count
#
part and the liver mass. Changes happen structurally which cannot be reversed. That is what is
#
written in the textbook. An irreversible change to the structural aspect of the liver is cirrhosis.
#
So they're saying that definition is this and you're saying cirrhosis can be reversed.
#
What nonsense is this? So that is, that is the problem with not getting updated. So what
#
happened was that initially when we used to talk to patients, when I used to talk to patients
#
initially about cirrhosis and they asked me, sir, can this get cured? Doctor, can this
#
get cured? And I said cirrhosis cannot be cured. You know, you can actually arrest it
#
at a particular stable stage. And that's about it. Some people progress and once they progress,
#
you will end up with a transplant at some point, which is actually for a patient. If
#
you hear that it's quite depressing. What happened was that there was this study when
#
I came across, there is a study. I mean, fibrosis is the process where your liver gets scarred.
#
I mean, medically speaking, fibrosis is when your liver is scarred. And once that fibrosis
#
progresses at the stage four of fibrosis is when your liver becomes erotic. So that is,
#
that is when it becomes irreversible actually. Fibrosis can also happen in the lung that
#
is known as pulmonary fibrosis. So there was a study where doctors, I mean, pulmonologists
#
actually used a particular molecule known as porfinidone and they actually treated pulmonary
#
fibrosis and saw that the fibrosis was reversing. Basically the drug dissolved the scars and
#
the lungs were improving structurally. So I said the fibrosis process in the lung, if
#
you look at the basic science part of it, molecular level, it's the same that happens
#
in the liver, the same kind of chemicals and the same kind of enzymatic reactions and everything
#
is happening in the liver also. So the fibrosis part is equal. So what if this molecule, if
#
I give it to a cirrhosis patient, will it reverse cirrhosis? So what we did was we did
#
a small pilot trial and I asked three patients if they are willing, if they would give me
#
consent to start this particular molecule to see if cirrhosis gets reversed. And they
#
were all fatty liver disease patients, obese with cirrhosis, stable cirrhosis, no other
#
issue. So I did a biopsy first, proved that there is cirrhosis and I gave them this drug
#
porfinidone for three to six months. And I did a repeat biopsy and I saw that the cirrhosis
#
actually was reversing in these patients with the use of this drug. So medically with a
#
drug you can reverse cirrhosis and this was proven. And we published this in the Journal
#
of Clinical and Translational Hepatology and the use of porfinidone as an agent to reverse
#
cirrhosis. So that whole idea of cirrhosis cannot be reversed is out of the window now.
#
Traditionally thought is out of the window. Now when you go back and look at other, because
#
liver disease is not because of a single cause, you can have multiple causes. For example,
#
hepatitis B, autoimmune hepatitis, these are all alcohol liver disease, can all cause cirrhosis.
#
So when I look back at the literature, I saw that the same molecule was used by a group
#
in South America and they treated hepatitis C patients and found out even their cirrhosis
#
was getting reversed. The fibrosis was getting reversed. So we have more data on it. So I
#
said, okay, this is something really new because nobody was talking about it. Then I found
#
out that 25 years back, there was a paper written by this brilliant pathologist called
#
Ian Wanless. Ian Wanless is one of the biggest names in liver pathology and in the liver
#
histology we say, you look under the microscope and see. So he was a great liver pathologist.
#
So he has actually written a paper where he has mentioned that cirrhosis can regress,
#
provided you actually halt the cause of cirrhosis. For example, what he did was when he looked
#
at patients who were on hepatitis B medications before and after, he found out that patients
#
when they took hepatitis B medications for longer duration, the cirrhosis and the fibrosis
#
scars were actually resolving with just hepatitis B management. And patients who were on alcohol,
#
when they stopped alcohol, their fibrosis was reversing. So he wrote a big paper at
#
that time, which was like two decades back. And he mentioned that cirrhosis is reversible
#
and it goes into something known as regression and new liver cells actually are regenerated
#
in areas where the fibrosis and the scars get dissolved. So which means the traditional
#
thinking of cirrhosis not getting resolved was there since two and a half decades before
#
and people still don't realize that and they are still stuck with the dogma saying that
#
cirrhosis is reversible. So this is something new that I could do for my patients. When
#
I look back at the literature in the immediate and the past, this aspect of reversing cirrhosis
#
was there initially, but now we have another molecule which we can actually use to reverse
#
cirrhosis. So this is the important aspect of getting to know the basic science behind
#
a particular disease. You can do new things for your patients.
#
And you mentioned the word dogma and that reminds me of two things. And one is of course
#
a classic story of Ignace Semmelweis, the doctor who realized in the middle of the 19th century
#
that all you need to do to avoid the majority of infections in hospitals is wash your hands
#
properly. And he was outcast from the profession. I think he spent time in an asylum or whatever,
#
very sad life. But basically he was a complete outcast because people refused to buy that
#
and countless lives were lost because no one paid attention to him. And similarly, so I
#
was diagnosed with type two diabetes last year, very overweight cholesterol type two
#
diabetes, all of that partly because you know, sedentary lifestyle during COVID and I let
#
it happen to myself. Now, intellectually, I knew what I kind of need to do to sort of
#
reverse it because people used to say type two diabetes is irreversible. And I felt that
#
the science now shows that that's not the case. And I initially I went to a doc, he
#
gave me some medication, but in three, four months, I realized that that's not the way
#
to go. I stopped the medication, decided to only focus on my diet and I reversed it. Like
#
my HbA1c was 7.7 now it's 5.7, right? Just through diet and lifestyle, basically keto
#
plus intermittent fasting for diabetes. It's not a hammer that can be used for every nail,
#
as you pointed out on Twitter, but for that. And again, you know, to just to mention this,
#
you get dogmatic resistance from people whose conception of medicine is somewhat older.
#
They're like, no, you can only manage diabetes, you can't reverse it and so on and so forth.
#
And I'll be giving them books and trying to explain and giving links to research and saying,
#
no, read this paper, read that paper. How dangerous is how dangerous is this kind of
#
dogma? Because I think a lot of the medicines that 10 years ago would have been standard in
#
say something like type two, actually don't do anything for the problem at all. They might
#
even make it worse. That is true. I think this this kind of traditional beliefs, I mean, I'm
#
talking about scientific, you know, traditional, older scientific traditional beliefs, where you
#
actually say that, you know, cirrhosis cannot be reversed or I mean, like, for example, diabetes
#
cannot be reversed or controlled just with diet and things like that. It impacts the patient
#
population because new information is always hopeful for the patient. For example, if I keep
#
saying that cirrhosis is reversible 10 years, 20 years down the lane, that is going to affect
#
my patients negatively. But if I tell them that, you know, there are studies that say that this
#
particular drug can reverse your cirrhosis and there are studies which say that if you lose weight
#
or if you stop drinking or if you take treatment for hepatitis B, your cirrhosis can get reversed.
#
So they have something to look forward to. They have something to add on from their own point of
#
view instead of just prescription medicines. You know, medicine is not just about pushing
#
pills into the patient. It's a lot of things. And I think getting to know something that is
#
updated in a particular area, which we thought was redundant or stuck like that for life. It's
#
like a fresh breath of air for both the doctor and the patient. So when that particular doctor
#
actually, he was a nice guy. I mean, on Twitter, he initially came out a little bit in the sense
#
that like I was a clown. You know, he was joking with me saying that, you know, what are you saying?
#
You're actually going against what is the current belief in medical practice. Are you calling
#
yourself a scientist and things like that? He was telling. Then I showed him the data in the DMs.
#
I messaged him. I did not do it on the other thing. I messaged him in the DM saying that my
#
paper is this and this. He was like shell shocked. He was like, I never knew this stuff actually
#
existed. And you can actually reverse cirrhosis. And he is now a better doctor than before because
#
he's going to tell his patients and he's going to know. I mean, and his patients are going to know
#
going to know more about their disease conditions in a better way now. But there are other doctors
#
who still won't take my or even open my research links. And they still keep talking, saying that,
#
you know, I'm wrong. And cirrhosis is reversible because it is written in a textbook. Textbooks
#
are not everything. You know, you have journal entries which are updated. Textbooks get updated
#
every five or six years only. So it's not like the final word and everything. And those kind
#
of doctors are actually harmful for the patient society. And I will say this without any
#
percussions. I mean, any regrets. I don't think such doctors deserve being doctors
#
continuously like this. I mean, every doctor must strive and look for something new for their
#
patients. And which is why I keep saying that, you know, a doctor should not be a doctor,
#
should be a doctor scientist. And that actually helps the patient because when you are actually
#
looking at the clinical research point of view, it makes you a better person from your patients
#
perspective because you're always looking at something new for your patients. And this is
#
exactly what happened when I started doing work on alcoholic liver disease. So we have a group
#
of patients where they have severe alcoholic liver disease known as alcoholic hepatitis.
#
And alcoholic hepatitis patients, if you look at the recommended treatment or approved treatment,
#
there is none. There are no approved treatments for severe alcohol associated hepatitis.
#
There is a recommended treatment which is short course of steroids that will reduce their jaundice
#
and hepatitis and it will give them benefit for one month only. Beyond one month, they are back to
#
square one. A lot of them will require liver transplant. So the only curative treatment is
#
a liver transplant. Now the problem is that these patients are heavy drinkers. They are sick and
#
liver transplantation may not be a good option to start with because they can get infected like my
#
first patient. He was actually an alcoholic hepatitis patient. And what happened was that
#
when I looked at such patients and Kerala is replete with alcoholic liver disease because
#
it's one of the states where there is maximum amount of drinking. I think we have about three
#
or five times more drinking than the national average in Kerala. And alcoholic hepatitis is
#
always a challenge to treat. So what happened was that a few years back, I think this was in 2015,
#
2016, when I entered into DM, we are given the choice of option of choosing our thesis topics.
#
So I mean, every DM MA super specialty course has one thesis topic. So we had to select two
#
thesis topics. So when my professor Sarin told me to look at things out of the box,
#
I was just looking at alcohol, hepatitis and things like that. And I got two papers from Europe.
#
Both the authors were women. One, her name is Lopez, Lopez and colleagues, and another lady
#
from France. They did some work in animal models and showed that in the presence of alcohol,
#
so what they did was they fed these small animals. I mean, you actually feed, there is a mouse model
#
of alcoholic liver disease where you feed mouse alcohol intermittently and they develop
#
alcoholic liver disease and you can study it. So they started feeding small animals a little
#
bit of alcohol and they found out that while the alcohol hepatitis was developing in these animals,
#
the change that they actually found out was that the bacteria inside their intestines were also
#
changing. So the good bacteria became bad bacteria in the presence of alcohol and that bad bacteria
#
and its functions and its metabolites and its products, that is what harmed the liver to cause
#
alcoholic hepatitis. So what they did was they gave good bacteria to these animals and found out
#
that the alcoholic liver disease actually reduced. So this is what later on became stool transplantation
#
in my patients. So I took that basic science data and I applied it in humans. So what we did was we
#
took about 8 to 10 severe alcoholic liver disease, alcoholic hepatitis patients and we took healthy
#
people. We took their stool, collected their stool, healthy people stool and we processed the stool
#
and we gave that stool through a tube to the alcoholic hepatitis patients. So this was known
#
as a stool transplantation and I was the first to do it in the world in liver disease. You were
#
the first to do it in the world? Yeah. Wow. So we did the first alcoholic stool transplantation in
#
severe alcohol liver disease in the world and what we found out was that the patients who received
#
healthy stool rich in good bacteria from healthy donors, their jaundice reduced, their hepatitis
#
reduced, their alcohol liver disease reversed and they came out of the transplant listing.
#
So they never needed liver transplantation after that. So the stool transplantation protocol was
#
born there as part of my thesis. So that is published in the official journal of American
#
Gastrological Association known as Clinical Gastrology and Hepatology in 2018. So we published
#
that paper and from there onwards we started this work on modulating the intestinal bacteria
#
to improve outcomes in alcoholic liver disease and I think we have published more than four to
#
five original papers on that topic and the American Gastrology Association has actually mentioned
#
that in patients with severe alcoholic liver disease, if there are no options for medical
#
treatment and they have no options for a liver transplant, this is a salvage option. So you can
#
actually save them, prevent them from dying by giving stool transplantation and this happened
#
because we went back and looked at basic science. This is mind-blowing. You know some of my friends
#
were speculating the other day that which of my guests is going to win the Nobel Prize first and
#
all the names we came up with you know Kartik Mullidhar and Ajay Shah was all economics related names
#
but I'm feeling that hey you know maybe you're the guy medicine. I mean this is something new
#
from a liver disease perspective but I would like to say that stool transplantation was actually
#
done by traditional Chinese monks many many many many centuries ago yeah. Wow. So what they used
#
to do was they they wanted to treat sick kids with dysentery or diarrhea. They used to give
#
fresh stool samples from healthy kids, just put them in water and feed them. That was known as
#
yellow soup at that time and they used to directly consume the stool from healthy kids and this is
#
well documented in Chinese traditional Chinese literature. So I'm confused about this. I can
#
understand now how it worked like why it worked. Yeah. But what was their theory for why they're
#
doing this? I think it was as observation. I mean everything like if you look at any of the
#
traditional practices everything was observation. So I think at some point they observed that if
#
you actually I mean everything has to I mean if you look at the principles that guide treatment
#
long back it's mostly everything was gut derived. So they say that you know the fire in your
#
belly is not good or a fire is too much so you have to extinguish the fire. I mean these are
#
the kind of treatments that used to matter the humoral theory things like that. So as part of
#
that I think a dysentery or a diarrhea sick child had some abnormal humors and fire in the belly so
#
to improve that they gave good fire from the other kid you know maybe that is how they thought at
#
that time but now we know why it works because of the good bacteria versus the bad bacteria
#
and there is this surgeon what he did was in 1950s he was seeing a lot of patients post surgery on
#
antibiotics who are developing something known as pseudo membranous colitis which is an opportunistic
#
infection that happens in patients in the post surgical period particularly patients in the ICU.
#
So your large intestine gets infected by this particular bacteria known as Clostridium difficile
#
C difficile it's its name and it causes torrential diarrhea and a lot of patients actually die with
#
it because of that severe diarrhea and infection their large intestine gets completely ulcerated
#
and destroyed. So what his name is Ben Iceman the surgeon's name so what Ben Iceman did was he took
#
this idea from traditional Chinese medicine and what he did was he took fresh stool samples from
#
his I mean the family members made it into an enema and gave this fresh good stool enema to
#
these patients and found out that their diarrhea drastically reduced and their Clostridium difficile
#
infection reduced and they survived they did not die and he published that. Now fast forward few
#
decades two two to three decades later a lot of work at the basic science level was happening on
#
gut microbiota which is basically the total name that we give for all the microorganisms in the gut
#
so when this work happened they found out that you know patients with Clostridium difficile
#
infection had a totally different kind of gut microbiota versus a healthy person. So they
#
decided that you know there are there is this particular group of Clostridium difficile infection
#
which do not respond to medicines at all so you give them antibiotics they get worse they don't
#
improve it comes back again and again and those are the patients who die. So what they did was
#
they did a randomized I mean this is like what how do you how do you how we test a hypothesis
#
right you do randomized control trials so this young physician from Belgium her name is L. Swann
#
Noode she and her group did a randomized control trial and they gave one group of patients with
#
recurrent severe C. difficile infection healthy stool through a tube put in the nose or through
#
the endoscope into the small intestine fresh stool samples with good bacteria and another group they
#
gave placebo which is sham treatment they actually stopped that trial halfway through before they
#
actually reached the sample size because every person who received good stool showed immense
#
improvement a rapid improvement from their symptoms and complete resolution of C. difficile infection
#
and so the stool transplant actually was first approved by the FDA for recurrent C. difficile
#
infection and later on when other scientists started looking at liver disease patients they
#
found out that this gut microbiome thing works in liver disease also and that is where those two
#
other researchers found out that alcoholic liver disease can improve with good bacteria which I
#
applied first in humans so this is the story of stool transplant so this is actually already
#
approved by FDA for a particular condition not recommended for any other condition but we are
#
doing it as a research protocol and as a salvage therapy to keep patients alive in severe alcoholic
#
hepatitis yeah you know I've always said that hey I don't take shit from anyone but you know
#
if I ever get lizard liver disease maybe I will couple of questions before we go into the break
#
just to sort of finish these strains of thought and one is that you mentioned how you know the
#
hypothecation doctor scientist how it's a good thing and would it also be fair to say that doctor
#
student a different hypothecation doctor student like if you're if you're learning all your life
#
if you're making that effort that's also important that all of us regardless of what field we are in
#
should have that hunger for learning because that's how we'll be the best at what we do
#
yeah I think doctors are all inherently students for life I mean every doctor should be I think
#
what differentiate being a student from being a scientist is that the student will learn what is
#
given to that what is given to you so you'll go read guidelines you'll go read things like that
#
but a scientist will actually be more curious so they will want to actually challenge the guidelines
#
or think out of the box so I think that is the difference between being a student and being a
#
scientist and every doctor should be a student because you have to read about new stuff new
#
treatment options everything they'll have to do for example in liver diseases also every day new
#
new trials come new new treatments come for example hepatitis c a decade back we could it was so
#
difficult to treat it was it was a painful treatment you have to take multiple injections
#
called interferon lasting 24 to 48 weeks severe side effects and everything and then suddenly
#
one day direct acting antivirals came daa which are just simple capsules you pop in once or twice
#
a day for three months and your virus is gone wow so that kind of learning is there as a student
#
and doctors know about it because nobody treats hepatitis c with those injections anymore every
#
doctor treats with this particular capsule but what is different is that how can you improve on
#
these treatments so that if you have a scientist mind only you can do that's wonderful and finally
#
before we go in for the break you know one of the eloquent pieces you've written for the morning
#
context and i'll of course link all your columns and your youtube channel and all of that from the
#
show notes but one of the powerful pieces you wrote for them was about alcohol and you've been
#
speaking about you know alcoholic sort of liver disease and all of that and a point that you've
#
made eloquently is that there is no amount of alcohol which is good for you you know there is
#
this myth that huh you know multiple days fine is good for the health is good for the heart all of
#
that and the point that you are making forcefully having studied it and worked with patients all
#
your life is that no you know no amount is good for you tell me a little bit about that so when
#
we talk about the traditional belief that moderate consumption of alcohol especially wine people say
#
or even spirits proper hard liquor about one or two drinks a day is going to be is going to be
#
good for you it's good for your health they say everybody but you have to define what it is good
#
for right so studies have shown that it is good for only a particular condition which is basically
#
your coronary artery disease your heart disease a particular aspect in heart disease is what
#
it is found to reduce but the same amount or even the even a lesser amount of that alcohol
#
can actually promote 10 20 other problems in you so if you look at alcohol yes there may be some
#
benefit that you've seen in studies but the risk far outweigh the benefits so when you look at
#
something that is when you say that something is going to be useful for you it has to be from
#
brisk benefit ratio like for example 10 people drive without a seatbelt and 10 people drive with
#
seatbelt and you look at that the 10 people who drive without seatbelt they get into a crash
#
eight of them died and out of the other 10 who had a seatbelt all of them survived so if you look
#
at the risk benefit ratio wearing a seatbelt is always good if it's just the opposite like for
#
example if if you have i always say this to my patients like if you if you have a particular
#
intervention for example in this situation we're talking about alcohol drinking alcohol so if you
#
have particular intervention if you have to look at everything that happens around that intervention
#
right it's alcohol is not the only thing that we are not just looking at the heart we're looking
#
at the liver we're looking at other organ systems also and studies have actually shown that single
#
exposure to alcohol in women that is even one drink per day or even even up to three drinks
#
or three to four drinks in a week can actually substantially increase the chances of getting
#
cancer breast cancer so are you going to protect your heart at the risk of getting breast cancer
#
i mean that risk is still there so that is why i say there is no safe level of alcohol because
#
you cannot call it safe you can only call it safe if it actually is going to have that single impact
#
which is going to protect your heart without any other issues but it's not like that you have it
#
will protect your heart yes maybe in some studies it has shown but it will cause umpteen other
#
problems around it so that is why i say no alcohol level is safe yeah and i i'm going to ask all my
#
listeners to please especially if they drink to you know read that article which are linked from
#
the show notes and that's a great point that it might help you in one thing but you got to look
#
at all the other shit that it's doing now my question then is that you know while reading
#
about diet and nutrition one of the sort of big scandals i came across was all through the 50s
#
and 60s a lot of the studies which showed that sugar was fine and fat was an enemy was funded
#
by the sugar lobby in the u.s which you know no one at the time knew and is it then the case that
#
today the alcohol lobby might be funding the publication of new species like this which will
#
you know cherry pick one sort of particular context in which alcohol may be good for you but not talk
#
about all of the others so is that part of the case or is it just sloppy journalism um i mean
#
if at all it was funded or paid for we would never know because i don't think anybody would
#
disclose so much but i think a lot of it has to do with sloppy journalism 100 like for example
#
smoking smoking actually reduces your chance of getting alzheimer's disease this is great right
#
but then it but then it causes so much of other cancers you'll die of lung cancer before you get
#
alzheimer's exactly or you will you will have enough to remember that you're dying of lung
#
cancer you know you'll not lose your memory that's even worse and same same thing if you look at
#
there was a study on beer and there is a study on wine and very interestingly there was a study
#
that was published in lancet which actually said that if you if people who are above the age of 40
#
if they have moderate alcohol consumption which actually improves their chances of getting reduces
#
their chance of getting metabolic syndrome and other heart related problems but if you drink
#
if you are drinking when you are below age of 40 it causes more trouble so that distinction also
#
they've made but the problem is that all of these studies are all observational it's not like they're
#
actually asking people to drink and then following them up you cannot have a prospective trial on
#
alcohol use it's impossible so these are all observational trials and a lot of confounders
#
are there so for example they might not have looked at other issues that are propping up in
#
these patients for example cancers how many of them develop cancers how many of them developed
#
other complications of alcohol use i mean none of these actually looked into that part is not
#
spoken about that is the problem with that study now when a journalist actually looks at that study
#
they will not talk about these issues they will just talk about what the study conclusion is
#
if you are more than 40 drinking alcohol will help you this is the biggest problem because as
#
journalists i think i mean especially as my medical journalists what they should do is to
#
they should know learn how to critique critique that paper also that is exactly what we do so
#
you can actually see that in a lot of these journals they have a section known as letter to editor
#
letter to editor so when the letters to editor are actually critiques of published papers and
#
it's brilliant you can actually see a lot of strengths and weaknesses in those letters to
#
editor so every journalist who is going to report on a particular study especially with
#
controversial topics like alcoholism or smoking i think they should first learn how to critique
#
the paper and then give a balanced view from the paper point of view and the weaknesses also
#
because good authors always mention the weaknesses of the study also there will be a limitation
#
section in that but a lot of these journalists don't even bother reading that they'll just read
#
the abstract i think probably and they will not include anything from the limitations part
#
but once that is done there will be clarity because the the whole aspect of moderate alcohol
#
is good for you good for you is being continuously propagated over the decades through media and
#
everything without actually talking about the limitations of these studies our problems
#
around it people still believe that a little bit of alcohol is fine actually people get offended
#
when i tell them to you know stop yeah i mean not even stop reduce they get so offended so one of
#
my friends prem panicker often talks about how one key aspect of the crisis in indian media today
#
is because of uh falling budgets and because of falling profitability you have less and less
#
journalists doing more and more work which means all journalists actually genderless they don't
#
know anything about any one subject so they're you know quite often in many newspapers your
#
person reporting on medicine and vaccines and all that will actually not have any understanding
#
of medicine and it's not necessarily their fault they've just been assigned to write a story i
#
know you got to do two more stories today so just kind of get it done and there's a phrase i love
#
called gelman amnesia like michael cricton coined it for his friend marie gelman and gelman amnesia
#
is that i'll read something in the newspaper on a subject i know something about you know and i'll
#
be like what shit is this they don't know what they're talking about but everything else in the
#
newspaper which i can't scrutinize myself i will take it as gospel right and which is the amnesia
#
that kind of happens so do you see that with medical reporting like at one level obviously
#
every medical reporter cannot know as much as a specialist like you but at another level there
#
is a basic degree of understanding they should have and they should be responsible with their
#
words so what when you read medical reporting in india like is it frustrating what is your
#
kind of sense it is very frustrating i mean i don't actually read any i mean i don't read on
#
a regular basis medical reporting in india i mean because but because i i can understand myself
#
about medical science what is what is new and what is not but from a common person's point of view
#
it's it's actually very frustrating because i mean take take the example of covid i mean the the kind
#
of disinformation from the headlines to the conclusions that a lot of media pushed were
#
actually all completely wrong and i don't think any there were any good articles on pro vaccine
#
the pro vaccination articles were actually absolutely i mean almost zero in in india if you
#
look at it but if there was a vaccine death a rare cause of vaccine side effect oh that was like
#
headline so this is this is the problem with and that particular side effect would would have
#
happened one in million and that's a lack of understanding of statistics also journalists
#
also have to you know understand it yeah so i mean they don't they don't know how to analyze that
#
data from from a public health perspective so journalism in medical journalism i think they
#
should inherently have something i i say they should inherently have a compassion for public
#
health it has to be pro public health but what is happening here is everything is fear-mongering
#
and and and i think that is what people also want to read on i think i don't know mentality
#
has changed or something but pro public health if they keep that in mind then they can actually
#
give good information and they can stop with this disinformation that is going on and a lot of that
#
actually has to do with repeated reading and reporting on such articles so i i think there
#
is no consistency in medical journalism that is that i have seen like for example if i mean i i
#
can take an example of preyanka pulla i mean she is she is there on twitter she is focused on one
#
particular aspect and she does it so well she's really good she's excellent in that i mean she'll
#
do that because she knows about it she'll not go here and there but if you look at other i mean
#
journalists what they do is they'll talk about one thing one day they'll talk about another thing
#
another day so that consistency in reading and understanding is not there and i think every
#
journalist should have a basic science understanding a medical health understanding just like a basic
#
level doctor i think like an mbps doctor they should know something about it to report it
#
properly fair point let's let's take a quick commercial break and when we come back on the
#
other side lots lots more to talk about have you always wanted to be a writer but never quite
#
gotten down to it well i'd love to help you since april 2020 i've taught 20 cohorts of my online
#
course the art of clear writing an online community has now sprung up of all my past students
#
we have workshops a newsletter to showcase the work of students and vibrant community interaction
#
in the course itself through four webinars spread over four weekends i share all i know about the
#
craft and practice of clear writing there are many exercises much interaction a lovely and lively
#
community at the end of it the course cost rupees 10 000 plus gst or about 150 dollars and is a
#
monthly thing so if you're interested head on over to register at indiancut.com slash clear writing
#
that's indiancut.com slash clear writing being a good writer doesn't require god-given talent
#
just the willingness to work hard and a clear idea of what you need to do to refine your skills
#
i can help you welcome back to the scene indian scene i'm chatting with dr abby phillips on
#
on all of his work and you know the reason i first heard about you is we were i was you know
#
dinesh thakur was on my show we did a phenomenal episode where he spoke about our medical industry
#
and while we were chatting after the show or in the break or whenever we were you know both
#
branting and raging against the quacks that surround us and he said i must check your workout
#
and i i've sort of been following you since then and intending to invite you on the show and you
#
know before we get to talking about quacks because i've also written against homeopaths
#
and ayurvedic for a decade and a half and gotten into trouble for it but before we get down to
#
talking about that i want to first talk about what medicine is like one thing which infuriates me
#
is when we talk about medicine and alternative medicine and my hope the point i keep making is
#
that there is no such thing as alternative medicine there is medicine which works which is modern
#
medicine and there is medicine which doesn't work or quote unquote this stuff that doesn't work we
#
shouldn't even call it medicine you know this equivalence that people try to imply irritates
#
me i'm also for that reason i hate the word allopath because it was coined by the homeopaths as a
#
pejorative term and it makes you feel as if there is some kind of equivalence that these are two
#
schools of thought and no they are not two schools of thought you know one is modern medicine that
#
works evidence-based medicine and one is not so give us an understanding of what medicine means
#
to you what do we mean by modern medicine by evidence-based medicine what is medicine what
#
are our standards so i think the term that everybody uses is allopathy which is actually
#
very wrong i think from even doctors use it even modern medicine doctors call themselves as allopaths
#
which is actually very wrong media uses it you see everywhere in the papers it's written allopathy
#
which is actually wrong so what what we are actually doing is i mean i would just call it
#
as medicine that is what it is and if if they want i mean if people want a little more clarification
#
on that then i can call it as science-based medicine or scientific medicine or evidence-based
#
medicine but it is medicine and medicine is something that or science-based medicine is
#
something that we we have evidence for its use we don't use it because we believe that it could
#
help we don't use it because it has been used for thousands of years and we don't use it because
#
somebody has gotten some personal improvement or gratification by using it that is not how medicine
#
works so we have a we have a particular drug call it as drug a and we want to know if it reduces
#
headache so we we first look at what the drug is so we have a drug and we know that this drug is
#
going to act on that particular receptor and that particular receptor is going to modulate the pain
#
and what we want to know and this we know from basic science studies and animal small animal
#
studies now we want to know if it works in humans too and we apply it in small group of humans first
#
to see if it actually reduces pain if it does then we do a larger trial either compare it with
#
placebo which is a sham treatment or compare it with the standard of care to see if it is equal
#
to standard of care or better than that or inferior and that happens with randomized control trials
#
and once you do that what you're actually doing there is that you're controlling for every other
#
factor that can actually affect the patient outcome so for example this is the problem with
#
testimonials there's a lot of people say that no i have taken this drug and my throat pain has gone
#
so you take it that that that is that is not right because that person could have had improvement in
#
that throat pain even without taking that drug because of other factors which we are not we're
#
we're not talking about in that particular story that is the problem with the testimonial but in
#
a randomized control trial such stories don't happen we are controlled the environment and
#
we know exactly what is going to happen and this is what we hypothesize so you give that drug and
#
it reduces pain in the humans but side by side we also look at other things that the drug is doing
#
it reduces pain but is it causing any other problems for that particular group of patients
#
so we look at safety also so we have efficacy which is effectiveness of that particular drug
#
and then we also look at the safety of that particular drug now we have we know that this
#
drug has some safety issues but it's not too bad we can still use it because its effectiveness is
#
much much bigger than the risk associated with it so now we start approving it so we have multiple
#
randomized trials done and then we synthesize all of these randomized trials known as systematic
#
review and meta-analysis which is actually the highest level of evidence some people actually
#
go one step higher and do meta-analysis of meta-analysis which is even the even greater
#
evidence and once that comes and that goes into recommendations or treatment guidelines
#
so people look at meta-analysis and systematic reviews and they say that you know this drug is
#
good for headache it has good effects and very minimal risk and the your fd or who are the
#
regulatory authorities approves it now people start taking this drug for headache it doesn't
#
end there so now you are phase four so in phase four you do post marketing surveillance because
#
in a controlled environment you're controlling for so many factors and sometimes you're controlling
#
it so much that you know you will have a feeling of false safety in that so when you actually give
#
it out in the real world you might actually find more side effects and what happens is that in
#
post marketing the drug companies the regulatory authorities they all see the number of patients
#
who are developing any other major issues with that drug and if some major new issues come then
#
that drug is then recalled so you don't you don't give it anymore it goes out of the guidelines
#
also so this is what science is all about science is all about correcting itself it never says that
#
yes i can cure this it never says that that is what your that term quackery comes only a quack
#
can say that i can cure this no science never says that science will say this is the best option
#
there could be a better option we are finding it out and when the better option comes the
#
best option is out of the window and this keeps happening for ever and ever and ever that is how
#
science is it's evolutionary medicine this is what scientific medicine is and there are a lot of
#
drugs that has been taken out of the market because they were actually good in first phase one phase
#
two phase three trials but when it came to real world scenario it it was found to be not useful
#
or maybe more adverse events happened and it was recalled and thrown off this particular aspect
#
the alternative medicine industry actually uses against science saying that you know
#
you look at ayurveda and homeopathy no drug has been recalled ever but in modern medicine you see
#
how many drugs have been recalled this is actually wrong because if there is no medicine recalled
#
that means you are not you are not evolving you are stuck in a time point it's primal and primitive
#
the real medicines evolve and older medicines get checked out so this is the difference between
#
a scientific medicine or what we call as actual medicine and this is what actually is evidence
#
based and beneficial for people so let me try to summarize you know why this process is important
#
and what it used to be in the past in the past before science evolves you know we make sense of
#
the world by telling ourselves stories about it so initially you have a sun god but then when you
#
realize the earth goes around the sun and there is a solar system you don't need the sun god
#
and you keep updating your frame of looking at the world you keep updating your stories
#
now initially medical systems evolved at a time where science was nowhere near this advanced no
#
germ theory no understanding of infections and bacteria and viruses and genes and all of that
#
so you come up with kind of primitive stories and you come up with kind of primitive ways of
#
treating people now people begin to believe in some of this medicine because of the following
#
reasons one of course is a placebo effect which we know is really powerful this is classic case
#
of henry beecher an american anesthetist in the world war two who ran out of morphine and used
#
salt water instead and the patient didn't know this salt water worked which is a classic placebo
#
effect placebo is incredibly powerful that's one the other factor that comes into play is
#
reversing to the mean like if i have a common cold is going to get better on its own but it's you
#
know it's going to reach a peak it's a bell curve is going to reach a peak is going to go back down
#
is going to get better on its own if when it is at its worst i popped some sugar pills or i pop
#
whatever i think is medicine at the time and then it gets better i will ascribe causation to that
#
and the other is a confirmation bias that if you have a belief that something works for me
#
you will notice the times it works but you will ignore the times it doesn't work and you will say
#
oh that was whatever so a lot of this anecdotal belief that oh this has worked for me that has
#
worked for me is a combination of these things some of the time it was placebo some of the times
#
it just got better on its own as most things do because the human body can be self-healing
#
in so many ways and some of the time you're noticing the time something worked and something
#
doesn't now what science does is that it takes these human frailties and these other factors
#
like the placebo effect or out of the window where you know if you have say a double blind
#
placebo control trial right what that essentially means is that you know you have two groups one is
#
given placebo one is given the medicine you're testing and it's double blind because neither
#
knows what they are getting so the placebo effect the power of belief can't come into play
#
and then you got to beat placebo or as you pointed out then you got to beat whatever the standard
#
treatment is if that is being measured against and this goes through various phases you have
#
multiple trials your meta studies after the medicine is released you see what it's doing
#
in the real world and alternative medicine does not put itself through this it hides behind the
#
veil of tradition and say that oh it's always what you know this stuff has always worked and
#
all of that and you know is this kind of a correct summation of this is exactly the right summation
#
and I think alternative medicine to some extent has been studied in randomized control trials
#
and has failed it and there are no good meta analysis also I mean you you don't have the
#
highest level of anything in alternative medicine because alternative medicine to start with they
#
don't have a proper hypothesis because if I give an example of homeopathy for example homeopathy
#
practitioners are not competent to diagnose a disease because what they do is they treat the
#
symptoms that because that is what they say right like cures like so if a substance causes that
#
particular effect in the human that substance will actually cure it that is what they say so
#
they essentially treat a group of symptoms and they call it as totality of symptoms and that
#
is been wrongly interpreted as root cause which is not the root cause and when they treat only the
#
symptoms you are actually missing the forest for the trees and that actually what happens is that
#
when you treat based on homeopathy principles for example you want to treat
#
let's say hepatitis b so hepatitis b virus can present with cirrhosis it can present with jaundice
#
it can present with a fluid in the abdomen which is known as ascites it can present in
#
in very different ways even for even as liver cancer it can present so if you ask a homeopath
#
to apply their principles and treat for hepatitis b they can never treat hepatitis b because they
#
will not know that this is the virus that is causing it they'll be just treating what the
#
patient will have as a symptom and you cannot apply that in a scientific study setting because
#
when you actually study scientific medicine you need to have a proper aim you have to have an
#
objective you have to have a primary outcome and a secondary outcome and when you apply these
#
homeopathy principles you can never actually materialize these outcomes and primary measures
#
and everything because you are actually only treating the symptoms so that is why when people
#
say that research is lacking in homeopathy or ayurveda it is not lacking it is because you
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can't research it you can't research it because it is unscientific you can only research scientific
#
principles yeah and and just you know for the sake of our listeners just take us into what
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the the methodology of homeopathy because what i find so amusing is that their idea is that the
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more you dilute a substance the more powerful it is which of course if you've studied basic
#
chemistry you know that's nonsense and you know james randy once asked a mathematician martin
#
gardner that what it amounts to a particular kind of dilution and this is what martin gardner said
#
where martin gardner said quote that's equivalent to taking one grain of rice crushing it to a
#
powder dissolving it in a sphere of water the size of the solar system with the sun at the center and
#
the orbit of pluto at the outside and then repeating that process two million times stop
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quote so you know the classic homeopathic dilutions for what are supposed to be their
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strongest medicines they won't even be a single molecule of the substance which is supposed to
#
be treating you they talk about the memory of water and other woo-woo and my first point about
#
all of these systems homeopathy is still relatively recent among the middle of the 19th century but
#
the rest of the stuff is centuries old is that and it's a point that you and krish shok have made in
#
this great instagram video which i'll also link to from the show notes is that all of these systems
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are okay as observational systems but they cannot possibly have a theory of the world that is
#
accurate because there's no germ theory then there is no understanding of bacteria viruses
#
uh the human body how how how genes work you cannot have a theory of how something works and if you
#
have if you're all your first principles are wrong if they're all fiction how can you treat anything
#
yeah how can you even test it so that is the whole point about homeopathy homeopathy is actually
#
i mean it's it's wonderful if you want to actually have some entertainment if you read about homeopathy
#
it's it's fascinating because i mean i when samuel hanneman who actually invented homeopathy
#
he did it from a good perspective because at that time allopathy the real allopathy was treating
#
patients with very hardcore practices for example they made people vomit induced vomiting induced
#
diarrhea letting out blood making them bleed trepanation that is burning putting holes in the
#
skull you know a lot of a lot of such primal primitive practices is what allopathy was
#
to add to that it is still practiced in ayurveda by the way so if somebody has to call something
#
as allopathic please do that to ayurveda because in ayurveda there is something known as panchakarma
#
where they actually induce vomiting and diarrhea and put leeches on the body to suck out blood
#
bad blood and good blood and stuff like that which is actually allopathy so allopathy exists yes and
#
but that is in ayurveda it's not modern medicine and they are coming back to homeopathy so he
#
uh samuel hanneman saw that and that was actually harming and hurting the patients more so he was
#
he wanted a very soft version of that so instead of giving strong stuff he decided that he will
#
give everything in a very dilute manner so that people can tolerate it and they did because he
#
diluted so much that there is nothing left in it so people tolerated it but the whole principles
#
were actually wrong so what happened was that if you if you follow professor edzard urnst on twitter
#
he is written brilliantly that the whole aspect of like cures like came with hanneman's exposure
#
to cinchona so what happened was that he he said that if if you take for example for malarial
#
fevers you have fever and nausea and rigor and everything and when he took cinchona he actually
#
felt that he had rigor and nausea and everything but that was actually because of cinchonism that
#
is because of he took additional cinchona and that was a cinchona poisoning it is not because
#
like cured like so the whole aspect of like cures like was actually based on a mistake
#
a misunderstanding and from there came homeopathy so the basic principle is fallacious and like can
#
never cure like it is impossible number one second is hanneman said that if you dilute the substance
#
more then it becomes more potent the stronger the substances it is less potent which is actually
#
wrong it is against chemistry and physics principles and the third thing so when people
#
started using homeopathy and patients started getting better better because of maybe placebo
#
effect everybody asked how does homeopathy work then i mean some there has to be a principle of
#
mechanism of working so then came the third part which is theory of vitalism he says that there is
#
something known as vital force inside the body which gets completely imbalanced because of
#
whatever disease process and if you do this like cures like and you know give a high potency which
#
is high potency means very very dilute stuff to people the vital force gets balanced and that is
#
how homeopathy works which is absolutely nonsense because you cannot measure or see vital force
#
there is nothing called vital force so this vital force theory became obsolete because nobody could
#
prove the vital force theory then homeopaths thought long and hard and decided that you know
#
you have to come up with a mechanism others people will start disbelieving them then came the water
#
theory so they said that you know you are succumbing the stuff so much in the vehicle either water or
#
alcohol the active substance may not be there but its essence is there and the water understands
#
that essence and that essence is what treats so to confirm this very interestingly
#
they did some theoretical and practical studies on it but could never prove it that water has
#
never nobody has proved it so the water theory went out of the window then science progressed
#
and homeopaths understood that there is now something known as nanoparticles so they said
#
that you know what actually we were wrong about the water theory it's actually nanoparticles
#
nanoparticles is what is doing it okay so now we can show that there are nanoparticles so what
#
there is a study from IIT Bombay and this is a hilarious study where IIT Bombay when experts
#
showed that if you look at the most ultra diluted homeopathic forms it contains nanoparticles and
#
the nanoparticles they identified through some major experiments and showed that nanoparticles
#
are present so this is the reason why homeopathy works now that same set of experiments was
#
redone by another group in Belgium a group of homeopaths in Belgium because even they want to
#
know because a big big thing right homeopathy finally has a mechanism so they did it and they
#
found out nanoparticles but what they actually found was that when the I mean if you know how
#
the homeopath prepares that medicine you know that they shake it vigorously to and fro and
#
multiple times so they found out that the nanoparticle was actually not part of the
#
medicine it was actually part of the bottle your silica particles from the bottle and it has
#
nothing to do with the medicine so nanoparticle failed there so they didn't have nothing to hold
#
on to now they have brought out quantum physics oh god right so now there is a quantum theory of
#
homeopathy there are a lot of theories coming up so i think now once 5g comes 7g comes i think
#
they'll use use those terms also as a part of mechanism for homeopathy so this is the story
#
behind homeopathy even now homeopaths don't know patients who improve personally with homeopathy
#
don't realize how it worked so we don't have a mechanism we have three principles that are
#
completely bogus and we have medicines that contain no medicine so this is the story of
#
homeopathy and if people actually understand this then i don't think they will actually
#
go for homeopathy the problem is people don't understand homeopathy they don't know
#
in depth about homeopathy so if you know about it i don't think people actually will go for it
#
so when i first came to bombay in in 94 i think around 1995 i must have fallen ill when i think
#
i worked in channel v and i had a very bad case of chronic bronchitis or bronchial asthma and it
#
came and for two or three months it was really bad i tried proper medicine sad i should have to use
#
the word proper but we have to distinguish now for this conversation and that didn't work and
#
somebody then said go to a homeopath and in those days i wasn't that well read i hadn't read up so
#
much so i went to a homeopath and after some trial and error my thing went away so for a couple of
#
years i was a believer i ascribed it to that then later of course i read about it and i figured out
#
that okay what happened was either placebo or the thing got would have gotten better anyway over
#
the course of time as it tends to do i also realized so it kind of wasn't that at all but
#
i run into so many people who are otherwise rational who will say no no but it worked for me
#
it worked for me and you know if you just think a little deeper you know how can it possibly work
#
for you and and one of the great myths about homeopathy is that hey it won't harm you you know
#
even though sugar is poison so sugar pills but leaving that aside they say hey it won't harm you
#
but my point is that if you put the economist hat on we have a term called opportunity cost
#
you know where you know and there is an opportunity cost if instead of taking proper medicine which
#
you should take you take these useless sugar pills then it can harm you because of that you should
#
have gotten a particular treatment instead you relied on these and whatever disease you have
#
get worse and this happened in australia where a few years ago there was this homeopath couple
#
of indian origin their daughter their child i forget the gender their child had eczema
#
and they tried to treat the child with homeopathy and the child died and thankfully they were
#
imprisoned but even then it's an incredibly tragic story of how it almost sort of becomes
#
ideological in the same way that if you believe in a religion or if we adopt an ideology you know
#
our sense of self is so tied up with it that we cannot take a challenge to it it is a personal
#
challenge and and and you know and i think beliefs in you know the story we tell ourselves about the
#
world can contain religion or ideology or it can contain that hey homeopathy is good for you or
#
ayurveda really works and all of that so when did you like talk a little bit more about this
#
myth because even beyond opportunity cause there are ways in which homeopathy is harmful and such
#
belief is harmful tell me about that i think i mean there are three ways that homeopathy can
#
be harmful one is like you said it drives the patient away from the real treatment so for
#
example everybody who says that you know they have benefited from homeopathy for whatever diseases
#
they should understand that every disease has something known as a natural history
#
so for example if you take covid majority of patients with covid they it resolves only if a
#
small proportion actually develops severe covid and there are reasons for it risk factors to it
#
but otherwise a influenza or a viral infection it happens it takes a few days peaks and then by the
#
seventh day you're okay you have cough and cold and things it goes away now what happens is that
#
people need outcomes and results quickly right so they'll do a lot of things initially they'll go
#
for all these proper treatments everything in the first five days and once it starts peaking they
#
say that you know we have taken this stuff for five days and the sixth late is still bad so now
#
let us drop this and let us go for homeopathy so they take homeopathy on the sixth day but
#
automatically the the the disease is supposed to come down on the seventh day it goes down on the
#
seventh day so there is a post hoc fallacy there they think that homeopathy is what actually
#
decreased it now you you extrapolate this to a real disease i mean these are self-limiting diseases
#
so the natural history of self-limiting disease is that they will limit themselves at some point
#
and some of them will limit in a few days some in a few weeks some in a few months
#
but if you actually treat a disease which really requires treatment for example if i
#
if i talk about hepatitis b virus infection which actually requires antiviral treatment and you give
#
homeopathy that disease is going to flare and that disease is going to kill the patient because
#
there is no proper treatment given so real diseases if you give homeopathy you are actually driving
#
the patient away from real treatments and that lands the patient in trouble and second is that
#
this is an unregulated area of alternative medicine nobody has standardized homeopathy
#
medicines a lot of companies make it governments make it there is no standard saying that you know
#
this homeopathy from this company is equal to that homeopathy from that company there is no standard
#
it's unregulated so we have a lot of homeopathy medicines which are either adulterated or
#
contaminated so a sensible homeopath knows that it's just water there is no active molecule
#
and he knows that you need something active in it to work so they adulterate it and this is very
#
common there are a lot of studies on it papers published on it saying that alternative medicines
#
especially homeopathy is heavily adulterated and they decide what to adulterate it with so if they
#
want to treat fever you will have a paracetamol in it if you want to treat arthritis or some
#
allergies there will be steroids in it so they adulterate it now the problem is that they don't
#
actually know proper pharmacology so what they do is they adulterate it to extents that it is toxic
#
or they adulterate it with old world drugs for example old world painkillers or anabolic
#
steroids and things like that which actually harms the patient so that is how secondly homeopathy
#
harms because of adulteration contamination third is something known as poor manufacturing practices
#
so you have 200 c dilution means it's just plain water it's so diluted you'll get nothing in it
#
but sometimes they don't actually dilute it so much the manufacturing will be actually
#
problematic poorly manufactured and it will actually have parts of the mother tinger in it
#
the mother compound which is actually alcohol and the active ingredient so you'll have arsenic or
#
lead or some toxic herb in it and that actually can produce toxicity in the human and this leads
#
to adverse events so you'll have poor manufacturing contamination adulteration and because homeopathy
#
was given for a real disease which required real medical management patients get harmed
#
the commonest if you look at all the patient stories who have improved from homeopathy i think
#
number one will be allergy number one will be allergy bronchial asthma or something to do with
#
the skin you know that's that's what what that's what commonly homeopaths treat and it will be in
#
a child mostly you know my child got relieved with homeopathy that's the commonest testimonial that
#
you get and it's very important to realize that bronchial asthma or childhood asthma or childhood
#
allergies they go away after eight to nine years of age so what they do is they'll give two years
#
first two years is when the allergies is very bad they'll give modern medicine everything it
#
is not going away and the homeopath will say that homeopathy is a long drawn process you have to
#
keep giving it for years it will go away so by the time they are five years old they'll start
#
homeopathy three years they'll give by the time the child is eight nine years old the allergy is
#
gone and they think it is because of homeopathy so every homeopathic testimonial is actually
#
linked to the natural history of the disease tell me any patient who has had a lung cancer or a
#
or an infection with a bacteria or an infection with a virus like you know hiv or hepatitis b or
#
it's hepatitis c treated with homeopathy and virus is gone or cancer is gone you will never
#
hear such stories you will never hear you will hear it when homeopathy is used along as along
#
with cancer medication as an integrative medicine that is the next fraud that they do integrative
#
medicine you mix something which which you mix something that works with something that doesn't
#
work and attribute the whole thing to the thing that doesn't work so you have chemotherapy and
#
radiotherapy going on and then you add homeopathy to it and you say that you know homeopathy also
#
worked so that integrative medicine part is also another story which they spin to mislead people
#
and one thing that i i find kind of bizarre is that so many people treat homeopathy as if
#
it is something that is a part of our tradition right it originated in germany hanuman and all
#
that but they treat it as if it is part of our tradition and that you're somehow being less
#
indian by you know taking modern medicine from the west and how how do you think that happened
#
how did it so i i think once the the alternative medicine industry is is a single unit you know
#
they don't distinguish between ayurveda homeopathy i mean even we have an ayush so h is at the end
#
and a is at the beginning so everything is together so they all practice together
#
because they are only each other to hold on to and no science there and a lot of people
#
wrongly attribute homeopathy as a traditional practice and they actually don't know about its
#
origins or its principles it's only 200 years of 200 years old i mean homeopathy was written
#
at a time when the light bulb was not invented it is that old but ayurveda was like pretty much
#
older 2000 3000 years back but they all club it together so you have that fake sense of
#
traditionality that it originated from our place and that is how it is being promoted also you know
#
you promote ayush together ayush promotes homeopathy ayush promotes ayurveda it promotes yoga
#
naturopathy everything together so i think that birds of a feather flock together kind of false
#
feeling is there in the alternative medicine community and also among the minds of lay persons
#
you know tell me then about ayurveda because ayurveda has one the connotation with culture
#
and our tradition is much deeper two ayurveda can often give a really warm sense to people like
#
there are specialized stores which will sell ayurvedic cosmetics i have myself bought shampoos
#
and soap gels from there and they are you know quite excellent and soothing to use and you know
#
so they that sort of softness that comfortness is kind of associated with ayurveda but in and
#
people will often say that this is traditional wisdom some of it has been validated by science
#
like the herbs we use like turmeric is supposed to be good for so many things and you have a great
#
video on that where you point out not quite so tell me a little bit about ayurveda then because
#
it would seem that belief in that is perhaps even more entrenched because it is not just about
#
medicine it is almost like a lifestyle thing you talk about wellness you talk about ayurvedic
#
spas you know so on and so forth i mean ayurveda is actually the elephant in the room you know
#
it's easy to debunk homeopathy because it has standalone bogus principles very easy to debunk
#
it but ayurveda is very different because not only it's it's part of alternative medical care
#
it's considered health care it has very strong traditional religious and cultural roots and of
#
course we are in india and india is the birthplace of it and because when you have to talk about
#
ayurveda and when i say ayurveda is a pseudoscience or it is not scientific i mean it purely from its
#
scientific its principles i don't mean it from uh you know i don't say it because it's from india
#
and india is a developing country so it is all it's not like that people take it in that sense it's
#
not like that you actually look at the principles where we use for example we discussed principles
#
of scientific medicine how a drug comes into the market and can go back or can be used for long
#
we discussed about that but when you discuss about ayurveda look at the principles of ayurveda just
#
like principles of homeopathy the ayurvedic principles are also all unscientific for example
#
ayurveda believes that diseases in the body are caused by imbalances in humors the humoral theory
#
that galen initially proposed as one of the so at that time there were four humors ayurveda has three
#
humors that is a tridosha so they say that there is this vayu pitta kafa these things get imbalanced
#
and then patients develop these diseases so we basically balance them and it becomes better
#
and then they have prakriti and a lot of philosophical stuff now it's all philosophy and
#
if you ask an ayurved to show where kafa is or pitta is or please define it they will never give
#
you a straight answer because you cannot measure it you cannot identify it it exists only in
#
imagination and in philosophy it's not actually part of anything and that makes ayurveda a
#
pseudoscience and based on that how can you treat someone because based on that you cannot
#
diagnose anyone in the first place so just like homeopathy ayurveda also treats symptoms but they
#
claim they treat root cause unlike modern medicine which treats only the symptoms which is which is
#
wrong it's like a propaganda that they they keep on talking about ayurveda does not treat any root
#
cause if at all there is a root cause identifiable and treatable and that is to scientific medicine
#
only for example jaundice ayurveda will treat every jaundice as jaundice but we know that jaundice
#
can be because of many many reasons you know jaundice can be liver related it can be blood
#
related also so you can have hemolytic anemias where your red blood cells get destroyed and you
#
can have jaundice because of that or you can have a liver failure because of different types of
#
viruses or alcohol or autoimmune liver disease and you can have jaundice because of that so you treat
#
the cause of jaundice then the jaundice goes away but ayurveda treats only jaundice so you have a
#
set of things to do for a patient of jaundice and you don't actually treat anything there no root
#
cause nothing and that actually versions the patient so in ayurvedic principles and and when
#
i talk about ayurveda the biggest problem that ayurvedic bring to the table is that are you an
#
ayurveda practitioner you are not have you done bachelors in ayurvedic medical sciences you have
#
not so what authority do you have to talk about ayurveda i mean you don't need any authority to
#
talk about it because you can anybody can rip apart and critique pseudoscience as they want
#
and it is part of scientists and clinical scientists to actually talk about pseudosciences
#
because it is important for their practice routine practice also which is why i talk about it and
#
also i have read the whole thing i have four versions of susada samhita two versions of
#
charaka samhita i have ashtanga hridaya which are the three pillars of ayurvedic classical
#
text and i have read them from cover to cover and i'm sorry to say it is completely pseudoscientific
#
there is nothing in it except maybe there are some good points on nutrition in the sense that not
#
the real nutrition but some stuff they say that in observational part is it's pretty good about
#
nutrition and some observations are pretty good for example susada samhita they talk about some
#
surgical procedures pretty decent stuff but this but it has all evolved from them and the the other
#
whole aspect of it is completely pseudoscientific but to talk about ayurveda from this aspect is
#
not easy because people are not going to listen to it what people do is that directly they'll
#
jump into the other aspects of ayurveda which is religion tradition and culture so they'll say that
#
we have been using it for 2000 years and it is still here it has not gone away which means it
#
is useful which is actually appealing to tradition fallacy which that is not how you use something
#
it is here because it's it's part of our tradition and culture and not because it is a science
#
second is people say that ayurveda has been you know it is actually a you're talking against
#
ayurveda because you're a christian now these are the these are the stuff that i get on twitter
#
you're a christian you don't know everything what you're anti-hindu you're anti-indian
#
go back to pakistan and things like that so that is the second type of argument that they bring
#
and the third type of argument they bring is that you are losing business you know ayurveda
#
treats patients and improves them you are not getting that business so you are losing business
#
you're talking bad about ayurveda these three arguments are actually not nothing to do with
#
the science there are there are not rational or scientific arguments and the best part is that
#
people erroneously think that ayurveda is lose making us lose business it's actually the opposite
#
i am actually getting more patients because they go for alternative medicine you know somebody who's
#
just sitting at home having some gas trouble instead of taking a little bit of you know
#
die gene or something yeah die gene or something some anti-acid something they go for ayurveda they
#
prescribe him a bunch of herbals and that herbals will actually cause him some herb induced liver
#
injury then they come to my hospital get admitted pay for the biopsy pay for the hospital charges
#
ultimately get a transplant and pay 25 lakhs so who's getting the business here i'm actually
#
getting more business here because of ayurveda so it's not like i'm losing business and i don't want
#
that business you know that is the whole point i want people to stop doing that stop harming
#
themselves so that we lose business this is the whole aspect of it but people don't understand
#
this part they directly jump into these irrational arguments when you talk about ayurveda come straight
#
talk about scientific reasons or whatever you can bring to the table from a scientific point of view
#
in ayurveda you will see that it is a house of cards that is why ayurveda don't come for a direct
#
confrontation ever even on twitter you can actually see i mean i just put up a something on
#
arsenicum album on homeopathy and you can just see the the responses underneath by an ayurved
#
he's just abusing me in hindi i mean it's it's it's complete i mean they're just irrational
#
when it comes to argument so you cannot win an argument with them and they feel that they
#
have won because we don't we ignore them at some point right and this is how it goes so
#
ayurvedic principles and homeopathy principles are both unscientific and not not sound enough
#
to call it as science and this is the biggest and same with siddha i mean if i don't talk about
#
siddha and the unani people will say that you know you're not talking about unani because
#
unani has a different culture it is mostly in the persian arabic this thing it's it's part of
#
more of part of muslim culture and siddha is mostly regional in tamil nadu but siddha also
#
has a tridasha theory and unani has four humors instead of three it has something known as black
#
bile also the others have bile kafa and vayu uh unani has black bile also that is the original
#
galenic uh humor theory so this is only the difference but all of them are sort of sciences
#
yeah and and you know one point that you made while speaking about ayurveda in the past is that
#
you know when ayurveda is taught in colleges people have to mix in some modern biology as well
#
because what the ayurveds originally believed was for example the brain is part of the heart
#
there was no concept of the brain as a separate organ and my thing is that you know when we are
#
knocking ayurveda and despite not being christian like you i am still going to knock it as vehemently
#
that when we are knocking it as a pseudoscience it's not exactly dissing the original ayurveds or
#
the field as it evolved back then we didn't know better this is what we knew you could conceive of
#
flying chariots but you could not have invented an internal combustion engine technology hadn't
#
progressed that far so it's not a knock on that it's just that we were less advanced and we are
#
more advanced now and you know what you correctly earlier we were speaking of how homeopathy became
#
popular in a time where you know just going to hospital could kill you because infections were
#
so rampant when modern medicine as it then was was at such a primitive stage it is natural that
#
people preferred sugar pills might even have been better for them but the difference the reason
#
why modern medicine has advanced so much and the reason that all of these have stayed more or less
#
fixed in time is the scientific method you know it is falsifiability it is a scientific method
#
you keep brushing up against reality testing everything testing testing testing understanding
#
the world better admitting your mistakes moving ahead and therefore you see such a sea change
#
you know in proper medicine in the last 200 years while homeopathy is still there you're
#
still diluting that stuff and possibly so that is why i say not experience but experiment yeah you
#
don't go by experience you go by experiments and if you put these practices into experiments you
#
can see that they'll fail enormously epically and that is why even after 2000 studies later
#
governments have identified i mean scientifically progressive societies i would mention
#
australia uk us they have all identified that homeopathy is sham and a lot of funding has been
#
stopped in the nhs and in germany people have to pay from their pockets to actually avail
#
homeopathic services now it's not part of the public funding system anymore why because they
#
have progressed we don't we don't do that because for us i think this is a big part of our
#
a big part of our economy you know it's it brings in money and it's not easy to just one day suddenly
#
make it vanish so there are a lot of reasons why it stays here in india and gets and gets the
#
limelight it is getting now and science science is not one of it that is the whole aspect of it is
#
not here because it is scientific it is here because of other reasons other than science and
#
health care yeah inertia tradition all of those things and what also strikes me is you know for
#
every ayurvedic doctor who says have you studied ayurveda you can't question you know no regular
#
doctor would ask you something like that it's a question of facts you know if a lay person like
#
me is to come and say that hey your theory of this is wrong i would have to explain why
#
and then i would have to you know and it would be falsifiable and you could easily figure out
#
what the truth is you know exactly like if somebody asked me you you prescribe paracetamol
#
even though paracetamol is the number one cause of acute liver failure in the world
#
i don't i don't tell them that are you a doctor have you studied mbbs
#
no i tell them the truth the truth is paracetamol in its routine dose is safe the reason why people
#
develop paracetamol poisoning is either because of overdosing as part of an attempt of attempted
#
suicide or it is because of overdosing accidentally that happens mostly in children because mothers
#
or fathers they actually they give more than what is required to reduce the fever and that actually
#
causes the trouble otherwise paracetamol is actually the safest drug in the world
#
if you use it as recommended and routinely but it is the poster boy for anti-modern medicine from
#
the alternative medicine industry because unfortunately it is the commonest cause associated
#
with liver failure because of overdosing or because of attempted suicides and this this we
#
will explain right we don't ask them you know are you an mbbs doctor what what what what authority
#
do you have to ask me come on that happens that questions come only when you are unscientific
#
and you don't know have any other ways to defend your practice yeah and like three common ways in
#
which you get attacked earlier like you pointed out none of them is making an argument all of
#
them is attacking the person so that is always a sign that you have lost you don't have truth on
#
your side exactly exactly and and most of them are ad hominem you know a lot of them are at home and
#
i have seen that homeopaths are more ad hominem than ayurvedic i don't know why but they are more
#
abusive and they harass more and i've had a lot of harassment and trouble with the homeopathic
#
community than i've had with ayurvedic community the handful of times i've written about these so
#
have i now why do you think that is is it because ayurveda at least is a part of the culture in
#
such a way that they don't have to feel threatened you know they are marketed very well they are
#
also doing their shower gels and wellness spas so they feel kind of more secure while homeopaths
#
at some level they must surely know that it's all vuvu i cannot actually put a finger to an exact
#
cause for that but i think ayurveda is much more acceptable in the community right so even if they
#
don't attack the messenger they are still comfortable but in in homeopathy it's different
#
because you have to go by testimonials to keep it alive homeopathy survives only on testimonials and
#
nothing else and because of that and it has nothing to do with patient care or health care
#
or compassionate care nothing it has everything to do with business so when you attack homeopathy or
#
criticize homeopathy you are actually criticizing the business of homeopathy you're actually
#
reducing the business of homeopathy and i think this is what makes them really angry
#
because you you don't want to lose patience for me when i if i lose patience or gain patience
#
it's it's not like i'm thinking from business point of view you know i've lost so many patients
#
or i've gained so many patients or today i got two new patients i mean i don't think like that
#
but homeopaths do they actually are they they actually are more into the business of health
#
care than actual patient care you know it's it's totally different and every alternative medical
#
practice is actually business of health care it has nothing to do with the compassion of patient
#
care there's nothing they will say that they are more compassionate i mean i i do appreciate two
#
things in homeopathy and ayurveda and i would i am going to be open about it the time that they spend
#
with the patient marvelous i mean like we spoke in our initial questions we were saying that you
#
know modern medicine doctors see so many patients they don't have time to spend a lot of patients
#
why they go away from modern medicine to alternative practices like ayurveda and homeopathies because
#
they listen to them they hear them out because they have more time to spend with the patient
#
a homeopath actually takes about two and a half to three hours of history alone from the patient
#
and they ask them everything what time do you take a bath how do you go to sleep how are you sleeping
#
i mean these are not related anything to disease but they still ask them and that is at a personal
#
level so they feel more comfortable and more confident with that particular homeopath rather
#
than that modern medicine doctor who just prescribe some pills and push them away so this is something
#
so important i think if somebody if a modern medicine doctor has to learn something from
#
homeopathy in ayurveda it is that you have to talk to your patient because without that communication
#
skill things don't work out well for both of you and this is where i want to bring in something
#
that i wanted to talk to you before where i said that i had an episode of violence against me and
#
this was initially starting from my and this is when i understood the importance of patient
#
communication that is how i learned i mean as a doctor i think we have learned learned it the
#
hard way these are things that these things are not taught in colleges and i hope younger doctors
#
also listen to this podcast because they should know this you don't they don't teach you this in
#
colleges and i think it's very important because patient communication is what clinches everything
#
and what happened was that there was this patient with severe alcoholic liver disease
#
and that patient was so sick and we advised for a transplantation they had no money and they had
#
probably nine or ten lakhs to spare for the whole thing for the transplant and a little bit left
#
for the other post transplant care and the transplantation at that time was not active
#
in my unit it was only in some other hospitals so i had to refer them to another hospital but
#
they quoted about 25 lakhs for the transplant at that time this was about six seven years back
#
and they said that sir there is no way we can do it but we want to do it because we want to help
#
our father so i said that you know i studied in iLBS and iLBS has a very cheap transplant
#
this thing charges so they they transplant patients at that time they used to transplant
#
patients within 10 to 11 lakhs so it was like a big deal for them so they took this patient
#
by flight somehow i optimized him stabilized him i just said go to a transplant i did not say
#
i did not say anything more than that and they just went so they thought everything is going to
#
be fine you go there get transplanted so by the time he reached there this patient became very
#
sick so my mistake was that i did not tell them regarding how this disease is going to progress
#
what to expect and what not to expect so i did not tell them that severe alcoholic liver disease is
#
associated with infections at any time patients can bleed anytime patients can develop sudden
#
blockage of veins in the liver at any time they can crash anytime and this this can happen during
#
the workup time before you reach there i did not tell them all this in detail so they went there
#
the moment they arrived at iLBS patient got very sick he was in on the ventilator for about a
#
couple of weeks the money that they had collected for the liver transplant actually went into just
#
managing the complications of this patient on ventilator so finally when the doctors there
#
optimized him for transplant they ran out of money and then ultimately he died there under hospice
#
care so he was supposed to die here in his home he went all the way to delhi and died there
#
bystanders family furious i mean there was nothing i could do there and i understood it was my fault
#
so they came back after everything after the burial everything and i i never knew about it
#
he just messaged me saying that you know the patient has died so i asked him what happened
#
he said no he died of infection and things like that and i said okay i i did not even say anything
#
more than that because it was on the phone on whatsapp nothing more i could say and i just left
#
it there after two months later after everything was settled his son a nephew and another guy i
#
think his brother they came into my opd they just he just uh i mean banged on my table and said you
#
destroyed our family so i was like shocked i didn't know who this guy was i suddenly i forgot it was
#
it was almost two months after his death and then suddenly he said that because of you my father
#
who was supposed to die at home in kerala he died in delhi and then he started abusing me right left
#
hand center they took my chair and they beat uh beat up my i mean beat the table and some stuff
#
there destroyed my files and everything and then they abused me and then they left while they were
#
going out they told every other patient who was sitting there that don't go into this guy's room
#
he will kill your family things like that i mean it was so bad i was so i mean i've never faced
#
that kind of stuff because i've done everything good for the patient right i mean as a doctor
#
we don't want to do anything bad for any patient we do everything thinking that is going to be good
#
for the patient and i did all that called up those people arranged everything for his travel and i
#
did all that and i got so shocked that they came back and did this to me then i reflected on it i
#
was depressed for a whole week or two i think i am still depressed when i think about that episode
#
because it was quite bad i mean i i when patients become violent towards you it's because you you
#
you spend all your life you're you're learning about yeah i did i studied for 15 years medicine
#
to help people and then once this happens to you you feel like an utter failure you know you're
#
like lost did you talk to them again no i did not because i i think it i don't think it mattered
#
because they they just left and i i think at some point they would have also cooled down
#
because i did not want to make things worse and i was depressed for about a couple of weeks
#
and then i at that time i reflected and what went wrong and i think every doctor should do that
#
if somebody if something is going on in your practice and your patients or family is not
#
satisfied please reflect what is happening you have to always self-assess a lot of doctors don't
#
do that and i figured it out that you know it was because of poor communication and from that time
#
onwards i tell the pros and cons of everything to all my patients like we discussed before i
#
talked to them regarding finances also everything is on the table for everyone to see and i've never
#
had a single episode of violence against me after that wow not a single episode when people die
#
and when my patients die actually their family comes to my room they cry a lot in front of me
#
and they thank me now i feel sad because i could not save that patient but they come and they thank
#
me and i i feel that i have done my part you know it is satisfying in in a bittersweet way
#
but they never become violent towards me and this is the this is the sleep that i
#
spoke to you about it's not a good sleep but for me i mean i cannot explain it i sleep well at night
#
because of this and this is very important and this is what i think one should learn from the
#
alternative medicine industry the way they talk to people i mean if i talk to when i when i say
#
that you know this homeopathy medicine is what caused liver injury to you or this ayurveda is
#
what liver injury to you patients defend them patients defend the ayurvedic practitioner and
#
the homeopath saying that no he's a good man yes that is the power of communication and i don't
#
know why people doctors can't understand it just imagine if every medical doctor proper medical
#
doctor communicates properly with the patient you will not have this alternative medicine industry
#
it will just go to smithereens and hundreds percent sure and would you say that's an
#
and i'm just thinking aloud here would you say that's an underrated part of the process of
#
treating someone that it is not just about you know how you treat what is happening to their body
#
but also that you understand their anxieties you understand their context and for that you have to
#
talk to them sit with them i think the whole issue is with our medical education system
#
you know right from the end of 12th grade you are pushed into a competition you have to get into
#
mbbs somehow then in mbbs you are taught the basics finish internship get into md somehow
#
then suddenly you get into dm somehow nobody is telling you here that you need patient
#
communication skills nobody is telling you that the patient is a person everybody is saying that
#
you have to diagnose you have to investigate oh this is how this is the algorithm to diagnose
#
you go like this and follow come on that is not clinical medicine and i think that that aspect of
#
clinical medicine was taught to be my my professors and that is exactly why i said they are a dying
#
breed i don't know about teachers now because when i see the quality of students that i deal with
#
because i have a lot of young doctors joining my unit as medical officers and everything
#
i don't see any compassion in them absolutely none which means their education was like that
#
nobody's taught them the real thing nobody's taught them to see the patient as a person
#
everybody is taught every student has been taught to see the patient as an algorithm
#
and that is how we approach the patient that is where you see everywhere approach to the patient
#
approach the patient it's not like approach the person and i think this is also very important
#
for clinical medicine once you do that and once you know your science i mean that is a good doctor
#
is it the case that you know i'm sure that many of your batch mates wherever you studied
#
would also not be compassionate in that way would get jaded would get whatever i mean compassion i
#
think is to a certain extent i'm not can it be taught like isn't it something internal that
#
comes to you i mean i mean internal is there definitely like for me because of lot of other
#
because i have been exposed to this from my dad so it was internal for me and i know how i mean i
#
understand its importance but i think it can be taught because if somebody if for example the
#
the students that train under me when they write their usmle and uk and they go they stay with me
#
for about a year because i trained the medical officers also who are with me and the main thing
#
that they have told me is that you know you taught us how to diagnose this you taught us how to
#
diagnose that they tell me that you it's very interesting the way you talk to the patient
#
and that is what actually impresses them and i think it can be taught because when you
#
you as a teacher what you practice is what they will learn so if you are a teacher who is just
#
going to prescribe the student will also just prescribe if you are a teacher who is interested
#
only doing endoscopies for the patient the student will also do endoscopies for a patient which who
#
does not even require endoscopy you know because that is what he's been taught and he's been
#
exposed to i think it can be taught and if they're a dying breed why do you think they're a dying
#
breed because i don't see because i mean the professors that i have dealt with at that time
#
and my batch mates you know we are all in the same we are all like-minded and when i see that
#
batch i still i'm in touch with these my colleagues at the time and they still practice that kind of
#
medicine that we have practiced you know very patient-centric when i see a fresh pass out
#
like a fresh dm guy or a fresh md guy who works under me or with me i mean this is maybe my
#
personal observation i don't know about i'm not generalizing to all but i see that they are more
#
interested in working up the patient and investigating more and you know you don't i ask them what is
#
the patient's name some of them actually have to go back to the paper and look at the name
#
you know it's it's that bad no no what i meant was not why do you think it's a dying breed
#
because which is what you answered but why are they a dying breed i i take it that they're a dying
#
breed i see it in other professions as well so this almost seems to be a common thing but why
#
i think medical education medical practice is more commercialized now you know it's no more
#
an art so clinical medicine is actually i call it an art of medicine with with strong scientific
#
principles it's still an art now it is not an art anymore it is commercialized science
#
so you need an artful science instead of a commercialized science and i think it's because
#
there's so many colleges so many people passing out of the college so much of stress on the
#
on the medical colleges and the medical people i don't i think that art part is lost somewhere
#
and the commercial part has come up it's beautifully put in it almost seems so sad this paradox that
#
while you know a lot of doctors trained in modern medicine will have the algorithms they'll understand
#
what's going wrong and how to treat it but they won't have the compassion and there'll be
#
alternative medicine people who have the compassion who are talking to the person for two hours two
#
and a half hours but they don't have the algorithms they can't do anything with it absolutely so you
#
need to strike a balance right so you need that algorithm and the compassion and that can happen
#
only in science-based medicine you cannot expect the alternative practitioner to have an algorithm
#
they won't they won't they are not trained in so the best way is to have a compassionate kind of
#
algorithmic approach to the patient from a modern medicine doctor yeah and that that works well it
#
works well for both so you know i mean one reason i guess homeopaths would get so angry and it's
#
happened to me and we'll discuss that also how people respond to writing these kind of things
#
is that you know the moment you if a person is trained in only homeopathy the moment you destroy
#
if a person is trained in only homeopathy the moment you destroy the basis of that you know
#
you are effectively saying that they're either delusional or they are a fraud and you are
#
obviously if somebody tells me i'm either a fraud or i'm delusional obviously you know it's natural
#
to respond with anger and you know so i kind of get that tell me about the real world consequences
#
of this because one of the things that you've been doing so well in your social media is documenting
#
the damage that bad quote unquote medicine does the documenting the damage that ayurveda does
#
documenting the many ways in which we are harmed by all of these so-called harmless herbal supplements
#
and so you know tell me a little bit about that what is he what do you think is the extent and
#
scale of that what have your experiences been like and around around when did you begin to notice
#
these and realize that these are a serious problem so this actually started off with so when i came
#
back to kochin to practice as a consultant junior consultant initially my whole idea was to work on
#
alcohol associated liver disease because kerala is replete with it and it was my interest whenever
#
you did stool transplants there's so many new things happening in that so that was my interest
#
so what happened was that i came here with a mindset to study alcoholic liver disease but what
#
what i faced in real life in my op-ed is that i started seeing a lot of patients with hepatitis
#
and jaundice without any cause no they had no known reasons for their hepatitis and jaundice
#
and they are like acute they presented quickly it's not like it's like a chronic ongoing process
#
suddenly within a few weeks they're developing jaundice and hepatitis so hepatitis is when you
#
have inflammation of the liver and your liver function tests will show very high abnormalities
#
in your enzymes sgot sgpt and all that and you'll have jaundice jaundice is clinically defined as
#
bilirubin more than three total bilirubin a lot of people actually mistake it as the lab value if
#
it slightly goes up they call it jaundice it's not the clinical jaundice is about three so what we
#
did was that when we looked at these patients background in the sense that three six months
#
prior to development of this jaundice when we looked at that this this particular group of
#
patients all of them were actually consuming traditional medicines you know herbal medicines
#
and homeopathy and whatnot and at that time we did not figure it out because the common sense
#
at that time was that naturally is herbal and safer no side effects everybody uses that because
#
it's safe when we looked at these products so what we did was we identified that traditional
#
medicines were being consumed and the timing was actually fitting this is known as temporal
#
correlation so they started at some point the traditional medicine and then they develop jaundice
#
and it fits it and you look at all the other causes of jaundice they're all not there it's
#
all negative so this herb induced or drug induced liver injury is basically a diagnosis of exclusion
#
you say that all the other stuff is not there and this is the stuff and it it fits with the timing
#
and we did liver biopsies so once we did the liver biopsy we identified so when if somebody
#
is consuming alcohol there will be a signature in the liver right that is how you identify
#
alcoholic liver disease has a particular signature so you know this is alcohol
#
viral hepatitis has a signature you know it's viral hepatitis even modern medicines
#
like paracetamol when you take if it's toxic you'll have a particular type of pattern of
#
liver injury when we looked at the liver biopsies of all these patients it was like crazy it was
#
like patterns never seen before in the sense that you will have patterns of paracetamol poisoning
#
patterns of alcohol poisoning patterns of viral hepatitis patterns of autoimmune hepatitis
#
everything in a single patient which is impossible so my pathologist was quite confused he's like
#
what is happening to these patients then we looked back and we retrieved these ayurvedic
#
supplements herbal medicines that they were taking we analyzed them and we found out that
#
they had multiple liver toxic components in it including herbs adulterants contaminants so they
#
actually brought out a mix a match of types of different types of liver injuries in these
#
patients and these were the cause of liver injury in these patients so we proved it this is what we
#
published in 2017 2018 in Indian journal of gastroenterology which is official journal of
#
the Indian society of gastroenterology one of the oldest societies in in India the very very
#
influential and famous society the moment this was published that traditional thinking was
#
completely broken you know we say that you know natural does not mean safe and herbal is not safe
#
ayurvedic herbals are not safe it can actually cause liver injury and some of these liver injuries
#
are severe enough that patients can die or they can go for in a transplant so we did that
#
beautifully done paper it was it actually got an editorial also written on it and that editorial
#
actually was the highest downloaded article in the history of that journal it was that that
#
that defective and this came out in the papers the in times of India ran a story on it then started
#
all the trouble so what happened was that Ayush ministry figured it out something has happened
#
this has come out and ayurvedic herbals are not safe there is a side effect so they started to
#
email me so initially it was in good faith emails saying that you know you have identified this and
#
which is something unique and things like that and we would like to talk to you regarding this
#
i said okay let us talk about it then the second mail came that you have to come to us alone
#
to our place to the ministry we will arrange for your stay and everything you have to come alone
#
we have to discuss alone so i said i'm not going to come alone why do you mention that you have
#
to come alone i mean my co-authors are there senior authors are there we'll come no you you
#
come alone that's that's fine then i said that i showed some resistance because i said that what
#
do you want to know actually and what do you want to discuss about if it is about changing policies
#
or bringing about a change in the herbal industry because you are the top apex guys sitting on top
#
there then i'm ready to have a conversation they said that then came a very weird kind of a letter
#
accusing me of a lot of deformation and all that saying that you did not check for this you did
#
not check for that you did not take the permission of ayurveda uh industry and ayush before you
#
publish this paper you know some nonsense like that i mean why do you need their permission to
#
publish a scientific paper and so many things like that and you don't you do not you do not have an
#
ayurveda author in that you should have an ayurveda author only then this is going to be valid and
#
things like that i mean crazy stuff so i said you know these guys are just you know trolling me and
#
i stopped i you know started ignoring but these letters kept on coming and ultimately they said
#
that okay you can call the editor-in-chief of the journal and you come alone and then we'll
#
discuss i said no there will be drug-induced liver injury experts there will be hepatologists
#
there will be clinical scientists and there will be journal people also who will have a panel
#
discussion with you on this so that something good comes out of it we'll have to make some
#
guidelines or bring out some information for the people no news after that they stopped messaging
#
me after that when i when i said that then i think i think i'm not sure how that happened but
#
two private pharma ayurveda pharmaceutical companies filed a case against me saying that
#
i'm defaming them so one was this big company called pangaja kasturi it's in kerala they market
#
products for arthritis and asthma and for arthritis that particular product that they
#
market called ortho herb i had actually analyzed that and published it in my paper and i shown that
#
it had high levels of arsenic and it was contaminated and that news actually spread like
#
wildfire in kerala because every household was using this this particular product so he filed an
#
fir against me and cops came to my op to my opd during my op hours and started questioning me
#
regarding this about defamation and things like that but cops were brilliant i told them this is
#
part of a scientific paper they understood and they left me so that part got cancelled so this
#
guy was like really pissed off he filed another case in another police station against me and
#
again those cops came and they they were a little more into the investigation again they wasted a
#
lot of my time my father's time also while we were seeing patients and then they wanted to
#
interview all the authors you know so i have a pathologist as an author i have the biomedical guy
#
who does the analysis for me and they are all from kochan university of science and technology i mean
#
real valid legit people and they went and spoke to all of them and the pathologist was actually
#
quite badly i mean in the sense that they were a little strong on him he had to show all the
#
slides that he looked at explain all that stuff he was just harassed quite a bit and he was really
#
down and he was the pathologist who actually identified these new patterns of liver injury
#
and that is like something unique so that paper actually was completely on his shoulders i mean
#
his finding is what helped me publish this paper he was so harassed that he actually left the
#
country he left india and he's now working in the uae and he's peaceful there he said i'm not going
#
to come back again if this is the if this is what happens to a scientist or a physician when they
#
bring out scientific truths i'm not going to come back so he started working abroad and he's not
#
come back up so i lost a good member in my team then once this happened and we started seeing
#
problems with other systems of alternative medicine also like homeopathy so we started
#
talking about homeopathy related liver injury so i have i published a lot of papers on ayurveda
#
related liver injury in normal people ayurveda if cirrhosis patients if they consume ayurveda
#
what happens to them that paper we published and even alcohol liver disease patients if they
#
consume ayurveda what happens so we have a bunch of good original papers on this
#
and the all papers have shown that these patients have very poor survival without a transplant for
#
example if you take patients with alcoholic liver disease who take herbal medicines the only 18%
#
of them will survive at six months and that's a very low number that's 18% of patients i mean
#
that's about 90% of them 80% of them dead for nothing without proper treatment and without a
#
transplant and in the case of cirrhosis patients when they take ayurveda for other reasons like
#
diabetes or whatever 53% of them die and these are all unnecessary health burden we can actually
#
avoid it you know avoidable health burden these people should have survived for longer duration
#
for decades if they did not consume that herbal medicine so that was the whole point so then we
#
started publishing on homeopathy so we have had a lot of patients who develop alcoholic liver
#
disease because of homeopathy because of homeopathy yeah because homeopaths what they do is they know
#
that the diluted stuff is diluted there is nothing in it so they start giving patients mother
#
tinctures mother tinctures are potent i mean for them it's not potent for them it's low potency
#
for us it is very potent mother tinctures contain absolute alcohol about 90 to 94 percent and an
#
active ingredient like arsenic or lead or something like that and patients consume this to get the
#
effect and they develop real proper adverse events because of that either kidney injury
#
we have had even patients with bone marrow failure after consuming homeopathy medicines mother
#
tincture and we published that and we spoke about it homeopaths are a totally different
#
breed when it comes to you know responses a group of homeopaths i'm talking about practitioners
#
i mean they consider themselves as doctors they took a car from north kerala came all the way
#
identified my lab somehow the lab where i analyze these products they identified the lab
#
they harassed my lab members the security and everybody took videos live videos of that lab
#
and then put it on facebook calling for violence against them so the homeopathy sympathizers and
#
apologists on their behalf started writing below that particular post saying that we'll kill them
#
and stuff like that i mean crazy my lab members got so scared and the lab director told me that
#
you know this is something we did not expect this and i was so worried for them and i was so sorry
#
that it got leaked out somehow and i told them that you know what let us stop this because they
#
were the ones who helped me with all the analysis of my all the drugs and all the papers we published
#
was just because of their beautiful work and i had to cut ties with them because i wanted to
#
i i wanted to make sure that they don't get into any more physical trouble so i had to stop my
#
analytical work for almost a year before another lab agreed to work with me and we have we have
#
a lab now who's working with us totally anonymous it's not it's nowhere in the state also and they
#
are doing the work for us now but because of this because the homeopaths responded so badly
#
harassed my lab members leading to the closure of our deal i lost a whole year of research work
#
because of that and that's actually quite quite if you look at a clinical scientist that's actually
#
quite a quite a huge time that is lost so these are the two major events that happened
#
and two three major events actually i mean from the ayush ministry from the pharma lobby
#
and also from the homeopaths directly in between this something else happened you know this is
#
nothing to do with ayurveda per se but it is to do with the herbal and supplement industry that is
#
herbalife so i published a paper on herbalife related liver injury where a patient actually
#
died a young woman died 23 24 years of age with two kids she died after consuming herbalife products
#
and this is not the first time it has happened herbalife is well known to cause liver injury
#
and death and about before i published my paper more than 70 cases of herbalife related liver
#
injury has been published from all over the world switzerland israel europe everywhere and mine was
#
the first from india from asia pacific region and we published that and herbalife is a different
#
kind of monster it is nothing like what we deal with the ayurveda industry they mailed me a nice
#
mail initially asking about patient details and all so i gave them i said that everything is on
#
the paper so i forwarded the paper to them the second mail i got was from an attorney in delhi
#
saying that you know i have defamed herbalife so you have to pay two million us dollars they're
#
going to sue me for two million us dollars so i said sue me no problem because i have evidence
#
to show in the court you're not going to win this you sue me no problem so i was holding my ground
#
what they did was something unexpected so they did not communicate with me anymore they directly
#
started suing the journal and the publisher so the report where i published that report in the
#
journal of clinical and experimental hepatology jch and the publisher was elsewhere so they start
#
they sent a lot of legal letters to them to the journal editorial board to the assistant
#
editor of the journal these people are like not expecting this right and i mean i can fight in
#
the court because i have some good friends at lawyers and everybody who is ready to willing
#
to help me but these people if they actually have to fight in the court they have to pay from their
#
pockets nobody is going to help them out and all that so they actually got scared of this legal
#
threat and they issued an apology letter without telling me and called my and in that apology letter
#
without any proper scientific validation they called my paper unscientific and said that
#
everything that i written in the paper was actually wrong and they are sorry for it and they
#
sent this apology letter to herbalife wow and because of that my paper was removed removed
#
without my permission and this was actually a big deal for herbalife and science lost and money won
#
there and this was actually blogged by major science integrity a scientist like elizabeth bick
#
she blogged about it retraction watch npr funded retraction watch actually wrote about all supporting
#
you obviously all supporting me because that paper was strongly scientifically valid and they
#
actually ran two peer reviews and both the peer reviews actually said that this is true
#
this paper has no science problems it is all true but because herbalife were hounding them
#
they removed that paper and and it was very sad to see the senior gastroenterologists and senior
#
physicians fumbled because if they had stood ground i could have actually gone to court and won that
#
case is that paper still online somewhere no no it's completely taken it out and everywhere i put it
#
up they take it out i put it upon a private server in research gate they took it out from there they
#
sued research gate i put it upon a place called inado i forgot the name this is also a public
#
server where you can upload your papers and everything they took it out from there also said
#
that they'll sue them so they're not allowed that paper to come up anywhere now it is uploaded in
#
dr elizabeth bick's blog and in retraction watches blog and in my personal website it's uploaded
#
there wonderful i'll link to it from the show notes so that is that is that these are the problems
#
that i faced mostly so from all angles legal police and even two million dollars of suing
#
and the best part is even after my paper came out multiple papers from other countries came out
#
i mean showing herbalife related liver injuries because those guys and and those journals were
#
strong-headed herbalife can't do anything there but because you were in india and an easy easy
#
target possibly so they thought i think so so i you know when cobit first started i got sort of
#
distraught at the kind of quacky remedies that these people were kind of coming up with coronel
#
and all of that and i wrote uh i was a columnist for the times of india i mean technically i still
#
have but i haven't written for the longest time apologies to my editors there so i i wrote this
#
piece about basically called beware of alternative medicine i'll i'll link it from the show notes
#
and i spoke out against homeopathy and ayurveda and in the end i had something about how the
#
ministry of ayush should not exist which i do strongly feel it's a ministry of quackery and
#
the ministry of ayush i don't know if it's a great honor or something but the ministry of ayush then
#
came out with a press release complaining against my article and demanding that times of india and
#
i apologize and time my editor there called me and laughing and said what do we do and i said
#
listen i am i am happy to double down never apologizing for that so nothing of that's what
#
happened but you know for a ministry to come out with a press release against an individual
#
article in a newspaper seemed to me just nuts but what you you know told me when we were chatting
#
in the break is that the times of india reporter who covered your first study just covered your
#
study said that so and so has a study out and this is what it says she had to go to court along with
#
the times of india because she got harassed and sued yeah by the ministry of ayush by the ministry
#
of ayush it went to the magistrate and from there it got chucked out but but imagine all that
#
harassment paperwork give me a sense of the incentives involved in that ecosystem because
#
i can imagine a big company like herbalife putting money might and trying to intimidate you and you
#
know back in the day iipm once did this to a bunch of bloggers filing cases from all kinds of different
#
cities so you have to you know kind of go you know it's just harassment and using money power
#
to whatever and i can understand a private company like herbalife do that i can understand
#
groups of hermaphrodite doctors do that because you know otherwise their sense of self is being
#
attacked their business is being attacked as you point out their livelihood what's the deal with
#
the ministry of ayush and all of this like what are the vested interests involved and surely there
#
is you know there must be some internal conflict between i mean our government also as a ministry
#
of health right and the ministry of ayush is you know directly counter to that so what sense do
#
you have of these dynamics and these vested interests and what's going on here i think the
#
most important aspect is that the ministry of ayush i think we need a ministry like that
#
for example in the u.s they have a national center for complementary interrogative medicine nccim
#
they regulate for example if they actually find out that a particular herb or a herbal supplement
#
or a herbal or dietary supplement is actually causing harm to the patient population or a
#
general population they bring out statements saying that you know beware at your risk this is
#
not evaluated by the fda this is shown to cause problems so please beware and use at your risk
#
but what our ministry is actually our ministry is supposed to do that ayush ministry is supposed
#
to regulate but what they're doing is that they have completely forgotten about regulation and
#
they're doing promotion so they are there just there to promote indian medicine indian traditional
#
medicine and they have actually brought everything into that umbrella term ayush and promoting
#
everything and if they actually if we if i say that or you say that something is harmful and that
#
part that is directly related to uh an ayush practice if they also say yeah it is harmful
#
then it it's it's directly saying that you know you cannot promote it so every time they're doing
#
promotion it's against their promotional values a classical example is when the covert pandemic
#
was at its peak ayush ministry actually brought out guidelines for treating coven which is one
#
of the most hilarious things i have ever read in my life and in that they actually mentioned that
#
people should take giloy khata a lot of giloy decoctions to prevent corona for this thing
#
infection very interestingly a group of doctors from just lock hospital in mumbai headed by
#
professor aba nagral they identified initially six patients who developed severe giloy liver injury
#
and they attributed it to some components in giloy which can act known as furanode diterpenoids
#
every i mean people say that modern medicine is chemical but they don't think they don't
#
they don't realize that everything is chemicals and and these are worse chemicals have not been
#
tested not been tested also so these plants have a lot of chemicals in their plant phytochemicals
#
and one of that chemical is known as furanode diterpenoid that can actually cause injury to
#
the liver and the injury is in in a very very unique manner that furanode diterpenoids can
#
actually modulate your immune system so your immune system loses its ability to identify self
#
which means it will start attacking you that is known as autoimmune autoimmune disease so your
#
you lose your immune cell starts attacking your organs so that particular attack comes in the
#
liver so that is giloy induced autoimmune like hepatitis so giloy this group found out that if
#
you take giloy as recommended some patients can actually get autoimmune liver disease autoimmune
#
hepatitis and those who already have autoimmune disorders like for example diabetes or thyroid
#
disease or rheumatoid arthritis these are all autoimmune diseases right so if somebody who has
#
already has a risk of autoimmune disease and they take giloy they have a higher risk of developing
#
autoimmune hepatitis with giloy this was published ayush ministry brought out a it's so funny i mean
#
i don't know how they can do that they brought out a big press conference saying that this study is
#
fake this study was actually published in a peer-reviewed journal you know under the indian
#
national association of study of liver inasli is the biggest national society for liver management
#
in the country and they called that study a fake and said that this is misleading so me and a lot
#
of my colleagues were actually discussing about this and we just started talking about giloy and
#
i said you know i have seen like three or four cases of giloy and my colleague started saying
#
that you know he has seen eight another colleague has seen four so i said why don't you guys publish
#
it he said like i mean we don't know how to go about it so what we did was we created this group
#
called the liver research club of india liverachi and 13 hospitals participated in that and we
#
published the largest series of giloy liver injury from the country from all regions and that was
#
published in hepatology communications which is an official journal of american association of study
#
of liver disease that was like a nail on the coffin for the ayush industry the lot of papers
#
ran because it's not just about six patients now it's now much more we are getting so many patients
#
from different parts of the country having giloy liver injury we brought out a lot of media wrote
#
about it i think the wire science wrote the best part of it banjot kaur she she wrote a really good
#
article on it about giloy liver injury and this was out in the open now still ayush got a statement
#
saying that this is misleading fake information i mean what they should have done is ideally
#
tell people that at least people who have some autoimmune disease process please avoid giloy
#
that's it that's all they require to do that is regulation right but if they do that the problem
#
is almost 70 to 80 percent of ayurvedic products contain giloy which means all of these products
#
will come under the blacklisting they can never do that because they are going to lose a lot of
#
businesses because ayush ministry i think has to take care of stakeholders concerns also so you
#
have a lot of private and public ayush industries running and everybody's i mean everybody's
#
products will be under the scandal if somebody ayush says that you know giloy is dangerous please
#
don't take it it can cause autoimmune hepatitis that means a lot of giloy products will be off
#
the shelves people will stop using it if they make a statement like that which is why i think
#
ayush to protect their stakeholders in the best of interest of business does this that is why they
#
behave like that and i think it is still to do with the business only and yeah they don't they
#
take they they look at the stakeholders part but not the public health part so the ministry of
#
ayush is not really working for the people of india it's working for these companies in the
#
ayush space i i definitely think so because if they would definitely going to be working for
#
public health and the people of india the italian ministry has blacklisted turmeric supplements
#
they have actually told people who sell turmeric supplements in italy to put a black level warning
#
because turmeric causes a lot of liver injury and bleeding manifestation so there is going to be
#
black level warning for turmeric supplements they are doing it there is evidence to it a lot of work
#
has been done a lot of publications has come out why isn't the ayush ministry doing it already
#
another i mean italian government is not like you know they don't do it without any reason they
#
have actually have reasons for it so if they are doing it why not ayush ministry is not doing it
#
so that that definitely means that they are ignoring or evading health related truths from
#
the people so they're not working for the people hundred percent not and an important sort of point
#
to note here is that this is a systemic problem it is not as if there is some outlier bad company
#
has produced a bad medicine it is not like that at all it is a systemic problem within ayurveda
#
itself like when you point out that 70 to 80 percent of ayurveda medications have giloy
#
you know it is a systemic problem everybody is at risk what is the sort of quantum of cases
#
that that you see how bad is it so i mean if you look at from my practice i think it would be a
#
little bit of there will be a little bit of bias because there will be a referral bias there because
#
i am the only person who actually works actively on complement and alternative medicine we do a
#
lot of herbals and herbal related toxicology analysis also my department and my unit does that
#
so i get a lot of referrals from other hospitals and other people also i mean so i have a i see a
#
lot more patients than what other people may be seeing other other doctors may be seeing
#
even then during the covid time i used to see about five to six new cases a week of herbal
#
liver injury including homeopathy and siddha and everything and now it has come down to three i
#
mean last week i saw three patients with herbal and homeopathy liver injury which is actually
#
a lot because if you look at it per month it's somewhere around 12 cases 15 cases of patients
#
who should not have been patients in the first place this is just added disease burden added
#
health burden to the community you can just avoid all of it you can avoid all this resource
#
utilization all this financial burden from the patient some of them even land up in liver
#
transplant 20 to 25 lakhs so much of unnecessary spending on it and this this is this is that this
#
is just the tip of the iceberg that i see if every doctor in the periphery in every doctor in an
#
institute with a proper department to look into adverse drug reactions from complementary and
#
alternative medicines does this i think these numbers will be much much higher it'll be much
#
higher because if you look at data coming out from the u.s and as asia pacific per se the number one
#
cause of something known as acute and chronic liver failure that is already patients have stable
#
liver disease they have underlying pre-existing liver disease and suddenly they develop liver
#
failure the number one cause of such acute and chronic liver failure initially was anti-tuberculosis
#
drugs we have a lot of tb patients we treat them some of them develop tb related liver injury
#
anti-tb drugs related liver injury now it has the number one causes complement already medicine
#
in asia pacific so that that is there it is emerging so if actually if you look at it from
#
an indian perspective what i am seeing is just the tip of the iceberg there'll be much much more
#
cases yeah and i imagine most people who are just taking herbal supplements won't even identify it
#
as a cause of something you know they think they'll think it's it could be diet it could be genes it
#
could be whatever they won't even consider it the harmless looking pill that they take everyone
#
excludes it yeah like if you ask them are you taking any other medicines they'll say no because
#
they think these are just nutritional supplements or safe herbals they won't even consider this
#
medicine and the irony is one of the things that you pointed out in one of your articles or talks
#
is that you know that there are supplements which are sold in india as medical supplements but in
#
europe they are only allowed to be sold as food supplements yes yes here they can write ayurvedic
#
proprietary medicine on on the top of it in europe the same company writes food supplement same
#
product because they're not supposed to you cannot prescribe as a medicine there that is that is the
#
true regulatory policy here you can just write anything and sell i mean you can see that from
#
what patanjali has been doing they're bringing out advertisement after advertisement saying
#
that they can cure diabetes and cancer and writing you know diagrit and levogrit and
#
things like that when when none of that actually works and nobody's bothered no action has been
#
taken on them till now and this is really becoming a banana republic when it comes to public health
#
give me a sense of the ecosystem of these different alternative medicines like we discussed
#
earlier that there is an undersupply of doctors of proper medicine in india but what is the size of
#
the ecosystem of ayurveda doctors and ayurveda training institutes homeopathic doctors and
#
homeopathic training institutes what is their training like can any of their training possibly
#
be useful because if we have such a massive shortage of properly trained personnel maybe
#
you know paramedics from here or you could teach these guys nursing or they could be useful in
#
some way you know what's the scene give me a sense of that ecosystem so i mean exact numbers i'm not
#
sure but i think the largest numbers of homeopathy medical colleges is in maharashtra homeopathy and
#
the largest number of ayurveda colleges is in carolina karnataka and a lot of these students
#
actually opt for ayush is because they have tried multiple times to get into mpbs and they could not
#
or their ranks are on the lower side and that is why they opt for ayush this is because it's a
#
single exam and all of this comes in under the single exam if you split it like mbbs is one
#
exam and ayush is another exam i'm sure nobody will go there to give separate ayush exams to get
#
into ayush medical colleges i see right so it is very different so it's a single exam and based on
#
your rank you go for ayush or mbbs so if you split it a lot of things will change another thing is
#
that if you actually do a bachelor's in homeopathy or bachelor's in ayurveda in kerala you have a
#
reservation quota for mbbs sorry for example you have reservations right you have quotas for
#
obc's and things like that right so there is a reservation system for people who do alternative
#
medicine they can get a direct entry into mbbs next time so you're forced to take a certain
#
number of homeopathic students and a certain number of ayurveda students into your proper
#
mbbs course yeah so there is there is a reservation wow yeah and i think one of my i mean the the one
#
of my main clinical research associate that i worked with dr arif he was a homeopath he's an
#
ex-homeopath he studied i mean he practiced for almost 10 years homeopathy and left it because
#
he understood it is pseudoscience now he's doing very good clinical research in my in my unit
#
and he was telling me that there is a reservation system for alternative medicine so if you do a
#
bhms or bms if you give a neat exam next time you will have preference over another general
#
category student for getting into mbbs that is what makes people go for integrative medicine so
#
you do both mbbs and bhms or mbbs and bms and they practice worst of both and end up doing bad for
#
the patient so this integrative medicine thing is also coming up so we have a lot of medical colleges
#
i mean catering to and i mean i won't call them medical colleges but colleges catering to
#
ayurveda and homeopathy and even siddha and naturopathy also are courses that are coming up
#
and unani a lot of them now the biggest part of this is that after they complete their training
#
their training actually involves both so if you look at the curriculum in bms and bhms there are
#
modern medicine subjects in that you cannot learn anatomy and physiology from classical ayurvedic
#
texts because in classical ayurveda they say that heart is a single chamber with a lot of vessels
#
going around it like tentacles and supplying every part of the body i mean we know that william harvey
#
identified the real circulation and it is not like what is in ayurveda so you can't teach them that
#
ayurveda says i think there are more than 360 bones in the body according to ayurvedic this
#
thing which is wrong so what they do is they teach them proper physiology anatomy and biochemistry
#
and everything and surgical methods and everything and then they ask these students to go and treat
#
them the ayurvedic way so when you when i spoke to some of these ayurveda students who are
#
i won't i won't say harassing me but responding rather rudely to me on twitter
#
they are saying that you have only studied allopathy which is not right i mean i have
#
studied scientific medicine you have studied only scientific medicine but in ayurvedic course we
#
are studying both we're studying ayurveda and scientific medicine so we have best of both worlds
#
i mean see the wrong impressions that these students have they study actual modern medicine
#
their question papers actually have modern medicine questions like for example what is
#
migraine how do you treat migraine and the next question will be how do you treat unmada
#
you know in unmada in unmada is basically mania in in in ayurveda and and you should read that
#
chapter where they say that the patient should be put in a well and then scared with snakes
#
and dogs and all that and then beaten up and all that that is how it is written in
#
ayurveda treatment of mania we know that is not how you treat mania so you have a mix of both
#
so you you people are so confused students are so confused about what is right and what is wrong
#
what is wrong because the syllabus itself is completely wrong even in homeopathy they teach
#
homeopathic pharmacology which is that dilution thing but they teach proper disease conditions
#
for example they talk they learn about infections when homeopathy has no germ theory even ayurveda
#
has no germ theory but they talk about infections bacteria viruses fungi and then they ask them to
#
treat with this diluted stuff i mean it's so confusing for the student so the whole course
#
pattern itself is so wrong if they actually convert the whole thing into modern medicine
#
pattern i mean i think we would have more doctors to serve more patients instead of
#
these half big doctor i mean half big practitioners that come out of these courses
#
and and the whole thing thing about bridge courses now there's something that the government was
#
planning to do is that bms and bhms candidates can actually do some six months course in a private
#
or a public hospital and then start practice practicing as a general physician or an mbs level
#
graduate which is actually even worse because they don't know basics of pharmacology biochemistry
#
anatomy physiology properly to apply it in a patient population so that so converting them
#
directly into doctors is it's not a it's not a good thing second aspect is like what you said
#
we can actually have them as paramedical for example take them completely out of their practice
#
and teach them a particular paraclinical or a paramedical or a biomedical course and then make
#
them go into that that that's that's actually a brilliant thing to do a lot of these ayurveda and
#
homeopathy doctors also do to get out of their courses they actually do masters in hospital
#
administration and then they start doing entrepreneurship and things like that they don't
#
practice at all so i have a ayurveda graduate who's working with me now in my clinical research
#
department i have a homeopath and ayurveda practitioner and she's actually fully into
#
clinical research work she stopped her practice now and now they are doing a course on bioethics
#
and all that so they are they are doing additional courses and trying to get into the you know
#
administrative in clinical research part of real clinical medicine so that that can be done but
#
directly making them in charge of treating actual real patient force with a small bridge course
#
i don't think it works because it took me 15 to 16 years to finish my medicine and then
#
another five years to actually understand how to deal with patients so how do how how can somebody
#
just do a bridge course in six months and become a doctor suddenly after passing homeopathy in
#
ayurveda so that that conversion also should be practical and it has to be either clinical research
#
based research associate based hospital administration paramedical paraclinical or biomedical that
#
actually helps yeah i mean a couple of things strikes me one is that i can't imagine as a
#
student what kind of dissonance i would have being taught a theory that is modern in terms of germ
#
theory and all that but being taught that the way to treat it is by diluting something a million
#
times or whatever i mean what does that dissonance do to you how can you live with that no i think
#
that dissonance is what makes them very aggressive yeah towards real doctors and scientists because
#
i mean somebody is telling them that you know everything that you have studied and been
#
practicing is actually fraudulent i mean i i think then that dissonance come into play and that is
#
when they get aggressive and that is what happens with when you argue with homeopaths and ayurveda
#
they always find a way to do business a new thing that i have seen is that a lot of these
#
ayurveda graduates what they do is they have now started on full on on instagram instagram has now
#
become a cesspool of alternative medicine practitioners wow cesspool a lot of ayurveda
#
practitioners start giving out nutritional advice and a lot of things like that and people just fall
#
for it i mean people love such general generalized stuff right generic stuff nutrition and how to
#
take care of your hair how to grow your fingers longer and what they do is along with that they'll
#
slowly start a supplements selling industry so you'll have another page of theirs where they
#
will be selling some supplements and this has now become the new stuff that these ayurveda and
#
homeopath practitioners do homeopaths do something additional so they'll have their clinic and attach
#
the clinic they will have a medical shop a pharmacy shop you just need a single license
#
a medical license i mean pharmaceutical license to sell both types of drugs as per the current
#
rule so they'll have modern medicines and also homeopathic medicines in that and what is going
#
to be selling is all modern medicines so they'll be sitting in their homeopathic clinic and prescribing
#
modern medicines which the patients will be taking so this is another trend that is coming up i mean
#
it's it's nothing they have studied at all it's just messed up completely messed up and social
#
media is just adding fuel to the fire one example of what they offer to do which you just gave was
#
how to make your fingers longer what's that no i'm just giving you i thought this is actually
#
something like that no there are there are there are homeopaths doing videos saying are you suffering
#
from excessive flatulence then i'll then they'll tell us how to reduce flatulence i mean some
#
nonsense stuff how to drink tea the right way wow yeah i mean there is a guy in kerala a homeopath
#
he does not disclose himself as a homeopath because if he does that then his viewership will fall so
#
he calls himself as dr rajesh kumar and he has a huge youtube channel more than a million followers
#
and he does this stuff how to drink your tea properly how to drink your coffee properly
#
how to sit properly how to stand properly how to drink water properly stuff like that and on the
#
side he'll be slowly in between he'll be selling his homeopathy stuff we do apologies to my
#
listeners this is one thing i won't be linking to in the show notes because out of principle
#
i'm simply not going to link to any quacks what you said earlier about the process of these kids
#
getting into the ayurveda colleges or the homeopathy colleges really interests me you said
#
they give they give a single mbb exam and because they can't get into a proper medical college
#
they end up going for these and therefore it strikes me that then the fundamental core problem
#
here is an under supply of medical education because what i would rather have is many more
#
medical colleges fine maybe these people came at the bottom of the exam and you feel they aren't
#
smart or whatever which is not always the case because even passing an exam is a particular
#
skill often you have the privilege to learn how to pass an exam which many don't but the point is
#
i'm a living example i was never a brilliant student in my entrance exams i mean i just i
#
just got through i i i got through in second attempt third attempt and all that yeah i mean
#
ranks don't matter at all everybody is a brilliant student given the opportunity yeah and in the end
#
you got so many awards like from one of your bios i'm just going to read this bit out since
#
you mentioned it i know you're modest and you won't want me to do this but i'll read it out
#
anyway because i was so impressed quote he was awarded the gold medal for academic excellence
#
in hepatology by the honorable president of india shri pranam mukherjee during the institute of
#
liver and biliary science's convocation and foundation day ceremony held 14th of january
#
blah blah date date and has won the prestigious american association for study of liver disease
#
consecutively in the year 2015 2016 and 2017 and was given honorary trainee membership to the
#
american association for blah blah it goes on and on so you know that that also impressed me that
#
you mentioned about how you had trouble getting into all of these but then you're excelling then
#
you're doing 165 papers you know which means you can give anybody a chance and a hundred percent
#
i mean i see on twitter i mean mbps students and talking about how they did not get through neat
#
they have a very low score and they feel depressed i said absolutely not i mean if you want to bag a
#
postgraduate seat get in any college that you want because ultimately it depends on how you
#
carry yourself forward you know if you are interested in something you have passion for
#
something your ranks don't matter at all you can excel and every student is a brilliant student
#
there is no poor student bad student i hate such terms every student is brilliant given the right
#
opportunity or given them or or if they have that knack of taking opportunities and is this an
#
and is this an artificial scarcity in the sense of scarcity of medical colleges or medical training
#
i really think so i mean we we have a lot of mbps seats probably but we don't have
#
much of specialty and super speciality training seats it's very very less so there is a lot of
#
stagnation and because of the stagnation a lot of lot of postgraduate seats i mean we are not
#
getting enough post graduates coming out properly and then there is a lot of brain drain a lot of
#
mbps people people going out more and more students are again coming into the competitive
#
exams every year and that is where a lot of them get fizzled out and they go into these ayush
#
related streams another aspect is that not just the lack of infrastructure and seats or
#
lack of medical seats there are some ayush there are some students who really want to do ayurveda
#
or homeopathy and that is because of legacy so there are these big ayurveda based families in
#
kerala and karnataka and tamil nadu and all they have a legacy they are like sixth and seventh
#
generation of ayurveda practitioner they'll have a business to run and all that so based on that
#
some of them actually opt for ayurveda and homeopathy to run their business otherwise i
#
don't think any sane-minded student will actually want to do ayush related make ayush as one of the
#
career options for themselves i don't think so so this is one possible bottleneck that there isn't
#
enough supply of doctors because there aren't enough medical colleges if they were like double
#
the number of medical colleges you have double the number of medical students and you know i
#
mean in an ideal world you would train everyone who wanted to be trained in medicine you train
#
them in medicine but it is what it is is it is another reason for why alternative for why
#
quackery continues to thrive is another reason that per capita they simply aren't enough trained
#
doctors so if you're living in a rural area you're living in a village there's no doctor in your
#
village what do you do you got to go to someone so is is is that also a reason because working in
#
a peripheral setup in a rural area i mean doctors don't want to do that now in india because i mean
#
it's it's it's quite poor i think except maybe few states or maybe few regions in some states
#
the rural practice is not a dream practice for a lot of doctors because see one is they struggle
#
to get into mpbs two is they struggle to get out of mpbs three is they struggle to get into
#
post-graduation and if you want them to go work in a rural setup for peanuts nobody's going to do
#
it with basic setup they actually want to work to the best extent for for the patient for example
#
if i go sit in a rural primary health care center what am i going to do because i i am i am trained
#
to manage patients who have undergone post who have undergone transplants i mean i'm trained to
#
manage patients who are critically ill in the icu critically ill cirrhosis management also i've
#
been trained if i go sit in a phc fever patients will come arthritis patients will come or if a
#
liver patient actually comes i won't be able to do anything much for them i'll have to refer them
#
to some other place so the the kind of work that i'm trained in and the kind of work output that
#
i'm going to do in a rural setup is completely mismatched otherwise government should make sure
#
that post mpbs or family medicine doctors are there md family medicine which are very good
#
very good category of doctors that we can actually promote to take care of the rural and
#
you know suburban area as well they should actually improve conditions and infrastructure
#
for them to actually work and improve patient care in these areas so it's not like a super
#
specialist has to go and work there you can actually have these group of doctors who are
#
trained to work in such situations go and work there but even that is not happening here
#
that is why patients in those areas they mostly go and get you know treatments from alternative
#
medicine practitioners and the best part is most of the alternate medicine practitioners who go
#
work there they prescribe modern medicines yeah they don't they don't prescribe their their kind
#
of practice there and that actually harms the patient more you know they just maybe prescribe
#
antibiotics for a viral infection which then antibiotics should be used for a bacterial
#
infection and they prescribe unnecessary painkillers and they the patients land up in more trouble
#
so you know you spoke earlier about you know a member of your team who was who felt so harassed
#
that he relocated to the UAE you know we've chatted about you've chatted about all the
#
different cases filed against you both by the ministry of Ayush and by so and so private
#
companies how you were almost physically attacked all of that equally even i remember when i wrote
#
my piece in fact a lot of the online trolling for that quite apart from the ministry of Ayush
#
complaint was actually not from Ayurveda people it was all from homeopaths and all of that
#
homeopaths and very vociferous very abusive it was just horrible and although i have gotten
#
mobbed often by all kinds of people and they're all horrible so my question is this that what is
#
the environment for the scientific temperament in india because when we look back to our past
#
as an independent nation you know i often keep talking about how you had a bunch of elites who
#
were ruling the country who tried to rule it in a top-down way and they thought they can spread
#
their values in a top-down way the liberal liberal tolerant values and they couldn't quite manage
#
and we are seeing that today that in a sense politics has caught up with society and equally
#
i worry that we talk of scientific temperament we talk of setting up iit's and all of that which
#
are great achievements in in their domains but the scientific temperament is not something
#
widespread at all and i am not optimistic when i look around me when i look at the kind of
#
harassment that you have to deal with when i look at when you tell me the story of your team member
#
having to relocate to leave the country because of harassment it doesn't make me very optimistic
#
so give me a sense of you know what is the environment what gives you hope do you think
#
that there is progress happening you know do you think you know where do you see that progress
#
coming from you know is there light at the end of a tunnel or is it the torch of a serial killer
#
what's what's so you add on to that part where my colleague actually left the country so i i have
#
another pathologist senior pathologist working for me now but if you look at my papers published
#
recently on ayurveda and homeopathy and all you won't see a pathologist name in that oh wow because
#
that senior pathologist has specifically asked me not to put her name because she would don't she
#
does not want the harassment to happen to her so that that part is also there so if you see the
#
last three or four papers we have published in ayurveda and homeopathy there is no pathologist name in that
#
it's quite sad yeah so that that was an extra point yeah so coming to this aspect of scientific
#
temperament you know i don't think i mean we should just talk about or blame the common person or the
#
lay person about lack of scientific temperament this is deeply deeply ingrained even in the doctor
#
community the lack of scientific temperament for example when i spoke about when i speak about
#
turmeric or ayurvedic product or homeopathy product or being not useful apart from the
#
common people who actually come with defenses or harassment towards me i was shocked to see i mean
#
first time i'm seeing that shocked to see oncologists cardiologists cellular biologists and all attacking
#
me on my statements so i was wondering what is wrong with them because i'm talking about an
#
alternative medicine practice and these guys are all properly trained scientists or clinical
#
clinicians and they still have a problem with it and you're giving links to the research and everything
#
absolutely complete evidence-based i mean i'm quoting published data also but they are just
#
so aggressive and some of them actually talk about testimonials there is this one one guy who is a
#
cancer surgeon who's telling that you know he used homeopathy in ayurveda and his some skin disease
#
went away i mean he's a cancer surgeon for god's sake i mean that's like one of the highest levels
#
of medical medical science that he can do and these are the people who are you know defending
#
an alternative medicine industry so i think the scientific temperament does not mean that you know
#
you're just trained in science or you're educated and you have an md degree or an ms degree or a
#
dm degree it means that you are able to think rationally and logically without any obstacles
#
from your traditional religious or cultural values you know you you need to you need to have that
#
power to separate both like i never talk about religion or i never quote religion or cultural
#
matters or anything i never even discuss that stuff when i talk about health care i know how
#
to differentiate both and i keep it separately it's different i i don't want to impose anything on
#
anybody from those those aspects but these doctors when they they are actual doctors they're not even
#
practice that's why i'm saying doctors these doctors when they actually come to defend
#
ayurveda or homeopathy they quote traditional cultural religious stuff not scientific stuff
#
just like a lay person talking and this is what is important because even though they are trained
#
in medical science the they have a lack of their incompetent in in the distribution between
#
what scientific evidence is and what unscientific aspects of whatever we are talking about is
#
and a lot of them don't even realize the real principles of homeopathy or real principles
#
of ayurveda that's where they come to defense they have not read about ayurveda homeopathy i
#
have read all the textbooks in ayurveda homeopathy my i have two sections in my room one is full of
#
graphic novels the other section is full of pseudoscience literature top to bottom and i
#
have read everything and it's all fiction yeah it's better than fiction i mean that's the actual
#
graphic novel sector yeah exactly yeah and and if they actually made some effort they would
#
definitely understand but they won't i mean like i said there are a lot of there are multiple levels
#
of obstacles in their thinking and scientific temperament is something that i think that should
#
be taught from the school level and also once you enter the college also i mean for example now
#
everything is going upside down for example like you asked me is there any hope if you asked me
#
today i would say things are really bad because what they're doing is they are now mixing ayush
#
related stuff into mbbs curriculum just yesterday an mbbs student forwarded me a question paper
#
which was asked during their first terminal exam and it had a question saying that provide
#
the physiology aspects of yoga in cardiac and cardiac physiology and something something i mean
#
come on that's not a question that you should be asking an mbbs student i mean yoga aspects of
#
cardiac physiology and all if yoga is something that is very close to indians just like turmeric
#
and when i say that yoga is a pseudoscience most of the people don't agree with me because they
#
don't know what yoga principles actually are yoga principles are actually pseudoscientific
#
principles the bindu and the chakras everything are imaginary stuff and when when when such
#
questions are being included in a proper question paper students will realize that i mean students
#
will erroneously realize that you know okay these are also maybe important stuff and they actually
#
will have you know i won't say best of both worlds but they'll learn about ayush and they'll learn
#
about modern medicine also and same thing is happening to ayush candidates now they are
#
learning modern medicine and their textbooks in detail but that's that slight percolation of
#
pseudoscientific teaching is now slowly coming into our proper mainstream literature mainstream
#
teaching also this is not a good sign at all because i have no idea where this is going to
#
end because you are going to have a lot of half big bitter students coming out of these colleges
#
and when you talk to them about ayurveda or homeopathy or yoga they will exactly behave like
#
the homeopaths are behaving now and they're supposed to be the real doctors who only take
#
care of our public health so if you if i look stand from today's point of view i think future
#
of india needs to change rapidly and some somebody somebody has to bring that change in somehow
#
it's not good looking just enlighten me on this so are you saying that mbbs syllabi is now being
#
changed to bring in these aspects under pressure from the ayush ministry yes i mean they already
#
have internship in ayush now okay like when i did internship i had an option of radiology forensic
#
medicine community medicine and things like that now they have an option of ayurveda yoga unani
#
siddha homeopathy homeopathy is an option for them to spend a week i mean spending one second in
#
homeopathy is a waste of time they have it's worse than a waste of time it could set you
#
backwards it could confuse you yeah exactly so and they have a whole week of posting there
#
and now slowly and steadily their papers are also getting question papers are also getting
#
included with ayush related practices and this is absolute nonsense and this is not the way you
#
teach medicine to students so about 20 minutes ago i was beginning to feel a little optimistic
#
because i thought part of the problem is solving the question of access that there are students
#
who want medical education you give them more medical colleges and less of them will go for
#
these and equally there are patients who have they had access to proper doctors would not
#
go for this quackery but what you're pointing to now is that the problem is more deep rooted
#
than that even people who have studied the science even people who you know cancer oncologists will
#
also you know find something in this which is which is kind of scary so what you know in your
#
small way you you fight every single day against this kind of misinformation and against this kind
#
of bad science as it were and and you're carrying on the good fight but in general how do you feel
#
civil society can counter this because a counter is not going to come from a ministry the counter is
#
not really going to come from even our medical colleges if our you know mbbs syllabi is dictated
#
in this way the counter may not even come from the scientific community per se if many of them
#
believe this but if determined people within civil society say that look we got to solve this problem
#
we got to do something about it you know what are the possible ways in which we can so one thing
#
that i have noted is that when i started this started talking about science and pseudoscience
#
about maybe three years back i used to always get i mean the majority of the responses that you used
#
to get were either abuses harassment or troll i never used to have any positive stuff regarding
#
what i was tweeting at that time but now when i look at if you look at the tweets and the responses
#
you will see that a lot of common people a lot of you know engineers and computer engineers and you
#
know lawyers and police officers i mean people who are have no idea about the medical field
#
completely non-medicals they come in support of scientific medicine they come in support of my
#
statements and this is something brilliant that i have seen so the whole aspect is to change
#
the mindset of the general people that actually will change the choices that they will they will
#
make for their children so for example if maybe about five six years back if somebody says that
#
you know i do not get into mpbs what should i do daddy and mommy what what should i do they'll
#
shall i take homeopathy or ayurveda they'll say yeah take it because you'll become a doctor anyway
#
so you take it so that is that was the thought process at the time but now if we keep on talking
#
about science and pseudoscience and how only scientific medicine and a science-based approach
#
can improve the community and a nation and people actually imbibe that if that question comes again
#
so one of these kids of one of these people who are now scientifically enlightened if they ask
#
shall i take homeopathy they'll say no don't take homeopathy go for veterinary medicine or go for
#
biomedical science go for physics or biochemistry those are scientific streams you don't have to
#
become a doctor to contribute scientifically to the community there are so many other options
#
so they will start looking for those options and that way when the demand comes down
#
i think slowly and steadily our community will become better from a scientific temperament
#
point of view so i i don't think there is any point in trying to modulate or you know influence
#
politicians or the ministry or even these institutions because all of these institutions
#
are now i mean they are they are completely under the control of whatever this governance
#
wants them to a classical example is it's very it's quite sad nimhans in bangalore
#
has a separate wing for ayurveda and yoga completely so a colleague of mine actually
#
went there to show some a doctor a neurologist and everybody who goes in there has to go through an
#
ayurveda and a yoga and a yoga practitioner also like it's become mandatory he was telling me he was
#
examined by the neurologist and everything he wrote some tests and he wrote some medications
#
and he asked them to go to the next room so he went to the next room and there is an ayurveda guy
#
sitting there and he's asking them questions and asking him yeah telling them stuff to do and things
#
like that so that has become integrated now what questions did the ayurveda guy ask you about his
#
diet and i mean he did not tell me in detail but about diet and sleep and how his dosas were not
#
right and things like that and then the yoga guy prescribed him some yoga posters and things like
#
that for his brain disease and things like that complete nonsense it's become totally integrated
#
now into the main mainstream so these things are happening in the main institutes and i think a lot
#
of money is also being pumped into these institutes for ayush related research a lot of it and instead
#
of really doing proper research ayush based research is now become a big deal in most of
#
the central institutes even iit they're all doing a lot of work for ayush csir is doing a lot of
#
product development for ayush aims is doing active ayush so i was i was visiting aims in bhubaneswar
#
they were actually doing a study on constipation and yoga intervention come on you just take a
#
dulcolax your constipation is gone what do you need yoga for that or treat the cause of constipation
#
maybe it's hypothyroidism you treat for thyroid disease your constipation is gone instead of that
#
they're making patients do all these asanas and all that and seeing if constipation gets relieved
#
what a waste of time and money all this is happening in central institutes now which is
#
quite sad yeah and it also you know you get this rhetoric from both homeopaths and ayurvedic people
#
saying that hey allopaths treat only the symptoms we treat the root cause wait a minute those people
#
can't even know the root cause because their whole foundation is so demonstrably crazy like in the
#
wonderful video you did with krishi shok you also pointed out about other aspects of ayurveda which
#
are demonstrably false like you know quite apart from vata pitta kafa having no basis in science
#
they will also talk about categories of hot and cold food which make no sense and they will say
#
honey and ghee can't be eaten together you'll die you know i have used honey and ghee together
#
milk and curd and fish curd and fish can't be used together
#
and and we don't we don't kind of question it which is sort of nuts no but you know one important
#
thing that and i'm thinking aloud here from what you said is that it's heartening that more and
#
more people speak up with you and i wish more and more people do this because what i have realized
#
is that it'll spread through society when good people are silent and too often we find this
#
we'll go online and too often i'll agree with someone on twitter but i'll think to myself that
#
hey if i actually comment i'll you know people will mob me i'll get into trouble we we stop
#
ourselves like that and i would just like to request everyone listening to this that one of
#
course you got to follow abby on twitter but every time he puts out a tweet that you agree with
#
amplify it either comment or uh retweet it and you know good people should not be silent when
#
there is so much at stake this is a this is a health issue for god's sake you know it's
#
when there is so much at stake so you know you've given me a lot of your time and
#
i want to thank you for that but before i do i'm going to ask you for a little bit more of your
#
time because my tradition at the end of my episodes is to ask my guests for recommendations of what
#
kind of uh books music films they really enjoy and would want to share with the world and uh and
#
i'm going to start with graphic novels because you're a fan of them as and my so i'm very keen
#
to know what you'd recommend that we read yes so graphic novel wise i'm not sure if everybody's
#
cup of tea but one that is very close to my i mean i just love reading it again and again is
#
something called as blankets it's by craig thompson beautiful book wonderful book just it's just
#
brilliant i mean i mean i can't explain it's it's so nice it's so soothing the second one would be
#
i'm not sure if people have read this it's all rosalie lightning it's by tom hart it's about a
#
parent to i mean a couple losing their child to sudden death syndrome and i mean i mean the i mean
#
the listeners would think that i am such a depressed i mean depressive tragic kind of guy
#
because a lot of books that i read are a lot to do with a lot of tragedies i think that's partly
#
because i've been molded that way my mind is molded that way because the kind of patience i see and
#
the kind of work that i do every day i try to look for bittersweet things in in you know in real
#
tragedy so these books stick with me and another book that i i love is it's supposedly a children's
#
book but i think it's it's it's more than that i'm not sure if you've heard of it it's called robot
#
dreams robot dreams is about losing something and then finding it but then still having that
#
lingering feeling that you have lost it wow right so that happens with me and my patients
#
when i see a patient who is supposed to actually die and you know he improves
#
and then i don't know what goes on you cannot actually you know you cannot actually predict
#
anything when it comes to health that is one part of medical science that you know you're
#
nobody to speak on what is going to happen to you or what is going to happen to your patients you
#
cannot you can never predict it so patients who actually improve and then suddenly you lose them
#
for example i've had patients who have fought severe liver disease came out of it
#
doing so well and then six months later eight months later they come with a severe bleed so
#
we call it as a varicell bleed that is when it happens in cirrhosis where you have large vessels
#
in the foot pipe and they burst because your liver is cirrhotic and you you vomit blood and
#
exsanguinate and die and some of them come with such torrential bleed you cannot you can't do
#
anything because when you do an endoscopy you just see a blood field you can't even identify
#
the source to control it and they die in front of you and they were doing so well and you suddenly
#
lose them and and it's like that you know you you you won the battle but then you you lost it at the
#
end but that feeling of winning is there but then you have lost it also right so these books actually
#
give me that kind of sense that is why i love these books and i keep them very close to me
#
and another book that i would recommend is mouse brilliant yeah mouse is a book that
#
it strikes hart spiegelman yeah hart spiegelman's book just strikes and another would be just to be
#
off track there is a book called bone yeah it is a large series it's very cartoonish but my god
#
that's like a really mature book it has so many sub stories in it and it's brilliant i love that
#
book bone and then i would say from a literature point of view a graphic novel that is very close
#
to me and i just love it is v for vendetta just brilliant i mean these are the graphic novels
#
that i love i have a lot of marvel and dc comics but i won't mention them here because they're
#
just entertainment value but these are some serious books that i i relate to in in my practice i mean
#
in my my profession and career because they're all bittersweet and tragic at the same time
#
so these are the books that i love movies one movie that is very very i mean something that
#
changed i i never knew that movies can affect you i mean this is the movie that actually
#
when i actually saw it i had this feeling that i mean movies you see for entertainment you know
#
you don't get affected by you know that is how it was all the while but this movie started affecting
#
me and this is when i said that movies are so powerful that it can it can challenge your
#
you know emotions cinema paradiso is a movie that i just love it is so fantastic and on the same
#
lines so many movies are there which i love but i mean i cannot i mean give i mean make a huge list
#
out here so i'm just thinking the the good ones that i've seen tell me whatever comes to mind
#
yeah so there is this movie i don't think everybody would have seen it there is a movie called tiger
#
tail it runs on netflix it's a fantastic movie about love and loss i love it tiger tail and
#
there is this movie called the town which stars ben afleck it's an action movie but it ends so
#
differently which is why i love that movie the town and then i would i mean i i don't like these
#
mainstream kind of trilogies and movies i don't i don't like them then something i just watch
#
without you know like a brainless watch is korean movies i love korean movies so one korean movie i
#
love is there is this movie called i saw the devil i don't think everybody should see it because it's
#
really crazy now that you said that everybody will rush to see that only i certainly will oh my god
#
i mean it's violent and it's brilliant i mean korean movies are inherently very violent so i
#
saw the devil is one movie i love then there is a new korean movie that i recently saw called the
#
called the round up brilliant action movie i love it there is a movie called memories of murder
#
brilliant korean movie fantastic memories of murder and if you ask me a series that i loved
#
there are two of them one is the series called then the night off it's a brilliant series it's
#
on hotstar i think everybody should watch it the night off and there is this series called true
#
detective season one that's superb wow mind-blowing so these are the ones that directly come to my
#
mind so when it comes to music i am very old school i love the 70s and 80s music so i am
#
completely into pink floyd def leppard metallica so basically i love the power ballads no i don't
#
like the heavy metal part i love power ballads and i would i love soft rock and rock ballads
#
so i have i love a lot of bon jovi i love man o war i'm not i'm not sure if people have heard
#
about all this i love this group called sabotage they have a they have a song called sleep i'm
#
telling you if you if you listen to that you will definitely slip off it is so soothing it's one of
#
the best songs i've heard sabotage sleep by sabotage and another movie another another song
#
that is that i i really love is songs by police sting and the police i love their songs and then
#
you know the classic cindy loper you know the classic 70s and 80s is i mean i i i can't imagine
#
songs better than 70s and 80s anymore i mean the ones you hear now nine i mean i think they're all
#
trash i'm sorry i guess we are too old i mean the only good band that i i like hearing now is i
#
think imagine dragons i love them they have got good songs but i i think i'm too old to actually
#
comment on new songs i love the 70s and 80s yeah very nostalgic yeah so finally congratulations
#
you have a book deal coming i know you don't want to divulge too many details which is perfectly
#
fine but tell me about this how has how have you fit writing the book into your sort of schedules
#
and anything that you wish to that you're okay with divulging about it is good for us yeah so
#
i mean this book project the book deal that has come to me was it's completely out of i mean it
#
was surprising and i was not expecting it i mean i always wanted to write a book because i love
#
writing literature especially medical literature but i never expected this to come so soon and
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this this actually happened because the a type of tweet that i do i have a long form tutorial
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where i talk about a particular patient case and how we came to a diagnosis of that patient through
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you know it's a kind of storytelling mode that i do on twitter it's a like a long thread form
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and i think i i did about 20 of those long thread forms which i have collected in my on my profile
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in twitter and i think i i got a lot of good response from my followers and friends on that
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and i got two or three offers from various publishers asking me if i would like to make
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this kind of work into a proper book which will actually look into you know hepatology person
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because as my handling publisher i mean the editor told me you know you have books on brain
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you have books on heart you have books on gut you know they all sound so sexy but we have no books
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on the liver so and the liver aspect of patient management and care is much more intense than
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what we actually see in in the other books and so this has to be there so they said that you know
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they said that you have to write a book on it and it has to be on hepatology based purely on your
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patient care and you know patient related stories and through those stories you will teach the
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common man what hepatology is and how the practice of hepatology is hepatology is from the past to
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the present so this is a huge project so i i think probably i'll i'm going to look at 1.25
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lakh words about 400 pages and hopefully i'll finish it in the right time maybe within a year
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and i currently what i'm doing is when i when i have a mood for writing that kind of
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you know stuff i do that and there is no timing to that so if i'm sitting in the opd and i get an
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idea about one particular section i just make a note on it and then i go back home and i write
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that paragraph or if i'm sitting at home and i i get some ideas on it and my kids are asleep
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and everybody everything is settled i spend some time alone maybe an hour or half possibly two or
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three days a week and then keep writing so i've not fully started on it yet but i have started
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and probably i have completed 16 pages or 400 pages wonderful i can't wait to read it i feel
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that it will be an important book and you know i i feel you do important work so thank you so
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much for taking so much time and you know sharing your insights with me it's been such a pleasure
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yeah thank you for having me i was i was very glad that i could do this with you
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and open up the way i did with you because you gave me this opportunity thank you so much thank you
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if you enjoyed listening to this episode please share it as widely as possible
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this is an important subject check out the show notes enter abbitholes at will
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you can follow abbie on twitter at the liver doctor that's t h e l i v e r d r i'll link it
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from the show notes all relevant links to him and his work will be there in the show notes
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you can follow me on twitter adamit varma a m i t b a r m a and you can browse past episodes of
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the scene and the unseen at scene unseen dot i n thank you for listening did you enjoy this episode
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of the scene and the unseen if so would you like to support the production of the show you can go
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over to scene unseen dot i n slash support and contribute any amount you like to keep this
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podcast alive and kicking thank you you
