My journey with the Pride movement began with a single word in a Malayalam newspaper: Swavargarathi (homosexual relation). As a heterosexual, it was not easy for me to understand its human weight. To my teenage mind, it was just a punchline for schoolyard jokes. We used unparliamentary language to tease each other, oblivious to the sting those words carried or the reality of the lives we were mocking. We were participating in a culture of ridicule because we simply didn’t know any better.

By 2015, I joined the digital trend of adding a rainbow filter to my Facebook profile. At the time, it was largely performative. I wanted to “appear cool,” but I lacked the depth of understanding to back up the symbol. I was signaling solidarity for a movement I hadn’t yet truly felt or understood.

The real shift began during my medical training. Completing my MBBS opened the door to the concept of human autonomy, the idea that if two consenting individuals care for each other, it is not my place to judge. But it was during my MD in Pediatrics and my DM in Medical Genetics that the rainbow stopped being a social filter and became a biological reality.

When I delved into the complexities of endocrinology and genetics, the world became much clearer. I began to see how the intricate dance of DNA and the precise signaling of hormones during development work together to shape who we are. Our sexuality isn’t a choice picked up from a YouTube video; it is rooted in the very blueprint of our being.

I often use a cricket analogy to explain this. In any team, you have a majority of right-handed players and a few who are natural left-handers. Being left-handed isn’t a choice, nor can a right-handed child be influenced into becoming a southpaw. It is just a natural variation. Yet, the most alarming myth I still encounter, even among educated circles in Clubhouse debates, is the fear of “conversion.” Many parents believe exposure to the movement can change the sexual orientation of their children. To a scientist, this is as illogical as believing you can change someone’s blood group through conversation.

The weight of this prejudice is also unevenly distributed. Gay men are often targeted with much more vitriol than lesbians or bisexuals. When a member of the LGBTQ+ community makes a mistake, society unfairly blames their entire identity. This is a burden of representation that heterosexuals never have to carry. Through my friends who are gay, lesbian, and bisexual, I’ve seen that they are as normal or abnormal as anyone else. They have the same ambitions and the same desire for a life of dignity.

The noise of social media, with its confusing terminology and performative influencers, can make it hard to find the truth. But we need to step back and look at the bigger picture of human history. We have given autocrats a chance to rule; we have celebrated rulers who sparked world wars; we have cheered for politicians who thrive on the poison of caste politics. We have historically placed our bets on hate and power, often with disastrous results.

So, why not try something different? Let us give one chance to love. Let us stop treating human variation as a threat and start treating it as a fact of our shared biology. If we finally choose empathy over prejudice, I am sure you will be pleasantly surprised by the world we build.

Modern medicine has a peculiar humility. It speaks in probabilities and acknowledges uncertainty. It accepts that many conditions require long-term management rather than instant cures. Social media healthcare, however, thrives on instant relief and certainty. The negative hooks in the video keep you engaged. Few spaces demonstrate this contrast more starkly than the rise of Instagram chiropractors in India.

Short videos showing loud spinal cracks, dramatic patient reactions, and bold claims of instant relief now reach millions. Neck pain, low back pain, headaches, ankylosing spondylitis, cerebral palsy, gastrointestinal complaints, and even animal ailments are presented as problems that can be rapidly “corrected” through joint adjustments. The visual language is powerful. The scientific foundation, unfortunately, is not. It is unpleasantly surprising to see how quickly centuries of anatomy, neurology, immunology, and rheumatology become unnecessary once the camera is turned on.

Critical appraisal

Chiropractic care traces its roots to ancient civilizations, including Chinese texts from 2700 B.C. and Hippocratic writings around 1500 B.C. In 1895, Daniel David Palmer formalized modern chiropractic in Davenport by adjusting Harvey Lillard’s spine, claiming to restore his hearing through subluxation correction. Palmer opened the Palmer School of Chiropractic in 1897, and he claimed that misaligned vertebrae disrupt nerve flow and cause disease. His son, Bartlett Joshua Palmer, advanced the field with aggressive promotion in the early 1900s. Early practitioners faced arrests for unlicensed medical practice, sparking legal battles that led to state licensing by the 1970s.

When evaluated through the lens of evidence-based medicine, chiropractic care occupies a very narrow clinical space. Systematic reviews consistently show that spinal manipulation may offer modest short-term relief for acute, non-specific mechanical low back pain and to mild mechanical neck pain. Even here, outcomes are comparable to physiotherapy, supervised exercise, or standard conservative care. Chiropractic is not superior or disease-modifying.

Beyond this limited musculoskeletal domain, the evidence rapidly collapses. There is no credible scientific support for chiropractic treatment of neurological disorders, inflammatory spinal diseases such as ankylosing spondylitis, migraine, cerebral palsy, gastrointestinal symptoms, or systemic illnesses. The traditional chiropractic doctrine that spinal “subluxations” disrupt nerve flow and cause disease lacks biological plausibility and has been rejected by mainstream medicine. Yet it remains alive and well on social media, where simplicity travels faster than accuracy. If spinal adjustments corrected inflammatory disease or brain injury, rheumatologists and neurologists would have noticed by now.

Instant transformation illusion

Social media chiropractic relies heavily on a familiar formula. A complex, chronic condition is reduced to a mechanical explanation. A single adjustment is performed. A sensory event, often a joint cavitation sound, is captured on camera. Immediate relief is declared, and the story ends there.

What is omitted is more important than what is shown. Pain is variable, and symptoms fluctuate. Regression to the mean is a well-described phenomenon. Placebo responses, expectation effects, and short-term neuromuscular relaxation can all create transient improvement. However, none of these equate to disease treatment or long-term benefit.

The extension of chiropractic adjustments to animals on social media marks a new low in scientific credibility. Veterinary chiropractic exists only as a controversial adjunct in some settings and is typically performed under veterinary oversight. The research base is extremely limited, largely observational, and far from conclusive. Animals cannot consent, cannot describe symptoms, and cannot provide objective outcome measures. Their inclusion in viral videos serves a single purpose, that is amplifying perceived authenticity.

Regulation, or the lack of it, in India

Perhaps the most concerning aspect of this phenomenon is the regulatory vacuum in which it operates. India has no statutory regulatory body for chiropractic practice. Chiropractic is not recognized as a distinct medical profession by the Ministry of Health and Family Welfare or the National Medical Commission (NMC). There is no chiropractic council, no licensing authority, and no standardized accountability mechanism. Unlike medical practitioners regulated by the National Medical Commission or allied health professionals governed by recognized councils, chiropractors in India operate in a legal grey zone.

Foreign chiropractic degrees, including those from the United States, do not confer the legal right to practice medicine in India. There is no Indian licensing examination for chiropractors, nor any formal recognition of chiropractic as a regulated healthcare profession. In such a setting, claims of clinical authority are not merely exaggerated; they are structurally unsupported.

The use of the “Dr” prefix further compounds public confusion. In an unregulated field, this prefix carries disproportionate persuasive power. This is not a trivial semantic issue. It directly influences patient decision-making, often diverting vulnerable individuals away from appropriate medical care.

Exploiting vulnerability

Chronic pain sufferers, parents of children with neurodevelopmental disorders, patients with inflammatory diseases, and pet owners facing limited treatment options share a common vulnerability. They are searching for hope. Offering fast, definitive solutions to these populations without solid evidence is not optimism. Rather, an exploitation disguised as confidence. Real medicine admits its limits. It discusses risk and refuses unsuitable cases. These qualities do not trend well online.

Instagram chiropractic in India is not merely an alternative therapy gaining popularity. It is an unregulated, weakly evidenced practice amplified by social media aesthetics and shielded by ambiguity. Its danger does not lie in joint manipulation alone, but in the deterioration of scientific thinking and informed consent. If complex diseases could be cured with a single adjustment, hospitals would be quieter, textbooks thinner, and chronic illness a historical footnote. They are not. The decibel level of a joint cavitation has yet to be shown to correlate with long-term clinical outcomes, but it correlates beautifully with views.

There is a simple rule that rarely fails to hold true. When someone offers an easy solution to a complex problem, think twice. If curing cancer were as simple as fasting for a few days, oncology departments around the world would be empty by now. The oncology textbooks would have been thinner than restaurant menus. TATA Memorial Hospital (one of the best in India for oncology) wouldn’t have taken 24 doctors every year for oncology training. The so-called “money-looting” private cancer centres won’t invest in costly machines like PET-CT, LINAC, and Gamma Knife. Loki rightly said in one of the Thor movies, “If it were easy, everyone would do it”.

Recently, K. Annamalai suggested that prolonged fasting could starve cancer cells and potentially lead to a cure for cancer. This statement matters not just because it is scientifically incorrect, but because of who said it.

Annamalai is a former IPS officer and the most visible face of the BJP in Tamil Nadu. Even though some people oppose him because of his political ideology, his academic credentials are excellent. For many people, that background signals authority and credibility. When such a figure speaks about health, people are more likely to believe him than their doctor. That is where the real danger lies.

Cancer is a complex disease

At its core, cancer is a genetic disease. Every cancer begins with genetic alterations within a cell. The reason for the genetic alteration can vary between patients and different cancers. The cause will be an inherited mutation, exposure to toxins, infections, radiation exposure, etc. Even advanced age can predispose to cancer due to wear and tear in the DNA repair mechanisms.

Lifestyle factors can influence cancer risk, but they do not override biology. Cancer does not develop because someone failed to fast. And it does not disappear because someone starts fasting. Cancer risk is shaped by a complex interaction of genetic susceptibility, age, hormones, infections, environmental toxins, radiation exposure, and lifestyle factors such as smoking, alcohol use, diet, and physical activity. This is why single-cause explanations are so appealing and so misleading. Complex diseases do not have shortcut solutions.

People want simple explanations and solutions for complex problems. Doctors can’t provide that always, and that’s where pseudoscience peddlers enter.

Obesity and cancer risk

Obesity is clearly associated with increased risk of at least 13 types of cancer, including postmenopausal breast cancer, colorectal cancer, endometrial cancer, liver cancer, and esophageal adenocarcinoma. The mechanisms are well studied. Chronic inflammation, insulin resistance, altered sex hormone levels, and adipokine imbalance, etc. contribute to cancer risk. Addressing obesity is good medicine.

But here is where we have to draw the line. Reducing risk is not the same as treating cancer. Fasting can improve metabolic health and aid fat loss when done in a structured, supervised manner. For individuals with obesity, it can be beneficial for overall health. Fat loss has innumerable benefits, but fasting is not a standalone cancer treatment.

Cancer cells are metabolically adaptable. When glucose levels fall, many tumors switch to alternative energy sources such as fatty acids, ketone bodies, or amino acids. They do not die because food intake is reduced. In real patients, prolonged or unsupervised fasting often harms normal tissues before it harms cancer cells. There is no clinical evidence that fasting alone can cure cancer. A cancer patient, in fact, requires an adequate amount of nutritious food with the recommended amount of protein.

India has seen this before. Navjot Singh Sidhu has previously made claims linking diet and lifestyle practices to curing cancer, in the context of his wife’s battle against cancer. But, he conveniently forgot the evidence-based treatment she received. Each time, doctors are forced to clean up the damage caused by oversimplified narratives. The pattern is familiar. A complex disease, a confident public figure, and an easy solution.

Why this matters so much

When influential figures promote unproven ideas, some patients may delay surgery, chemotherapy, or radiotherapy. Some may even totally abandon evidence-based treatment. More importantly, this will create distrust of oncologists among the people. Cancer patients are already vulnerable to malnutrition, muscle loss, immune suppression, and cancer cachexia. Unsupervised fasting can worsen outcomes and reduce tolerance to life-saving therapies.

Research continues on short, supervised fasting or fasting-mimicking diets as supportive strategies during cancer treatment. These approaches are experimental, adjunctive, and used only alongside standard therapy under medical supervision. They are neither cures nor replacements for evidence-based treatment.

Always be cautious when a complex disease is offered a simple fix. If it were that easy, medicine would have adopted it long ago. Supervised fasting can improve metabolic health and help with fat loss. Fasting may reduce long-term cancer risk indirectly by addressing obesity. But fasting is not a cancer treatment. Public influence carries responsibility. Authority in administration or politics does not translate into expertise in medicine. Cancer care must remain grounded in genetics, biology, and evidence, not in appealing shortcuts. Patients deserve nothing less.

If cancer could be cured by not eating, humanity would have accidentally solved oncology during its first famine.

Every now and then, someone proudly announces, “Why were we taught algebra? Why were we taught history? Why did we need poetry? Useless stuff, never used any of it in my entire life.”

And once again, the internet claps like trained seals. These individuals are usually from industries like arts, philosophy, poetry, politics, etc. It’s almost fashionable now to trash the education system as if it’s some ancient relic created to personally inconvenience adults. But this argument has a giant logical fallacy. It assumes that the only valid education is the kind we can directly plug into our bank accounts or grocery lists. Reality is a lot messier.

We treat schools like a shopping list. “Does this help me file taxes?” “No.” “Useless!”

But education is not a crash course on adult survival hacks. It’s the long-term construction of your mind. The contents like algebra, history, literature, and geometry are simply scaffolding. The actual building is your ability to think, argue, question, analyze, imagine, and act with awareness. You might forget the details, but the muscle stays. In life, at various junctures, we have to make decisions where there is no clear right or wrong. We will face situations where we feel confused about the future. Well-read people, who have received quality education, tend to have a higher chance of making the best possible decision, even if the subject concerned is not their forte.

Take history, for example. It teaches you patterns. It teaches you that humans love repeating the same stupid mistakes in new costumes. It teaches you to identify propaganda, racism, bad politics, and social decay before they explode. If we don’t learn history, we’re basically toddlers with credit cards. Emotionally loud, factually clueless, and surprisingly easy to manipulate.

Similarly, algebra teaches structure and logic. It strengthens the part of your brain that handles decisions involving multiple variables. Literature teaches empathy, perspective, the ability to express thoughts, and the skill of interpreting other people’s words. That, by the way, is pretty important if you don’t want to be fooled by WhatsApp forwards and self-proclaimed “wellness” gurus.

Does this mean our education system is free from flaws? Definitely not. It can be refined. We absolutely need basic financial literacy, civic sense, basic law, duties as citizens, awareness about digital safety and misinformation, and practical life skills included in our curriculum. These are not luxuries. They’re necessities.

But here’s the important bit. Asking for improvements is not the same as declaring the whole system a failure.

We judge the education system by what is missing but ignore the vast foundation it has already built for us. Most adults underestimate how much of their reasoning, scepticism, creativity, and judgement comes from subjects they think were “useless.” People who say “I never used history” are often the same people who fall for revisionist propaganda. In case people still remember, the second COVID wave hit us hard because we loosened our guard after the first wave. We forgot that in the Spanish Flu of 1918, the second wave caused the maximum damage. People who say “I never used algebra” are often the same people who get tricked by shady loans and WhatsApp miracle-cure forwards.

The “education is useless” argument survives because it’s a convenient hoax. It gives people an excuse to blame school for everything they don’t understand as adults. Is the system perfect? No, and we need an upgrade. Should we throw the entire thing into a dustbin because someone couldn’t expand (A+B)²? Not even close.

Education is not bad. Our understanding of education is. The foundation is there; all we need is better furnishing, smarter designs, and modern utilities.

Blaming the whole house because the wiring needs an upgrade? That’s not wisdom. That’s just lazy outrage dressed up as insight.

Ayurveda is heritage, not healthcare.

Modern medicine survives because it questions itself every single day. If a drug fails, it’s thrown out. If a treatment works, it becomes standard. That’s how science works. Ayurveda doesn’t work like that. The texts remain frozen. Doshas, panchakarma, vata, pitta, kapha, none of these stand the test of proper trials.

And the safety angle? Heavy metals like lead and mercury have been found in Ayurvedic products again and again. If the same were found in an allopathic drug, it would be banned overnight. But Ayurveda gets a free pass because it’s “traditional.”

Now look at the money. In the 2025–26 Union Budget, the Ministry of AYUSH got ₹3,992.9 crore. Almost four thousand crore rupees. A 14% increase from last year. Imagine if that were spent on district hospitals, ICUs, cancer treatment, or rare disease research. Instead, it goes into pushing pseudoscience, building Ayurveda colleges, and organizing days like this. It is nothing short of a massive waste of public funds.

And who benefits from this circus? Brands like Patanjali. The empire was built on selling “Ayurvedic” powders, tablets, and pastes fronted by a baba. Yoga on TV in the morning, herbal toothpaste in your shopping cart by evening. They’ve marketed “cures” for everything, be it diabetes, infertility, or even cancer. This is not medicine. It’s marketing. And the religious halo around it ensures that any criticism is painted as “anti-Indian” or “anti-Hindu.” In reality, it’s just another corporate business with godmen as brand ambassadors.

Meanwhile, look at how Ayurveda is treated in many developed countries. There, these products cannot be sold as medicines. They are marketed only as “dietary supplements” or “herbal health products”, with disclaimers that they are not intended to diagnose, treat, cure, or prevent any disease. That itself shows the global stance: Ayurveda may have cultural or wellness value, but it is not medicine. Only in India do we pretend it is equal to modern healthcare.

Let’s be clear: speaking against Ayurveda is not speaking against Hinduism. Hinduism is a religion. Ayurveda is a pre-scientific system of healthcare. Criticizing Ayurveda is not an attack on faith; it’s a demand for evidence. Mixing the two is a political trick to silence questions.

The real danger is the false equivalence. When the state promotes Ayurveda alongside modern medicine, people think both are equal. They are not. Cancer won’t disappear with herbal decoctions. Diabetes won’t vanish with powders. Every time a patient delays proper treatment because they were promised a “natural cure,” lives are lost.

Ayurveda has value as a cultural heritage. Keep it there. Celebrate it in museums, books, or even as wellness tourism if people want it. But stop confusing heritage with healthcare.

World Ayurveda Day is not about health. It’s about politics, money, and branding. And as usual, the ones who pay the price are patients.

When I entered the medical field as an undergraduate student in the year 2012, only five colleges were in the government sector: Thiruvananthapuram, Kozhikode (Calicut), Kottayam, Thrissur, and Alapuzha. The Government of Kerala subsequently added seven more to its roster, and as of 2025, 12 medical colleges are operational in the state. However, except for the first five, the rest are lacking even the basic facilities. Institutions in Thiruvananthapuram, Kozhikode, and Kottayam are still holding on, still offering relatively decent services. Alappuzha and Thrissur follow closely behind. But others, Kollam, Kannur, Manjeri, and Idukki, are frequently reported to be in bad shape: vacant faculty positions, poor equipment, non-functional tools, and stretched staff. The disparities are no longer marginal; they are systemic.

Idukki Medical College had even lost its accreditation due to a lack of facilities prescribed by the NMC. Konni and Palakkad are not more than a glorified outpatient department. In a state like Kerala, where the population density is so high, a fully operational medical college is required in each of the fourteen districts. As Wayanad and Idukki district consists largely of difficult terrains to travel, the inhabitants need a decent medical college for their heal needs. Despite this huge gulf in the availability of healthcare, Kerala is still managing to top the health metrics, and credit goes to private hospitals and clinics that made healthcare accessible.

The rising manpower crisis in public medical college hospitals is another concern. Faculty shortages, delayed pay revisions, and heavy workloads are now topics of protest, not whispers. The Kerala Government Medical College Teachers’ Association (KGMCTA) has warned of boycotts of teaching and outpatient services if their long-standing demands are not met. Whenever there is an inspection from the medical council, the existing faculties would get shunted to medical colleges like Idukki, Wayanad, Konni, etc, to maintain the standards. Instead of filling new posts and strengthening the system, this measure has only robbed Peter to pay Paul, weakening the parent institutes further and shrinking the services they were already struggling to provide.

A telling incident involved Dr Haris Chirakkal, head of Urology in Thiruvananthapuram Medical College. He publicly revealed that surgeries had to be postponed because essential surgical implants and tools were unavailable. For patients without means, that delay is not just an inconvenience, it’s real harm. Rather than fixing the supply gap, the government responded with a show-cause notice to Dr Haris. An expert committee was formed, but what worries people is whether the promised action will follow.

Meanwhile, pay anomalies persist. Entry-level assistant professors argue that their salary is unreasonably low, making government posts unattractive. A gastroenterologist, who completed his/her DM, will earn anywhere between 2.5 and 4 lakhs in a private hospital. Now compare that to the entry-level pay in the Kerala Medical Colleges. Many doctors face delayed promotions and outstanding arrears from past years. Temporary transfers and staffing gaps throw off both teaching schedules and patient service. In medical colleges like Konni or Idukki, the shortage is acute enough to degrade everything from OP capacity to inpatient care.

Also adding to the cracks is the problem of surgical equipment and supplies. In recent months, the state government has allocated ₹100 crore to resolve hospital supply crises caused by unpaid dues to drug and equipment suppliers. Surgeries at major colleges (Thiruvananthapuram and Kozhikode) have already been disrupted because firms have refused to deliver until arrears are cleared. Some colleges are sourcing essential items at inflated costs to compensate.

An opposition report calls the state’s system “cracking at every joint.” It states that flagship programs like Aardram Mission are stalling, new facilities remain under-utilized due to lack of sanctioned staff, diagnostic services like MRI have long wait times, essential surgeries are being done under torchlight in some cases, and drug shortages are common. The famous “Kerala model” in public health is being exposed as less stable than assumed.

So yes, Kerala has non-trivial successes: low IMR, reduced MMR, strong literacy, good awareness, and health-seeking behaviour. Kerala has also shown flashes of remarkable resilience in the face of public health emergencies. When the Nipah virus struck, the state’s rapid contact tracing, strict isolation protocols, and community-level awareness campaigns drew international praise. During the COVID-19 pandemic, Kerala initially managed to flatten the curve effectively through early surveillance, strong local body interventions, and efficient use of its primary healthcare network. Unlike many other states, Kerala did not face an oxygen crisis even at the peak of the pandemic. These achievements underline that Kerala’s strength lies in its preventive and community health mechanisms, even though its hospital infrastructure continues to show cracks. The structure underneath, public medical colleges, public hospital equipment, faculty numbers, and fair pay, are under strain. Without urgent corrective steps, what looks like strength might reveal itself as fragility.

Nevertheless, the crisis is not unsolvable, but it needs a strong political will and administrative discipline. First, the government must stop the practice of shifting existing faculty around for inspections. Instead, sanctioned posts should be created and filled in every college, especially in Kollam, Kannur, Manjeri, Idukki, Konni, and Palakkad. Robbing one institute to save another only weakens both. Second, the pay anomalies must be corrected without delay. Nobody can expect a young specialist, after slogging for over a decade in training, to accept a salary that is a fraction of what private hospitals pay. If the state wants good teachers in its medical colleges, it must match pay with responsibility. The state has the resources, but it needs to be allocated judiciously. One such example is the pension scheme for the personal staff of ministers, where individuals become eligible for lifetime pensions after just two years of service. This highlights how political decisions can sometimes create financial imbalances.

Third, procurement has to be streamlined. The incident with Dr Haris Chirakkal exposed how even flagship colleges like Thiruvananthapuram fail to keep surgical tools ready. Essential drugs, implants, and machines should not become bargaining chips between suppliers and the government. Clear budgetary allocations and timely payments are basic, not optional.

Fourth, infrastructure has to be strengthened district by district. In a state with such a dense population and difficult terrains, every district deserves a fully functional medical college. Half-baked OP-style colleges only create the illusion of coverage.

Fifth, accountability and transparency must improve. When services collapse, blaming doctors is easy, but it solves nothing. There should be public audits of faculty strength, patient load, and equipment availability in every government college. People deserve to know what is missing and why.

Finally, the state has to rethink its health model. Kerala cannot go on relying on private hospitals to cover up the cracks in public institutions. Equity demands that government hospitals remain the backbone. Without serious investment in manpower, infrastructure and fair pay, the so-called Kerala model will remain a mirage, strong on paper but weak on the ground.

With the emergence of the T20 format, cricket has penetrated many more countries as the matches get over in three hours compared to the seven-hour-long ODIs. However, central asian and east asian countries are still far behind in skills and infrastructure. In this article, we will be discussing a five-point roadmap to popularize cricket outside South Asia.

1. Regular Asia Cup/Asian Games in T20 Format

Right now, the Asia Cup alternates between ODIs and T20s. The problem is simple; there’s a huge gulf in quality between the traditional powerhouses (India, Pakistan, Sri Lanka, Bangladesh, Afghanistan) and the rest. In ODIs, smaller teams barely stand a chance. If we make it a permanent T20 tournament, at least there’s competitiveness. Add to that — expand it to 8 teams so that at least 3 outside the big five (Nepal, UAE, Oman, Hong Kong, etc.) get their shot against Asia’s strongest. Also, the ACC needs to make it mandatory for the nations to participate in the Asian Games.

2. One Slot in Franchise Leagues for Associate Asian Players

Every franchise league in Asia, IPL, PSL, BPL, LPL, allows four overseas players. Most of the leagues allow 7-8 foreigners in their squad. Why not create an additional slot reserved only for non-Test Asian nations in the squad? A Nepalese, Emirati, or Omani player getting a season inside an IPL dressing room is worth years of associate-level cricket. Look at the Afghanistan players. Despite having no international cricket at their home, they excel because of the exposure they gained from playing in IPL and other T20 leagues. Even if they don’t always play, training with quality sides will fast-track their development. Fans from those countries will also connect instantly with the leagues.

3. Take the Asia Cup to Non-Traditional Hosts

Why must the Asia Cup always rotate among India, SL, BD, and UAE? If we want to grow the game, we need to take the men’s and women’s Asia Cups to places like Oman, Nepal, and UAE more often. These countries already have decent facilities and huge fan interest. Hosting tournaments with eyeballs means their cricket boards earn money, and that revenue can go into grassroots programs. Nepal especially has shown it can fill stadiums for even associate matches, imagine what a packed India or Pakistan fixture would look like in Kathmandu. Also, Nepal is investing a significant amount in building stadiums as well. In the future, we may see a proper home-away format Nepal Premier League.

4. Inclusion in Domestic Tournaments of Powerhouses

For growth, associate teams need regular competitive matches. India’s domestic structure is a perfect training ground, as is the case with Pakistan. The national team of Afghanistan had participated in Pakistan's domestic National T20 Cup as the Afghan Cheetahs. Similarly, before becoming a strong force, Sri Lanka had played against Indian domestic sides in the 1960s and 1970s. Teams like Nepal, UAE, Oman, and Hong Kong can be added to the Ranji Trophy Plate Group or to the Syed Mushtaq Ali Trophy. Indian domestic sides are stronger than the usual opposition these nations face. Playing here will raise their standards and provide consistent exposure that ACC qualifiers alone can’t offer. The Nepal team will find it more useful to play against Kerala than against Mongolia any day.

5. Bilateral and Trilateral Tours with A Teams

Boards may argue that sending full senior teams brings no financial gain. Fair. But even sending India A, Pakistan A, or Bangladesh A can do wonders. A bilateral or trilateral series hosted in Nepal, Oman, or UAE will pack stadiums and bring in money for those boards. For the powerhouse, it’s also useful. Their bench strength gets tested in different conditions. For the associates, matches against India or Pakistan in any form will always be a huge boost, both financially and emotionally. India A, Oman, and Nepal tournament at the Al Amerat Cricket Stadium will do a world of good for Oman.

The Asian Cricket Council, along with its test-playing members, needs to take active steps to spread the game to new shores. In football, the UEFA EURO Cup is as glamorous as the World Cup because of the competitiveness of the matches and the 24-team format. Asia has the potential for the same in cricket if the right steps are taken.

What is Shilajit?

Shilajit is a sticky tar-like substance formed from the slow decomposition of plant material trapped in Himalayan rocks over centuries. Chemically, it is a complex mixture of fulvic acids, humic substances, dibenzo-α-pyrones, and trace minerals. Fulvic acid is often highlighted because it can form complexes with minerals and has antioxidant properties. Supplement companies have taken that fact and stretched it into claims of “nutrient absorption” and “testosterone boosting.”

Evidence for testosterone boost

The strongest scientific claims about Shilajit come from two studies.

1. A study enrolled 96 men, of whom 75 completed the trial. Participants took 250 mg of purified Shilajit twice daily for 90 days. Results showed a ~20% increase in total testosterone and a ~19% increase in free testosterone compared with placebo.
   

2. Another trial studied 35 infertile men, 28 of whom completed the protocol. Participants received 100 mg Shilajit twice daily for 90 days. Researchers reported improvements in semen quality and a ~23% increase in serum testosterone compared with baseline.

At first glance, these findings look encouraging. But there’s a catch: both studies were conducted by Ayurveda doctors, and the sponsoring institutions have close ties to the Ayurvedic industry. Ayurveda as a whole has long been criticized for lack of robust evidence, inconsistent standardization, and safety concerns. So while the results are interesting, they come from within a system that itself has not met modern scientific standards of proof.

Fulvic acid: guilty by association?

Here’s the critical nuance: the testosterone effect is observed with whole Shilajit, not with isolated fulvic acid. Fulvic acid on its own has not been shown in human studies to increase testosterone. Reviews describe it as an antioxidant and chelating agent, but claims of hormonal activity remain unproven. Marketing that labels fulvic acid as a “testosterone booster” is misleading, it is Shilajit, with its mix of multiple bioactive compounds, that shows some signal in trials.

Another frequently repeated claim is that fulvic acid “enhances absorption of nutrients from the gut.” There is some in vitro and animal model evidence that fulvic acids can bind minerals, potentially altering absorption. But in human studies, the proof is thin.

A randomized, controlled trial of oral humic acids in patients with irritable bowel syndrome with diarrhea found no significant benefit over placebo (Haufe et al., 2021). The study did not measure nutrient absorption directly. In short, the idea is biologically plausible, but we lack convincing clinical data.

Safety and Money

Not all Shilajit is created equal. Raw or unpurified Shilajit may contain toxic levels of heavy metals such as lead, arsenic, or mercury. In 2021, both the U.S. FDA and Health Canada issued public warnings and recalls of fulvic acid products due to unsafe heavy metal contamination. These were not fringe advisories; they were nationwide alerts after testing confirmed elevated levels of heavy metals.

And here’s another reality check: a small pack of branded Shilajit costs about ₹1000 in India. That same money could easily buy a decent supply of protein supplement or contribute to a gym membership, both of which have far stronger, proven effects on muscle growth, fitness, and overall well-being. Shilajit, by comparison, offers only modest, uncertain benefits.

For most Indians chasing a “fit, filmy six-pack body,” these supplements are just marketing gimmicks feeding off desperation. If health and fitness are the goals, a disciplined exercise routine and adequate protein intake will get you far more results than a jar of resin.

References

1. Pandit S, Chauhan NS, Dixit VK. Effect of Shilajit on testosterone levels in healthy volunteers. Andrologia. 2016;48(9):928–934. PubMed

2. Sharma P, Joshi T, Joshi A, et al. Clinical evaluation of purified Shilajit in oligospermia. Andrologia. 2010;42(1):48–56. PubMed

3. Haufe S, Gammel G, Schiefke I. Humic acids in patients with diarrhoea-predominant irritable bowel syndrome: results from a randomised controlled trial. Biomedical Journal of Scientific & Technical Research. 2021;33(1):25584–25591. PDF

4. Carrasco-Gallardo C, Guzmán L, Maccioni RB. Shilajit: a natural phytocomplex with potential procognitive activity. Int J Alzheimers Dis. 2012. PubMed | Full text

5. U.S. Food and Drug Administration. FDA advises consumers not to use fulvic care powder and tablets from Black Oxygen Organics due to elevated levels of lead and arsenic. 2021. FDA advisory

6. Health Canada. BlackOxygen Organics recalls fulvic acid tablets and powder due to potential health risks. 2021. Health Canada recall
   
   

But as I grew older, I began to see the Yakshi not only as a ghost story but also as a reflection of society. Sometimes, she was a convenient scapegoat for murder. If a man was killed for revenge or land disputes and his body left by the roadside, people would say, “Yakshi attacked him.” The fear of the supernatural shut down suspicion. Sometimes, she was a guardian of secrets. People who hid wealth, contraband, or even carried out illicit activities in certain groves or shrines discouraged others from entering by spreading tales of Yakshi. Ghost stories became protective fences, keeping the curious away.

There were also the simple mysteries of life and death. A sudden cardiac arrest that struck a healthy-looking man on a nighttime walk, or an accident caused by someone drunk and wandering in the dark, could be explained away as a Yakshi encounter. Snakebites, fevers, or seizures that left a person dead in strange circumstances all seemed to confirm her presence. In an era before modern medicine, the Yakshi filled the gaps in human understanding.

Ghost stories also reflected the morals and anxieties of the community. The Yakshi, often depicted as a woman who lured and punished men, was a patriarchal warning: don’t wander drunk, don’t flirt, don’t succumb to desire. For women, it was a way of saying that stepping outside traditional roles made them dangerous, even monstrous. The supernatural figure became a cultural policeman, shaping behavior through fear.

And yet, not all Yakshi stories are about control. Some are stories of survival. Women who faced abuse or violence, with no means to seek justice, may have turned their silence into whispers of revenge. A man who wronged a woman and then died mysteriously could be said to have fallen into the Yakshi’s trap. In that sense, the Yakshi became the voice of the voiceless, a form of justice in a world that offered none.

Interestingly, many of these stories began to vanish when the Kerala State Electricity Board installed electric posts, and villages were lit up. The fear that thrived in darkness lost its power under the streetlight. Ghosts, after all, belong to the night. Once there was light, they retreated into memory, cinema, and imagination.

Looking back, it feels as though the Yakshi was never just a ghost. She was a cover for murder, a guardian of secrets, an explanation for sudden death, a symbol of patriarchal fear, and sometimes even a cry of revenge. Kerala’s ghosts tell us less about the other world and more about this one — our fears, our violence, our desires, and our silences. Perhaps that is why they continue to linger in our imagination. The Yakshi may no longer haunt the banyan trees of our villages, but she still lives in the stories we tell when the lights go out.

After the Congress’s defeat in the 2021 Kerala Assembly elections, there was a growing demand among party supporters for change. Many felt that the old guard, represented by leaders like Ramesh Chennithala and Mullappally Ramachandran, had failed to provide the energy or strategy required to take on the Left. As pressure mounted, the party’s high command made a bold shift: VD Satheesan was chosen as the new Leader of the Opposition.

Satheesan’s leadership style was markedly different. He signaled that it was time to push more young leaders to the forefront and create a new narrative for Congress in Kerala. Rahul Mamkootathil, already known for his friendship with Shafi Parambil and his ability to energize the youth cadre, became one of the faces of this generational shift. In Kerala’s political circles, few names rose as quickly in the last decade as Rahul Mamkootathil. A lawyer by training and an orator by instinct, Rahul cultivated the image of a modern politician: approachable, articulate, and ambitious. Together with Shafi, he symbolised the generational shift that the Congress party was eager to project in a state where it had been struggling to re-establish its dominance. He gathered attention from the media with his skills in live TV debates, where he didn’t hesitate to launch a scathing attack on Chief Minister Pinarayi Vijayan.

The turning point came in 2024, when Shafi Parambil vacated the Palakkad Assembly seat after being elected to Parliament. The Congress think tank took a calculated risk: they fielded Rahul, who was not from the Palakkad district. Dr. Sarin, a youth congress leader from Palakkad, expressed his differences and left the party due to the candidature of Rahul. Later, he was fielded as the candidate of LDF. It was a gamble that could have backfired, but instead, it paid off handsomely. Rahul won, turning what seemed like a handicap into proof of his statewide appeal. That victory was symbolic as it marked the success of the “youth experiment” Satheesan was championing.

Rahul’s victory and his appointment as State President of the Indian Youth Congress gave him both clout and visibility. For many party workers, he was the future. But for others, especially those who had been sidelined in the reshuffle, Rahul, Satheesan, and Shafi together represented the reason they had lost influence.

The Allegations and the Audio Clip

The scandal broke in waves. An actress alleged obscene messages, a transgender activist accused him of inappropriate online behaviour, and finally, an audio clip surfaced in which Rahul was allegedly heard urging a woman to terminate a pregnancy.

The media seized on the clip, framing it as a threat. But interpretations vary. To some, his words reflect coercion. To others, they reveal panic: an unmarried politician terrified of the fallout from a pregnancy out of wedlock. The woman’s calm but resistant tone appears to have triggered his frustration, giving the conversation its harsh edge.

What remains uncontested is that the relationship appears to have been consensual, at least initially. The dispute arose only when pregnancy entered the picture, colliding with Rahul’s political calculations.

Congress’s Response

The Congress leadership acted swiftly. Without waiting for a formal complaint, Rahul was suspended from the party and forced to step down as Youth Congress president. Leaders like Ramesh Chennithala and Uma Thomas spoke publicly against him, making it clear that Rahul was now politically isolated.

Behind this speed lay more than just moral outrage. With state elections approaching, the Congress think tank could not risk the possibility of more women coming forward. Probably the think tank might have got internal information about the flirtatious image of Rahul. Even a single fresh allegation would have been disastrous for the party’s image, as they are desperate to come back in power after 10 years. In a way, Rahul became collateral damage in a larger political strategy of damage control.

At the same time, the episode also revealed the internal politics of the party. Those sidelined after the 2021 defeat, who had watched as Satheesan, Shafi, and Rahul consolidated power, found in this scandal the perfect opportunity to strike back.

What makes Rahul’s case striking is the contrast with how other Kerala politicians have weathered similar storms. CPI(M) MLA and actor Mukesh, for instance, faced allegations of sexual misconduct raised during the #MeToo movement, but he continued in office without facing disciplinary action from his party. Similarly, Kadakampally Surendran, a senior CPI(M) leader, has dealt with political controversies and accusations in the past, yet retained his position and remained in active politics. Their parties shielded them, arguing that electoral legitimacy outweighed personal controversies unless proven in court.

Private Choices, Public Judgments

The controversy also raises an important question: where should the line be drawn between a politician’s personal life and their public role? If Rahul misbehaved with women without consent, that is a crime. If he had a physical relationship without consent, that too is a crime and must be condemned.

But what about consensual relationships? Rahul is unmarried. Should flirting or consensual affairs really be the basis on which we decide the fate of a political career? At the end of the day, politicians should be judged by their public actions, their policies, and their ability to serve people, not by the details of private relationships, unless those relationships involve coercion or abuse.

A Career in Suspense

For Rahul Mamkootathil, the road ahead is uncertain. He has gone from being one of the most promising young leaders in the state to being suspended and politically cornered. For Congress, the crisis highlights both its strength, i.e., the ability to act quickly in moments of danger, and its weakness, where internal rivalries often shape outcomes as much as facts or fairness.

Whether Rahul bounces back will depend on the outcome of inquiries, the timing of state elections, and how the public ultimately decides to view him: as a young leader undone by personal choices, or as a scapegoat caught in the middle of party politics.

The explosion wasn't an accident; it was a confluence of perfect conditions. The Jio revolution of 2016 made data available at an affordable rate in India, and most Indians craved new avenues for entertainment. The Pandemic and the lockdown following that set an ideal platform for a boom in the digital media industry. All of a sudden, a million new YouTubers and Instagram influencers emerged. With people stuck at home, sports viewing skyrocketed. Betting apps offered a way to monetize fan knowledge, turning passive watching into an active, potentially lucrative engagement.

However, the existing rules of India were against involving money in a game that involves “chance” and not “skill”. Platforms like Dream11 have masterfully positioned their fantasy sports product as a game of skill, where knowledge of players and strategic thinking matter. This legal nuance allowed them to operate legally in most states, normalizing the act of putting money on sporting outcomes.

A critical driver was the business's fundamental economics. Unlike capital-intensive tech start-ups, developing a betting app did not require a massive investment. Many used cheap, white-label software solutions that could be rebranded overnight. Hence, the profit margin they had was astronomical. The model, based on a "platform fee" on every bet or a percentage of player losses, generated a relentless cash flow with negligible overhead per additional user. This also meant that the betting platform could spend millions on marketing, allowing them to outbid traditional companies for sponsorships and flood every advertising channel.

For outright illegal betting apps, operating required a cloak of invisibility. Banned international brands like 1xBet simply changed their names. Platforms like 1XBat and others with similar-sounding names proliferated, using mirror sites to bypass government bans.

Many sites masqueraded as sports news portals like Dafanews and Parimatch News. Users seeking "expert tips" were redirected to actual betting platforms, a clever disguise to attract traffic.

This normalization would have been impossible without celebrity might. MS Dhoni and Virat Kohli advocating for a "fantasy sports" app lent it immense credibility, transforming a speculative activity into a mainstream hobby. Actors added a layer of coolness and excitement, and the list included Shah Rukh, Aamir, Shahid Kapoor, Ranbir, and so many more. Thousands on Instagram and YouTube built channels on "betting tips," acting as a direct salesforce with affiliate links, often without disclosing the risks of addiction. Most of the internet users might have heard the line “....ek chhota sa gem khelakar ghar baithe paise kamaana seekhen” from Instagram influencers. Former cricketers like Aakash Chopra wore sports team jerseys with the Dafanews logo in multiple videos on his YouTube channel.

Alarmed by a rising tide of user addiction, financial fraud, and devastating personal ruin linked to these platforms, the Indian government has moved from caution to decisive action. The online gaming bill, which was recently passed by both houses of Parliament, will bring a full stop to the operations of the real money gaming apps. Also, promoting them is a punishable offence now.

This is where the story becomes a national dilemma. The low-cost, high-profit model meant these companies had unmatchable cash to spend on sponsorships. They became the financial lifeblood of Indian professional sports.

While the IPL attracts numerous traditional sponsors, the main sponsor of almost half of the teams is Dream11. The Indian national team’s jersey also shows the same logo in bold font.

For leagues like the Indian Super League and Pro Kabaddi, which are still building financial stability, a deal with a gaming app is often the single largest source of private revenue, crucial for covering player salaries and operations. Top teams like Mohun Bagan, FC Goa, Punjab FC, and Chennaiyin FC had these platforms as their main sponsor.

A ban doesn't just affect the apps; it threatens to create an immediate economic crisis for sports. The fallout could include a massive revenue shortfall for leagues and teams, reduced salaries for the club staff, cutbacks on youth academies, scouting, and operations, hurting long-term development.

The new laws won't make these apps disappear, but will force a painful maturation. Smaller, fly-by-night operators will shut down, unable to comply with KYC and tax norms. Leagues and teams are now forced to wean off this easy money and build a sustainable model, diversifying revenue through merchandise, non-endemic sponsors, and better broadcast deals. It’s a necessary step for ethical growth, but a difficult one.

The era of the Wild West is over. The Indian online gaming industry is being ushered into an age of accountability, a move that protects consumers but also fundamentally challenges the financial playground of modern Indian sports. The final bet is on whether the leagues can adapt and survive without their most lucrative and controversial benefactor.

Obesity and type 2 diabetes are among the most pressing health concerns of modern life. What makes it more puzzling is that these conditions have a strong genetic component, yet evolution is expected to weed out genes that harm survival. Why, then, would so many people carry genes that seem to predispose them to these diseases? Two competing evolutionary theories, the Thrifty Gene Hypothesis and the Drifty Gene Hypothesis, attempt to answer this question.

The Thrifty Gene Hypothesis

Proposed in 1962 by geneticist James Neel, the thrifty gene hypothesis suggests that our ancestors evolved genes that helped them survive times of famine. These "thrifty" genes made people highly efficient at storing fat during periods of food abundance, which they could then use during lean times. In an era of unpredictable food supply, this was a survival advantage. So, during the time of the feast, humans stored fat, which can be used during times of famine.

Neel's idea was widely accepted for decades. As famine has been a recurring theme in human history, many researchers found it plausible that natural selection favored individuals who could build up fat quickly. However, in the modern world, where food is abundant and physical activity is limited, the same genes that once helped our ancestors survive now make us vulnerable to obesity and diabetes.

Despite its appeal, recent studies have questioned the validity of the hypothesis. For example, evolutionary biologist John R. Speakman argues that if these thrifty genes were so advantageous, they should have become nearly universal in human populations. Nevertheless, not everyone is obese. Also, detailed historical data show that famines weren’t frequent or deadly enough to create the strong selection pressure required for such genes to spread rapidly.

The Drifty Gene Hypothesis

In response to the flaws in the thrifty gene idea, Speakman proposed an alternative in 2008: the drifty gene hypothesis. According to this theory, obesity-related genes didn't spread because they were helpful. They spread because they were neutral and drifted into the population by chance.

The drifty gene hypothesis is based on the idea that early humans were once at high risk of being eaten by predators, so genes that kept body weight in check (so people could run and escape) were under strong selection. But around 2 million years ago, with the advent of fire, weapons, and group living, humans became top predators. The selective pressure to stay lean disappeared, and the regulation of body fat started to drift without evolutionary checks. Some people ended up with genes that allow them to gain weight easily, and others didn’t.

A Scientific Debate

While the thrifty gene hypothesis offers a purposeful story of survival, it lacks robust genetic and evolutionary evidence. On the other hand, the drifty gene hypothesis doesn't assume fatness was ever useful. It suggests that the variation in body fat regulation is a product of random evolutionary processes.

Modern studies, including genome-wide studies, have found little support for widespread positive selection at obesity-related genes. Instead, the genetic architecture of obesity seems to fit better with the drifty gene view.

In the end, this debate is not just academic. Understanding the roots of obesity can reshape public health approaches. This also reminds us that blaming individuals for their weight may ignore a much deeper evolutionary and genetic reality.

Reference:

1. O'Dea K. Overview of the thrifty genotype hypothesis. Asia Pac J Clin Nutr. 1995;4(4):339–40. PMID: 24394420.

2. Speakman JR. Thrifty genes for obesity, an attractive but flawed idea, and an alternative perspective: the ‘drifty gene’ hypothesis. Int J Obes (Lond). 2008;32(11):1611–7. doi: 10.1038/ijo.2008.161.

3. Southam L, Soranzo N, Montgomery SB, Frayling TM, McCarthy MI, Barroso I, et al. Is the thrifty genotype hypothesis supported by evidence based on confirmed type 2 diabetes- and obesity-susceptibility variants? Diabetologia. 2009;52(9):1846–51. doi: 10.1007/s00125-009-1419-3. PMID: 19526209; PMCID: PMC2723682.

The difficult truth is that if a woman carries mutations in specific genes, her risk of having repeated molar pregnancies climbs steeply. Also, there is a chance that one of these moles could turn malignant.

Not all molar pregnancies are the same. Some are complete, where the tissue is made almost entirely from the father’s genetic material. Others are partial, where two sets of chromosomes come from the father and one set from the mother. The frequency differs across the globe, but the broad estimate is about one in every 500 to 1500 pregnancies.

If a woman has gone through one molar pregnancy, her chance of it happening again is roughly 1.5 percent. After two episodes, that risk rises dramatically to about one in four. Some women are just unlucky; others carry a heritable predisposition, known as familial recurrent hydatidiform mole (FRHM). This condition passes in an autosomal recessive manner.

The main players are three genes: NLRP7, KHDC3L, and PADI6. These genes ensure that the ovum carries the right set of instructions and that early embryonic development runs smoothly. When mutations creep in, the egg is stripped of vital epigenetic marks, the kind that decide which genes should be active or silent. Without those signals, the placental tissue grows abnormally, the embryo fails to form, and what follows is a molar pregnancy.

Mutations in NLRP7 account for 48 to 80 percent of cases of RMP. KHDC3L mutations account for another 10 to 14 percent of cases. This gene works in tandem with NLRP7. If one fails, the other can’t save the process. PADI6 is less commonly implicated, but when mutated, it disturbs the egg’s architecture and the earliest stages of embryonic life.

Women carrying these mutations generally do not suffer health issues outside reproduction. But within the sphere of pregnancy, the effects are profound.

What can be done

Diagnosis begins with genetic testing. Tools like exome sequencing or targeted gene panels can pinpoint mutations in NLRP7, KHDC3L, or PADI6. Identifying the cause is not only academically satisfying but essential for guiding the couple’s choices.

Treatment options are limited. Natural successful pregnancies in women with these mutations are exceedingly rare, though a few case reports keep the hope alive. The most reliable path is using a donor egg, which bypasses the genetic defect in the woman’s own ovum. Alongside this, counseling plays a crucial role, not only to discuss risks like malignant transformation but also to provide psychological support for repeated losses.

If you or a family member has faced recurrent molar pregnancies, consult a Medical Geneticist. They can map out the genetic reasons and discuss the way forward. For the treatment of the mole itself, a Gynaecologist remains the right specialist. Together, they form the team that can guide you through this complex condition.

Medical Genetics is one such exam in which the candidates need to do a bit of focused preparation to score well. A major chunk of questions come from Nelson, and the aspirants usually find it hard to solve.

Resources I used

Emery’s Elements of Medical Genetics

The major chunk of questions comes from Emery, and you need to read this textbook from cover to cover. The explanations given in the book are easy to understand, and there are mock questions from each chapter at the end of the book. A few questions of INI-SS November 2022 came from the mock questions of Emery, and hence, you are advised to solve those questions before the exam. Even some pedigree chart-based questions were also taken from this same book.  

The PDF version of the 15th edition is available online.

Nelson Textbook of Pediatrics

Nelson is the bible of Pediatrics, and we need to know all the verses of our bible. In INI-SS, you need to develop decent knowledge on “General Pediatrics,” and for that, you need to read Nelson. Focus more on Neonatology (Teratogens, Dysmorphology, Antenatal diagnosis of diseases), Inborn errors of metabolism (mucopolysaccharidosis, glycogen storage disorders, sphingolipidosis, organic acidemia, urea cycle defects), and Skeletal dysplasia. Study even the nuances of Down Syndrome, Turner Syndrome, Klinefelter Syndrome, Noonan syndrome, and microdeletion syndromes. While reading other systems, concentrate on the genetics part of diseases. For example, if you are reading nephrology, study in detail the mutations causing congenital nephrotic syndrome. Tables given in the Cardiovascular system describing the genetic association of various syndromes and congenital heart diseases are important.

Indian Journal of Practical Pediatrics (IJPP) – Genetics edition (Jan – Mar 2019)

IJPP releases a nice compilation of articles and case reports once every 3 months. Each release is a storehouse of relevant information, and the first edition of 2019 focussed on genetics. It is available online for free.

https://www.ijpp.in/admin/uploadimage/Jan-Mar-2019.pdf

IAP January 2022 e-newsletter

IAP January 2022 e-newsletter was focussed on various aspects of medical genetics. A few chapters were written by faculties of AIIMS Delhi. This pdf helped me to understand topics like genetic testing, next-generation sequencing, and the genetics of skeletal dysplasia.

https://iapindia.org/pdf/child-india/2022/CHILD-INDIA-JAN-2022.pdf

YouTube videos

One of the major hurdles I faced while preparing was understanding the genetic testing methods. The description given in the standard textbooks is not sufficient to understand Sanger sequencing, MLPA, FISH, Karyotype, CMA, various types of PCRs, etc. Hence, I relied on various YouTube videos to understand such complex procedures.

YouTube videos by various entrance coaching firms were helpful for biostatistics. I saw YouTube videos of Unacademy and Prepladder for epidemiology and biostatistics. Reporting systems of various study designs are frequently asked (ex: PRISMA, STARD).

Important miscellaneous topics

1. Enzyme Replacement Therapy

2. Gene Therapy

3. Sustainable Development Goals

4. Global Nutrition Targets 2025

5. National guidelines for TB, HIV, and Asthma

6. Dengue

Special advises

Practice calculation-based questions

One or two questions involving calculations will be there in the exam and you need to practice those questions. Some questions require only common sense; however, some require the application of Bayes theorem. Never forget to learn the calculations based on the Hardy-Weinberg equilibrium.

Practice pedigree charts

Do let me know if you have any further queries.

This article is about 5 homeopathic remedies that are comical, and reading this will give you a basic understanding of the fallacies in the system of homeopathy.

Luna

Luna, as the name suggests, is a homeopathic remedy made from the energy of the moon. Yeah, you heard it right, moon. This “mind-blowing” remedy is prepared by exposing water to moonlight for a few hours and then diluting it to the required concentration. Even though no one knows what moonlight does to that water, homeopaths believe that Luna can cure a spectrum of diseases ranging from acidity, epilepsy, somnambulism, and worms to menstrual complaints. As per the Materia Medica by John Henry Clarke, somnambulism is a lunar effect, and worm affections are most troublesome at the full moon. He also tried to explain epilepsy as another effect of variations in the moon’s size as visible to us, and even went on to say that skin diseases are frequently influenced by the moon.

Modern science has proven beyond doubt that phases of the moon cannot have an influence on these diseases. Nevertheless, pseudoscientific homeopathy continues to prescribe Luna as a remedy for various ailments.

Murus Berlinensis (Berlin Wall)

This ‘magical’ homeopathic remedy is made from the fragments of the Berlin Wall, which separated East and West Germany till 1989. The use of this remedy, as per homeopathic textbooks, is to break down emotional barriers and boost relationships. If this is true, then the North and South Korean leaders should have this simultaneously in order to improve relationships between them. What is more disappointing is that Ainsworth Pharmacy, which holds royal warrants from the Queen and Prince Charles, is selling this remedy and because of the involvement of the royal family, this useless medicine gained a lot of popularity.

Plumbum mettalicum (Lead), Mercurius solubilis (Mercury), and Arsenicum album (Arsenic)

Heavy metals are regarded as the most toxic substances by modern science. In fact, there are dedicated chapters for each of these metals in the Forensic Medicine & Toxicology textbook, which modern medicine students learn in their second year of the course. However, homeopaths tend to make medicines from any substance, and no government authority questions them. They make remedies from these toxic substances, which they claim heal various ailments, even though there are no randomized controlled trials to support their claims.  Whenever scientists raised doubts regarding the safety of these heavy metal preparations, homeopaths argue that the preparations are diluted enough not to cause toxicity. Nevertheless, case reports available in PubMed-indexed journals refute their claims of the safety of these remedies. The Kerala Government even gave Arsenic album tablets to school-going children to improve their immunity against COVID, which proved that our awareness about science is next to nil.

X-Ray

The preparation of X-ray homeopathic remedy is similar to that of Luna, by exposing water/alcohol to X-rays. Homeopathic materia medica suggests this remedy for various skin and bone cancers. This remedy apparently has the ability to stimulate cellular metabolism and arouse both mentally and physically, as per homeopaths. A tenth-standard student knows that X-rays cannot impart any superpowers to water or alcohol to make it a medicine, and such preparations can’t destroy cancerous cells.

X-ray exposure, if it goes beyond the prescribed limit, can cause damage to the body and can lead to the development of malignancies. Homeopaths applied their “like cures like” principle (Similia similibus curantur) on this fact and prepared a remedy, which actually lacks logic.

As the fundamental principles are unscientific in homeopathy, the medicines and preparations lack logic. Notwithstanding that, our governments still promote this unscientific system by spending millions of public money. Even developing countries like Nepal don’t support this sugar pill medicine. By providing a bachelor’s degree in homeopathy, we are jeopardizing the careers of many students who opt for this subject for graduation.

References

Berlin Wall pills: a cure for emotional trauma – or royal-endorsed quackery?

BERLIN WALLIES Pharmacy used by the Queen is selling pills made of Berlin Wall ‘that boost relationships and break down emotional barriers’

Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy

Arsenic toxicity from homeopathic treatment

Indian medical students, who were pursuing their studies in Ukraine, were the most affected Indians in this whole matter. They lost their valuable months of studies because of war and there is no assurance from any organization that the classes will resume again. This article aims to address their plight and we have taken input from Malavika (name changed for privacy) who is a student at a Ukrainian medical university.

Malavika completed her higher secondary education in the year 2017, and then she dropped one year for entrance exam preparation; however, her rank was not good enough to secure a government seat in Kerala. The private colleges were charging exorbitant fees and hence she opted for Ukraine as the cost of studying in Ukraine was relatively less. She got admission to Odessa National Medical University through a recruitment agency operating near her home. She is currently in her fourth year of the course.

Even though 1.6 million students appear for the NEET-UG examination, only 90,000 MBBS seats are available in India. Consequently, the probability of securing an MBBS seat is just 5.6% for an applicant if we consider that all applicants have an equal chance. Besides, the cost of MBBS in private medical colleges is sky-high. A portion of Indian parents prefer sending their children to Ukraine because of better quality education and they can’t afford the hefty fee charged by Indian private medical colleges. The cost of medical education in Ukraine is way more economical (18 to 20 lakhs for 6 years) in contrast to the same course in Indian private medical colleges (50 lakhs to 1 crore for 5.5 years).

It may appear strange for some people that Ukraine is one of the most preferred destinations for medical aspirants of India, a country which is far away from India and doesn’t have the fame of the United States or Britain. Ukraine offers around 80,000 seats annually for foreign medicine aspirants for undergraduate courses. Out of this 80,000, Indian citizens enroll themselves in around 20,000 seats. Medical aspirants from countries like China, Egypt, Turkmenistan, Morocco, Nigeria, Turkey, and Israel also come to Ukraine to complete their MBBS equivalent degrees. Universities like Danylo Halytsky Lviv National Medical University are centuries old and they provide quality education at a reasonable cost. Ukraine, before this war, was a peaceful nation and there were no incidences of atrocities against foreign students.

“MBBS at Ukraine consists of 6-year long course and a 1 year of internship”, Malavika said. “In the initial 3 years, we are given theory lectures and in the latter three, we get clinical exposure. The foreign students are taught in English itself. I am currently in my fourth year.”

“The Ukrainians, whom I know, like our teachers, neighbours, apartment owner, etc. all have been nice to me. I still talk to my apartment owner and they ask us to remember them in our prayers. We are having online classes now and after each class, the teachers say “If they don’t destroy us, we will meet tomorrow “and it is difficult for us to hear that. A few days back, we heard the sound of airstrike sirens in between the class.”

The Indian students received a lot of flak from India itself for not moving out of Ukraine before the war despite the warnings from the Indian embassy in Ukraine.

“We didn’t expect the situation to become unpleasant even though there was tension rising between Russia and Ukraine. The place where we lived didn’t face any problem and when we used to talk with the natives, they all gave us an impression that there is only a remote chance for war to happen”, she said.

“In Ukrainian universities, attendance is very strict and if you miss a certain number of classes, you will be debarred from the course. Certain universities were reluctant to take online classes for their foreign students. I was in my fourth year and I just have 2 more years left in my course. We were in a catch-22 situation and we had no idea to solve it.”

“Nevertheless, our parents did inform us about the situation from India, and following their advice, we booked tickets when we got to know from them that the situation is getting dangerous. We tried to book the tickets for the earliest flights but tickets were not available due to huge demand. Hence, we got tickets for flights in the second week of March. We were still hopeful then and not many of us thought that Russia would start their invasion. The war started as an unpleasant surprise for us and our flights were cancelled due to the war situation.”

The first advisory for Indian citizens staying in Ukraine came on February 15th, 2022 from the Indian embassy. The advisory asked the Indians to leave Ukraine temporarily till the situation improve. This advisory was used by many pro-government groups as a weapon to verbally attack the Indians who were stranded to cover the deficiencies in the evacuation operation of the government of India. The pro-government clans claimed that the Indian government had advised their citizens almost 9 days before the commencement of the war to evacuate even though the reality was something different. The very next flight to India after the release of the advisory was on February 20th, which was 5 days later. The Indian Government didn’t increase the frequency of flights to accommodate all the 18,000 Indians and once the war was started, all the flights got cancelled. The most difficult part of the evacuation was crossing the border of Ukraine and the students had to do that on their own. One Indian student from Karnataka even lost his life during the war while standing in a queue to buy groceries at a supermarket in Kharkiv when Russian shelling began in the city.

“Our parents were constantly trying to get in touch with the central government. We were expecting some kind of help from the Indian embassy, but notwithstanding that, we didn’t receive any. We waited for 3 days and by then we understood that no one is going to help us. Hence, we decided to help ourselves and we arranged a bus to cross the Moldova border. Then we travelled across Moldova to reach Romania from where we could catch the flight to India arranged by the Indian government”, Malavika said.

Even though the students as well as their parents breathed a sigh of relief when the government managed to bring everyone back home, they had more challenges to face.

As per the National Medical Commission (NMC) notification dated 18/November/2021, the foreign medical graduation course should be completed within ten years from the date of joining the course. This should include the one-year mandatory internship at the university where the course was held and another one-year internship in India. The rule of mandatory one year internship at the university where the course was held is not applicable to current batch of students as the notification came after they joined the course. However, it will take at least 6 months to prepare and write the screening test in India, and the students need to pass that to do an internship in India. Since the course duration is 6 years in Ukraine, a student who does medical graduation in Ukraine will take at least 7 to 8 years to complete the whole process (6 years course, around 1 year to clear screening test in India, and internship of 1 year in India) and the window given by NMC is only 10 years. If the students lose 2 to 3 years due to war, they cannot complete the course in this 10-year window and they won’t be eligible for permanent registration in India.

Another problem faced by these students is that, as per NMC provisions “the entire course, training and internship or clerkship shall be done outside India in the same foreign medical institution throughout the study and no part of medical training and internship shall be done in India or in any country other than the country from where the primary medical qualification is obtained.” This means that the students cannot resume their studies in another country or university and the chances of a resumption of teaching in Ukraine in the foreseeable future are bleak.

NMC, on March 4th, made it clear that foreign medical graduates who are facing problems to complete internships due to compelling situations like the COVID19 pandemic and war can complete the remaining part of their internship in India. However, the students who haven’t reached the stage of internship are staring at a dark future. Organizations like Indian Medical Association (IMA) have urged the central government to bring an end to the uncertainty about the future of Indian medical students whose studies have been disrupted due to war. IMA also requested the government, as a one-time measure, to allow the students to complete their education in Indian medical colleges. Having said that, NMC and Health Ministry opposed the West Bengal Government’s decision to allow second and third-year MBBS students who had returned from Ukraine to complete their education in their state medical colleges. This clearly means that NMC is in no mood to bend the laws and give admission to the evacuated students.

The ball is in the government’s and NMC’s court. These two bodies can bring a positive change to the situation by allowing some moderation to the regulations so that these 18,000 students’ futures will not remain in jeopardy. The possible solutions are:

1. Allow all the students to continue their studies at Indian medical colleges. This step can face a lot of resistance as a lot of students who have previously opted for medical courses in India other than MBBS or did MBBS in other foreign nations due to lack of MBBS seats may find themselves betrayed.

2. Allow those students who completed at least 3 years of studies in Ukraine to continue their studies in Indian medical colleges. This measure will also face the same criticism as that of option number 1 but to a lesser extent.

3. Waive off the 10-year limit to complete the foreign graduation and also allow the students to complete their studies in other foreign countries.

Author’s opinion

The government needs to take a warm-hearted approach toward the students to solve the issue. Remember, if we make it difficult for them to qualify, we are losing 18,000 potential doctors.

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Herculean working hours

The Welsh labor rights activist Robert Owen coined the phrase “Eight hours labor, eight hours recreation, eight hours rest” as early as 1817. The labor laws state that only 8 hours of work shall be allowed for any employee and if the employer wants to extend that, then overtime payment shall be given. Nevertheless, PG doctors have to work 80 to 100 hours a week without any holidays and this tiring schedule does affect their physical and mental health. Studies have found that if too much time is spent on patient care and paper works, resident doctors may not feel that they are gaining knowledge from these experiences and feel disappointed that they have no time for learning and thinking about their patients [1]. A tired doctor may not be in a state to patiently listen to the complaints of the patients and they may get provoked easily if the bystanders of patients try to irritate them. 

The humungous workload also has taken a toll on the academics of junior doctors. Researchers have found that reducing residents’ workload will enhance attendance in academic activities like conferences, improve duty hour compliance, and improve patient safety [2].

We are overworked. Still, our basic demands like fair pay, proper working hours, weekly off, etc. are not met. In paper, everything is perfect and in practice nothing is served.

Dr. Jishnu Janardhanan (Resident Doctor)

In a study done by Patricia et al. [3], it was found that the resident doctors have to do multiple works simultaneously during their shifts and there had been multiple interruptions while doing each task which could result in errors in patient management. This holds so true in the Indian scenario as well. For example, a PG doctor, while examining a case, will be asked to collect blood test results from the lab and to accompany a patient for a CT scan after that. This may result in errors in the diagnosis of the patient whom the doctor was examining initially.

The attitude of the common people towards doctors

There exists a mistrust towards doctors in the public domain. Even in the movies dating the 1980s, we can see doctors being villainized. For a great majority of the common people, doctors are those who are always money-minded, who form a malicious nexus with the pharmaceutical companies and even do harm for their patients for personal gains. Few are envious of the living standards of the established doctors and they think that all the doctors live in those standards. Consequently, these kinds of baseless thoughts result in a lack of empathy for resident doctors who work day and night for the betterment of the patients. There is an increasing trend in the number of medico-legal cases filed against doctors and doctors have started practicing defensive medicine (the ordering of tests, procedures, referrals, or avoidance of high-risk patients or procedures, to reduce medico-legal cases) for the sake of their safety.

Even though doctors are in no way responsible for the lack of facilities in hospitals like lack of beds, delay in getting blood test results, delay in getting a slot for scanning, etc. patients show their frustration at doctors. Only very few hospitals and medical colleges have Public Relations Officers (PROs) at all the ICUs and major wards to talk with the patients and to sort out these problems. Doctors at the rest of the medical colleges have this administrative job as well and studies have shown such stressors have resulted in suboptimal patient care [4]. 

Incompetent government

The doctor-patient ratio of India is one of the worst in the world; we have 1 doctor for 1456 people against the WHO recommendation of 1:1000 [5]. There is only 1 government doctor for a population of 11,000 people and there is only 1 dental surgeon per 175,000 people [6]. When the COVID pandemic hit India, Government should have taken it as an opportunity to strengthen our health infrastructure. Instead, they promoted Ayurveda and Homeopathic remedies which are unscientific and we saw what happened in the second wave.

Kerala Government, instead of appointing new doctors, appointed resident doctors at COVID first-line treatment centers (CFLTC), making manpower shortage even worse at medical college. They had no concerns about the academics and workload of the PG doctors. Studies have shown that increasing manpower at hospitals has resulted in improvements in resident perceived educational value and clinical experience of ward rounds [7].

Even after taking continuous duties, sacrificing personal time, doctors are the ones who are crucified for lack of resources, failed government policies, and political melodramas.

Dr. Ananthu Joseph (Resident Doctor)

Toxicity of the departments

The faculty members of government medical colleges usually have excellent clinical acumen. However, some of them still want to run the department in the same way when they were residents. Residents hardly get any holidays and they are forced to work 7 days a week. Certain faculty members consider it a sin to grant leaves for the residents. When residents ask for a leave, some of the professors deny that by stating a weird reason that they used to work even harder during their residency. Residents may get leave if they fall sick, but may not get leave if it to take rest for one day so that he/she will be fresh to work in the coming week.

Despite pushing PG doctors to their limits, faculties have no shame in asking favors like helping them prepare presentations and write-ups to submit for journals. A minor section of faculties even asks residents to carry books and bags to their car.

“Greedy doctors” propaganda

There is a popular narrative that doctors care only about money and there exists an unholy nexus of doctors and pharmaceutical companies. The average salary of a resident doctor is 65,000 (ranges from 45,000 to 100,000) and the working hours per week are over 80 hours. Remember, a resident doctor is at least 25 years old when he/she joins for PG and at the same age, however, an IT professional who is placed at a good company will also be earning the same amount and his/her working hours will be around 50 hours per week with a week off. Also, there is nothing wrong with making money in a legal way without compromising medical ethics. Doctors have sacrificed more than 10 years to become a specialist and hence they deserve good pay.

I would recommend the common man to visit the duty room of resident doctors and their hostels. The dilapidated rooms and unhygienic sanitary facilities at these places may not match with the “money-minded doctors” narrative.

“The residents are trained in a work environment that fulfils all conditionalities of an unhealthy system. Long hours of continuous duty stretching more than 24 hours coupled with sleep deprivation, lack of personal care, and complete disregard for mental health directly affects the standards of medical care. Moreover , system itself glorifies the toxic environment and overburdened residents “

Dr. Geetanjali (Resident Doctor)

Absence of a proper referral system

Even though we have a good network of primary health centers, community health centers, and district hospitals, people still seek care at tertiary care centers like medical colleges even for trivial illnesses like a sore throat. A study conducted at a tertiary care hospital in Uttar Pradesh reported that among the people who consulted doctors at the outpatient department, only 50% required care from a tertiary center [8]. Even though many medical colleges provide outpatient consultations to only referral cases, people come to the emergency department for minor ailments. This will add to the burden of an already stretched system.

What can we do to solve this problem?

• Strict compliance to work hour restrictions for residency. Government should implement the Central Residency Scheme, which was formulated following a Supreme Court order in 1992, which guarantees a weekly off on rotation basis and work hour restriction of 12 hours a day [9].

• Manpower up-gradation across all government hospitals so that the ideal doctor: patient ratio can be achieved

• Strengthening of peripheral hospitals so that only very necessary cases get referred to medical colleges.

• Capping of admissions per day depending upon the number of doctors available for duty. This can be done only if the peripheral hospitals are strengthened with manpower and infrastructure.

• Educating the public about the purpose of each level of health care so that trivial diseases like common cold and pharyngitis won’t seek treatment at tertiary centers.

If Government and health departments fail to implement these critical changes in the residency program, doctors will continue to face the heat of patients’ frustration. As doctors are also humans, they will retaliate after a breaking point. Ultimately, doctors will resort more towards defensive medicine to escape from all medico-legal cases which will indirectly harm the patients.

References

1. Resident Perceptions of Service Versus Clinical Education

2. Service census caps and unit-based admissions: resident workload, conference attendance, duty hour compliance, and patient safety

3. Observations of residents’ work activities for 24 consecutive hours: implications for workflow redesign

4. The Impact of Duty Hours on Resident Self Reports of Errors

5. The doctor-population ratio in India is 1:1456 against WHO recommendation

6. 15-hour shifts, no sleep or water: India’s resident doctors cry ‘I Am Overworked’

7. Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation

8. Morbidity Profile And Drug Distribution Pattern At A Newly Established Tertiary Care Hospital

9. About duty hours of resident doctors

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The crux of the matter

In case you don’t know, post-graduation after MBBS consists of a three-year-long course in which the doctor needs to treat patients and study the subject simultaneously. At any given point in time, three batches of junior residents (PG doctors) will be present in the medical colleges. Admission to PG courses is through the NEET PG examination which is usually conducted in January and the admission process will get completed by May of the same year. Due to the COVID pandemic, the NEET PG entrance exam was conducted in September after a delay of 9 months, and the counseling process of the same is still facing a roadblock due to a court case concerning the reservation of Economically Weaker Sections (EWS). The case has been under the consideration of the Supreme Court since October and the next hearing is on January 6th, 2022. This has resulted in the deficiency of one-third of PG doctors in an already manpower deficient health system and this also means that all medical colleges across India are working with 66% of the actual workforce. The delays in admission to post-graduation courses also resulted in the washout of a year for the PG aspirants.

The second part of the problem is the herculean work schedule of resident doctors. The work schedule of resident doctors is one of the worst across all service sectors and most of the time, the schedule is so hectic that it goes against the basic rights of a human being. Junior residents are forced to take 36 to 72 hours long shifts multiple times a week and no one even talks about it. They are forced to skip their meals, let alone their household chores. As Government medical colleges are the only hope for a major section of the society who can’t afford the bills of corporate hospitals, the crowd at medical colleges is almost always unmanageable with the current strength of doctors. As the workforce is too low, PG doctors can’t skip their work even when they fall sick. A doctor attending to patients with an intravenous cannula fixed at her vein is not a rare sight at medical colleges. Pregnant and lactating PG doctors take tiring shifts when their counterparts in other service sectors take maternity benefits. Delay in the arrival of a fresh batch of PG doctors worsened the existing human resource crisis.

The Kerala Scenario

When the resident doctors realized that the counseling process of the NEET would not happen shortly, they started protesting all over India and Kerala medical postgraduates also joined the strike under the banner of the Kerala Medical Post Graduates Association (KMPGA). KMPGA put forward the following demands in front of the state government:

1. Appointment of Non-Academic Junior Residents (NAJRs) till new batch of junior residents arrives.

2. Reinstatement of 4% annual hike in the stipend of JRs.

3. To write a letter via a proper channel to the central government to expedite the process of NEET PG counseling.

It must be remembered that the KMPGA had already met the Health Minister of Kerala, Mrs. Veena George, once in August to discuss the first two issues (NAJRs and stipend hike) and then Minister gave the representatives verbal assurance that all the attempts would be made from her side to fulfill those demands. However, no positive moves were visible from the side of the minister even after 4 months. The strike started with boycotting all non-emergency services and it went like that for a few days.

Are the demands of KMPGA genuine?

The first demand was to appoint NAJRs to increase the manpower in the medical colleges. If manpower increases, it will benefit doctors as well as patients. The patient’s waiting time will decrease and will get better care, and the doctors will face less work pressure.

The second demand was to reinstate the 4% annual stipend hike. In 2019, after a token protest by KMPGA, Mrs. K K Shailaja (then health minister) agreed to this hike annually. Nevertheless, the finance department withheld this yearly increase in stipend citing the COVID pandemic as a reason. However, it must be kept in mind that various other states have given salary increments to doctors as a token of recognition and appreciation for the selfless work done by the doctors. Moreover, the stipend of junior doctors is inadequate considering their duty hours. If someone deserves an increase in salary in this period, it is the junior doctors who risked their lives to save the patients.

The third demand was to put pressure on the central government to expedite the NEET PG counseling process. The health ministry just needs to write a letter to their counterparts at the central government which doesn’t cost anything.

How did the Kerala Government react to these demands?

Neither the health minister nor the Directorate of Medical Education (DME) acknowledged the demands of the resident doctors and tried to downplay the situation by pointing their finger towards the central government. Consequently, KMPGA gave notification that the strike would be escalated by boycotting the emergency services as well and that move did bring a positive change. The Health minister met a few representatives of the KMPGA and gave verbal assurances that NAJRs would be appointed soon. She, however, ducked the 4% stipend hike demand by informing them that the matter is still under the consideration of the finance department. As she didn’t keep her promises given during the previous meeting conducted 4 months back, KMPGA wasn’t convinced by her verbal assurances this time and moved forward with the protest which included a boycott of emergency services as well excluding COVID care.

In this critical situation, when junior doctors were fighting for genuine causes, a mature administrator would have negotiated with them again to solve their grievances. Contrary to that, Health Minster ordered the Principals of all GMCs to expel all the junior doctors from hostels who were participating in the strike. The administration of each medical college asked the resident doctors to vacate the hostel immediately without even considering that there were pregnant ladies and lactating mothers among them. This immature and senseless action led to widespread outrage against the minister and the next day, she took a U-turn and said no such directives were given by her office.

A day later, a notification for the recruitment of 373 NAJR posts was released by Govt. of Kerala. This move appeared as an eyewash as the total deficiency of PG doctors in the state is around 1,000. Moreover, the government hasn’t mentioned any timeline of the recruitment process also in this order.

Our health minister, Mrs. Veena George, conveniently forgot that our health system could contain deadly diseases like Nipah and COVID without a catastrophe because of these young resident doctors along with other health care staff. The so-called “Kerala Health Model” was built on the blood and sweat of these youngsters. Our health minister was more interested in gimmicks like late-night emergency department visits at medical colleges to get better media coverage.

Take-away for the common man

This strike, if it turns out to be successful, will eventually benefit the common man. More doctors mean more people to look after the patients and that will improve the care that the patients receive. The lag for surgeries will decrease, the waiting period for consultations will improve, more doctors will be available for intensive care, and that list of benefits goes on. Doctors will get more time to rest which will improve their clinical decision making which will again benefit the patients. You don’t want to get operated on by a doctor who hasn’t slept for 3 days, right? 

Feudalism, once a prevalent system in our society that was undemocratic, ended long back even before we were born. Despite that, the vestiges of that system are still hanging on in our medical system pushing the health care professionals to work as slaves. This fight is against that slavery in disguise and the public should stand with the doctors.

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Millions of our fellow citizens were directly affected by the second wave, and the scar it left hasn’t healed completely. On the brighter side, the daily case count drastically decreased, and the vaccination drive is happening at top speed. Almost 1 billion doses of vaccine have been administered so far, and the situation is currently under control. All the sectors have resumed their work like the pre-COVID times, and in Kerala also, the situation is the same. The Kerala government has lifted all the restrictions imposed due to the case surge as caseload has come down, and is also planning to restart schools from the second half of November. 

On September 20, 2021, the Government of Kerala (GoK) announced that they would distribute Arsenicum album tablets, a homeopathic remedy endorsed by the Ministry of AYUSH but not recommended by the World Health Organization (WHO), to all students at school (1). This is done as a preventive measure against COVID-19 infection as vaccines are not yet available for children in our country. Arsenicum album is not a new term for the Keralites, as this medicine had already stirred controversy when the previous health minister of Kerala, Mrs. K K Shailaja, remarked that Arsenicum album is effective in increasing immunity and preventing the virus infection. Indian Medical Association (IMA) Kerala wing criticized the minister at that time as the medicine lacked scientific evidence (2). The talks around this remedy hibernated for a year, but the latest order by GoK reopened the same chapter.

In this article, I will explain why this homeopathic remedy shouldn’t be distributed in our schools for children.

Principles of Homeopathy are unscientific

Homeopathy originated in the first half of the nineteenth century, even before the germ theory of disease was proposed. Despite that, the principles of homeopathy are baseless, and there has been no attempt to rectify those principles. The concepts of vital force, water memory, like cures like, and dilution increase potency didn’t stand the test of time and were hence discarded by modern science. Unfortunately, due to a myriad of reasons, modern-day homeopaths still follow those age-old postulates. Even a basic understanding of chemistry, biology, and physics is enough to debunk the concepts in this pseudoscience.

There is unambiguous evidence in modern medicine to suggest that homeopathy is nothing more than a placebo and hence shouldn’t be used as a treatment modality (3). In case you want to know in detail about the basics of homeopathy, you can check my article on the principles of homeopathy given below.

Arsenicum album lacks evidence from randomized controlled trials

If you take the pain to search “Arsenicum album” in PubMed, you will find hardly 3 clinical trials conducted on this medicine. One trial was conducted to find whether it is effective in treating fever in children post-DPT vaccination, another one on neonatal calf diarrhea (an animal study), and the last one on its effect on patients with Arsenic toxicity (4). However, there is no clinical trial on its effect on COVID-19 infection or its complications. Without well-designed clinical trials, how can we allow this drug to be given to our children? The vaccines of COVID-19 went through thorough scrutiny before getting approval from the WHO, and we know that health care activists did raise questions about Covaxin till Bharat Biotech released the data on the phase III trial. Isn’t it prudent to say that such a rigorous quality check should be applied to the Arsenicum album as well?

Immunity boosting is a scam

Immunity can’t be boosted, period. The best that you can do is stay healthy. Consuming nutritious food, avoiding substance abuse, and living in a pollution-free environment can help you stay healthy. The antibody levels and the count of immune cells have to be in a normal range, and anything beyond the normal can cause problems for the body. We call it autoimmune or autoinflammatory diseases in scientific language.

In certain immunodeficiency disorders, like X-linked agammaglobulinemia, we have to supplement antibodies. However, that is a different situation, and a normal person doesn’t require immunity boosting.

Creating a sense of false security

Children and their parents may get an untrue sense of security from the disease if they believe in this homeopathic medicine. Unlike popular perception, children do follow the mandatory steps of COVID protocol like wearing a mask, maintaining social distance, and handwashing. If we teach the children that sugar pills from homeopathy can save them from COVID, they may stop adhering to those restrictions.

It is worth noting that Covaxin, our indigenously developed vaccine manufactured by Bharat Biotech, is on the verge of getting approval in the pediatric age group as well (6). Hence, it’s safe to say that vaccines will be available for children shortly and we don’t need to resort to fallacious medicines.

Toxic effect of Arsenic

This has been an issue raised by scientists who were skeptical about homeopathy from the beginning. In homeopathy, a ‘mother tincture’ is made first, and then it is diluted to various concentrations. According to their myths, dilution increases the potency of the remedy. The homeopathic principle that dilution increases potency can’t fit into modern science. Homeopaths have been using complex terms like quantum physics, nanoparticles, transfer of energy during particle collision, etc., and a poorly interpreted IIT Bombay study to claim that drug particles do exist in homeopathic medicines even in 200C dilution. However, in this case, to tackle the arguments against the use of Arsenic, they are resorting to the fact that no original drug particle exists in a 30C dilution, which is ironic.

Wastage of taxpayers’ money

Kerala, or India in general, is not a financially strong region. Our economy is not surplus, and the government finds it difficult to meet both ends. In such a scenario, we need to prioritize our resources and make sure that the resources are judiciously used. The cost of giving Arsenicum album to all school children can be diverted to more productive actions, like purchasing PPEs, supporting the people who are financially hit by the pandemic.

Therefore, no one can justify the use of the Arsenicum album as prophylaxis in children, and the government should reconsider this decision. If you are a parent of a school-going child, do consider not giving these sugar pills to your child.

References

1. Homeo preventive drug against COVID-19 for Kerala school students

2. IMA slams Kerala health minister for endorsing homoeo medicines to treat COVID19

3. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy

4. Arsenicum album – PubMed

5. After flak, Ayush ministry withdraws homeopathy advisory

6. Bharat Biotech submits data from Covaxin’s trials on children to DCGI

7. Arsenic Toxicity

8. Arsenic toxicity from homeopathic treatment

9. Budget 2019: In fillip to traditional medicine, AYUSH ministry gets Rs 1,939.76 crore

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Notwithstanding all these positive aspects, I always felt that people here are judgmental about the appearance of other fellow human beings, especially about the attire of females. As a person who spent almost a decade at medical colleges, I have heard numerous sexist comments from the faculty regarding the dressing sense of their students. More often than not, girls are at the receiving end of those “laws of the land”. My time at a North Indian medical college didn’t expose the dark side of such oral codes; however, in Kerala, I experienced such medieval customs and traditions. In Kerala, there is a concept of “Kulastri” which means the ideal figure of a lady as per the redundant age-old traditions. “Kulastri” means a woman who obeys all the laws set forward by society. It includes certain dress codes also. Western dressing styles and various contemporary trends are forbidden for girls as per the customs. Unfortunately, our medical colleges are still not out of the clutches of those needless concepts even though we have crossed two decades in the twenty-first century.

In MBBS, the undergraduates are taught to treat a human as the human itself and not based on color or caste. Nevertheless, a set of faculty members don’t follow the same principle with their students. There exists an oral diktat that only a particular set of clothing is allowed in the lecture theaters and labs. The boys are asked to wear a shirt tucked-in, formal trousers, and shoes; and females are asked to wear “normal and respectful” salwar kameez. “Normal” here means no leggings and jeans are allowed, and some departments even go to the extent that they orally ban tops with slits. Slits in tops are primarily meant to make movements easy and due to the fear towards faculties, girls were even compelled to use safety pins to cover the slits.

The anatomy department allows only churidars without slits. Leggings were banned but now the situation is slightly better.

Student of Calicut Medical College

After talking to students of medical colleges across Kerala, what I realized is that Anatomy departments are notorious for implementing such regressive dress codes. Being a first-year department, comments and rules made by the Anatomy department can have a long-lasting impact on the students. What is even more interesting is that the faculties who push these strict dress codes for girls are lady faculties, probably because of the conditioning they received in our patriarchal society.

In the first year, we can’t wear the dress that we like. We have to live in fear during the first year because of internal marks.

Student of Kottayam Medical College

Certain faculty members pass off belittling comments such as “leggings will make patients sexually attracted to you”. Though superior standards are expected from faculties of medical colleges, it wasn’t surprising for me to hear these demeaning remarks because being literate doesn’t mean educated or civilized.

Now, if you think that all these nonsense rules are only for boys and are over by the end of the first year, you are wrong. In the first year, boys have to wear formal shirts and trousers along with shoes, and they always need to maintain a clean-shaven face. The faculties of clinical subjects are not angels either. They shame the boys who grow a beard by using words like “Kanjaav” which means illicit drug abuser. Extrapolating that weird logic will place Jason Momoa (Hero of the movie Aquaman) in the list of the drug lords. Maintaining a trimmed beard is difficult than having a clean shave face. Certain units of departments like general surgery and internal medicine force the boys to wear full sleeve shirts and shoes. The rationale for the dress code is to develop a sense of respect among the patients for doctors. By projecting such irrational grounds for dress code, we are underestimating the intelligence of the patients. Developing a fine rapport, addressing the concerns regarding the illness, and curing the illness will earn accolades and not the apparel of the doctor. Decent clean attire is necessary but sticking to the terms set in the 1960s doesn’t make any sense.

In the year 2016 Trivandrum Medical College: the most prestigious medical college of Kerala, released a circular which mentioned a dress code for boys and girls. As per that circular, boys should avoid wearing chappals and jeans while girls are forbidden from donning leggings, short tops, and noisy ornaments. The order led to mass outrage, and still, the circular is not strictly followed at TMC.

Opinion of the medical students

“Dress code is the result of the weird mentality of our professors that we shouldn’t get any more freedom than what they got 50 years back and we should still be wearing what they wore in the 90s“. (Student of Trivandrum Medical College)

“At the age of joining Medical Colleges, every girl is mature enough to realize the encroachment upon her rights when comments or actions are being made against the way of dressing. However, the students are put in such a difficult situation where they can’t even explain themselves because just the thought of going against these faculties are sufficient enough to make sure where you are gonna end up in your exams. I think this pent-up frustration is the most tiring thing. Dressing styles of every person should suit their comfort; how can you then expect it to satisfy your realm of thinking and conventions? It’s high time, the so called “cream of society” put an end to the practice of harassing and abusing students based on their dress code”. (Student of Trivandrum Medical College)

Author’s opinion

Medical colleges shouldn’t be used to push the personal agendas of consultants. The faculties are there to teach the students and to treat patients, and not to protect the “Indian culture“. The decision to wear what dress should totally on the student and the so-called anti-western style thoughts should be discarded. If a person feels an intention to slut-shame a girl because of her dress, the problem lies with the former and not with the would-be victims.