Why all medicine men should watch Munnabhai M.B.B.S

Shuvendu Sen in The Times of India

It does not have the somber ambiance of The Doctor, where a brash MD himself succumbs to throat cancer and is hushed to humility. It does not carry the macabre interaction of a supposedly psychologically disturbed man and a tyrannical nurse as seen in One Flew Over the Cuckoo’s Nest. Neither does it inspire an awakening as Philadelphia did through a gay lawyer fighting AIDS.

Munnabhai MBBS is anything but the tempting medical plot hashing out tears, tension and hope. It walks clear of such obvious seductions. Truth be told, the movie is as loud as it can get, carries all the ingredients of Bollywood absurdity and harps on emotions, raw and running. But take a moment to peer beneath the rubble and you would smell a treasure. A rare treasure’s takes on a mission that has degenerated into a profession soaked with cynicism and slit throat parlance. And I am no film reviewer.

Let us take an earthly stand. When was the last time, we physicians have put our right hands up and taken the oath that we would take care of patients over and above vested interests? When was the last time, save glorious exceptions, we have crossed the borders of our financial gains and taken a bow for the penniless sufferer? When was the last time we thanked the hospital sweeper for his services to patient care? For that matter, when was the last time a medical book was written to highlight the absolute necessity to reach out to a stage four cancer patient other than through mindless chemotherapy and pain medications? Fact remains that medicine, like none other profession has become the yardstick of a cultivated upper lip vocation, to pursue and prevail. In our pursuit for perfection we have lost the imperfect patient.

And the fact that Munna bhai, despite all his convivial and genteel mindset, was a full blown quack, a rank outsider, drenched in liquor, roadside patois and all that was coarse and callous, made the white coat adorned messiahs look even more like bloodless bodies. Harsh words, but if anything had been flushed down the drain in the practice of medicine, it had to be empathy and emotions. Formless jottings have replaced tender words. Machines have superseded probing minds. An impatient doctor sits across the floor, rummaging the symptoms, inaccessible to the sufferer.

But of course, Munnabhai M.B.B.S has its own share of absolute lunacy. The frequent fist fights, the semi clad on-campus dance and the lugubrious antics are a far cry from the austere charm and book like precision of its western counterparts. But there’s a reason why British Medical Journal took a note of this movie. One suspects the makers of this movie played the human mind well.

Sometimes the finest sustains longer when drowned under the gross. The fine trickle beneath the plunging waves has always made its presence felt. Cure has always been the visible highpoint of medicine. It is the unseen, unspoken care that needs visibility. Munna bhai was all about that care.

Injection drug which claims to help people lose more weight than they would by dieting or exercising could soon be available through the NHS

by Patrick Sawer in The Telegraph

A treatment of injections that can help people lost a stone more than they normally would by dieting or exercising more has been approved by health watchdogs.

Liraglutide, which has been described by doctors as life-changing, could be available on prescription in months.

Slimmers typically lose almost a stone more than they would by simply watching how many calories they consume and doing more exercise.

Trials showed that some severely obese patients lost so much weight they were able to abandon their wheelchairs and walk normally for the first time in years.

Liraglutide also lowers blood pressure, raises good cholesterol and prevents diabetes. 

According to its makers, Novo Nordisk of Denmark, the drug even produces a 'feel-good factor', making dieting a pleasure.

But some experts have already warned it does not provide a long-term solution to the growing problem of obesity in Britain.

Novo Nordisk will apply for it to be prescribed on the NHS after Friday’s ruling by the European drugs regulator that it is safe and effective.

There are fears however that Nice – Britain’s drugs rationing body – will judge it too expensive for routine use on the NHS.

Liraglutide costs from £2.25 a day, which is roughly double the price of Orlistat, the only other prescription diet drug.

Patients inject the drug into their stomach before breakfast every day. It works by suppressing appetite.

Liraglutide, which will be given the brand name Saxenda, is already used at a lower dose to treat diabetes. It is based on a hormone found in the gut and sends signals to the brain that trick it into feeling full.

As a result, people eat 10 per cent less food than normal.

Trials of Liraglutide found that men and women who injected themselves daily lost an average of 19lb in 12 months. This is almost a stone more than they would lose by being on a diet and increasing the amount they exercise.

Furthermore one third or those who took part in the trials shed 23lb – more than a stone and a half. For a 14 stone woman that kind of weight loss would usually mean dropping two dress sizes.

The drug which, like insulin, comes in an injectable pen, also has such a significant effect on blood pressure that patients can dispense with the drugs they use to keep it under control.

Like Orlistat, its prescription is likely to be limited to those who are obese or who are overweight and have another health problem such as high blood pressure.

Mike Lean, professor of human nutrition at Glasgow University, told the Mail: "Liraglutide is absolutely life-changing for many of our most difficult-to-manage patients. Most do well, and some amazingly well. And it is extraordinarily safe, at least over the two to three years for which we have good evidence, with no signals to suggest serious side-effects.

"The only real downside is that it is jolly expensive."

Professor Jason Halford, former president of the UK Association for the Study of Obesity, said: "It is potentially very exciting. The real benefit of it is that it is targeting appetite. It strengthens the effects of satiety."

Obesity levels have doubled over the past two decades, making the UK the second-fattest nation in Europe.

Extensive research has found that being obese can lessen person's lifespan by as much as nine years and raise the risk of a host of health problems including diabetes, heart disease, stroke and cancer.

Tests have shown that dieters taking liraglutide lose almost twice as much weight as those on Orlistat.

However, Professor Iain Broom, director of the Centre for Obesity Research at Robert Gordon University in Aberdeen, said that drugs were never going to provide a long term answer to obesity.

He said: "Until society changes and the Government’s relationship with the food industry changes and the food industry itself changes, we are not going to get anywhere very fast."

The European Commission is expected to approve the drug’s licence within the next two months, paving the way for it to go on sale. Novo Nordisk says it could be launched in Europe, including the UK, this year.

Politicians who demand inquiries should be taken out and shot

From Stephen Lawrence to Bloody Sunday, an inquiry serves as the establishment's get out of jail free card

• 
• • Simon Jenkins
  • The Guardian, Tuesday 25 June 2013 20.30 BST

Neville Lawrence, Stephen Lawrence's father, at a press conference responding to the publication in 1999 of the report of the Macpherson inquiry into the Stephen Lawrence killing. 'The call for yet another inquiry into the Stephen ­Lawrence murder – by some counts the 17th – must make it the most interrogated death in history.' Photograph: Sean Smith for the Guardian

There should be a public inquiry. Indeed there should be a judicial inquiry, a veritable "judge-led" inquiry. Into what? That does not matter. An inquiry has become the cure-all for any political argument. Whether the subject is a dud police force, a dud hospital, a dud quango or a dud war, only a judicial inquiry will atone for wrongdoing and do penance for public sins.

An inquiry defers blame. It throws the ball into the long grass and kicks the can down the road. This week's call for yet another inquiry into the Stephen Lawrence murder – by some counts the 17th – must make it the most interrogated death in history. As withBloody Sunday and Hillsborough, a British scandal is measured not in deaths but in juridical longevity.

Politicians who demand inquiries should be taken out and shot. In almost every failure in a public service – run by or regulated by ministers – we know perfectly well what happened and who was in charge. Guilt should lie at the top, or at some recognised cut-off point. An inquiry merely replaces the straight, sure arrow of accountability with the crooked line of pseudo justice. It is the establishment's get out of jail free card.

For a minister to set up an inquiry – or his opponent to call for one – is like a bankrupt board of directors calling in consultants. The hope is that it may soften the line of blame, fog the argument, postpone the day of reckoning. A minister declares, "I have asked the distinguished Lord Justice So-and-So to leave no stone unturned." By the time he does, the minister prays he may have moved on. The furniture of blame will have rearranged itself.

Almost all public inquiries are nowadays political. In 1998 Tony Blair, eager to push forward his Ulster peace process, set up yet another inquiry into Bloody Sunday. The Saville inquiry became a scandal of judicial extravagance and delay (into which, of course, there was no inquiry). In 2009 Gordon Brown wished to take the heat out of the Iraq war before an election. He set up the Chilcot inquiry, now so dormant it can be of use only to scholars of latter-day Blairism. Two years later David Cameron, under attack for his links to News Corporation, sought a judge known to be eager for higher office and chose Lord Justice Leveson to investigate press ethics. From the resulting shambles Cameron escaped scot free.

In the Victoria Climbié inquiry of 2001, thunderbolts of damnation were hurled on to the heads of hapless social workers. Trials and inquiries cursed officials, police, councillors and local managers. Lord Laming's subsequent report came up with 108 recommendations, so many as to allow responsibility to disperse like seeds from a dandelion. When a minister says "we are all to blame", he means no one is.

The recent bevy of inquiries into the Staffordshire and Cumbrian hospital scandals has shone a mesmerising light on modern quangocracy. Highly paid officials with ill-defined jobs that are nothing to do with health argue over who said what, when and to whom. The row cannot save a single patient, while the resources diverted must jeopardise thousands. The salaries and fees roll on.

Government by retrospective inquiry is not government at all. It is a first rough stab at history. Its strangest feature is the deference shown to lawyers and legal process. All professions have their biases and the law is no exception. The sanctity of court process, important in trying a criminal case, is hardly relevant to the politicised context of a modern public inquiry. Judges, for good reason, do not speak the language of politics. As we can see from their hysteria over legal aid, they certainly have no comprehension of budgetary priorities.

Those attending the 2003 Hutton inquiry into the death of David Kelly found it an eerily legalised process. It led to a whitewash so unconvincing it had to be repeated, in effect, a year later by Lord Butler. The Leveson inquiry was likewise conducted as if it were a trial of the press for the mass murder of celebrity reputations. No attention was paid to the ethics of the electronic media, let alone to those of lawyers who were equally assiduous users of hacking services. The reality is that inquiries set up to get politicians off a hook usually do so by finding some other individual or group to hang on that same hook.

De Tocqueville remarked that the intrusion of lawyers into every corner of government meant that "scarcely any political question … is not resolved into a judicial question". A lawyer is to a modern politician what a priest was to a medieval one – someone on hand to help in a scrape, to dispense indulgence for wickedness.

If political accountability were truly a matter for judicial determination, parliament could pass laws and go home, leaving judges to decide on their efficacy. Everything could be rolled into one ongoing, everlasting public inquiry, to which every political upset could be referred for trial and execution. Parliament could be removed to the royal courts of justice with the lord chief justice as Mr Speaker.

We know what this would be like. We can see it today following the centralisation of town and country planning by Cameron's eccentric commissar, Eric Pickles. Local plans and decisions based on them have been superseded by Pickles's targets and instructions to his planning inspectors. This plays so fast and loose with local discretion that any planning application is worth taking to appeal. Planning is no longer a local function but determined ad hoc by Whitehall inspectors, followed by public inquiries and potential judicial review. It is not planning but financial combat.

As a result, planning is set to join immigration in the soaring total of judicial reviews. What was once a relatively smooth mechanism for deciding what sort of building should occur and where has become a judicial free-for-all (or rather costly-for-all). Expediting government through legal process is a contradiction in terms.

Democracy cannot work without a clear line between a decision and someone who can be held responsible. That means clear when the decision is taken, not clear to subsequent inquiry. Big centralised organisations such as the NHS stretch that line to breaking point. Public inquiries validate that breakage. They are a menace. Lawyers should stick to the law. Elected politicians who screw up should come clean and resign.

Top Ten Jokes at Edinburgh Fringe This Year

The top 10 festival funnies were judged to be:

1) Nick Helm: "I needed a password eight characters long so I picked Snow White and the Seven Dwarves."

2) Tim Vine: "Crime in multi-storey car parks. That is wrong on so many different levels."

3) Hannibal Buress: "People say 'I'm taking it one day at a time'. You know what? So is everybody. That's how time works."

4) Tim Key: "Drive-Thru McDonalds was more expensive than I thought... once you've hired the car..."

5) Matt Kirshen: "I was playing chess with my friend and he said, 'Let's make this interesting'. So we stopped playing chess."

6) Sarah Millican: "My mother told me, you don't have to put anything in your mouth you don't want to. Then she made me eat broccoli, which felt like double standards."

7) Alan Sharp: "I was in a band which we called The Prevention, because we hoped people would say we were better than The Cure."

8) Mark Watson: "Someone asked me recently - what would I rather give up, food or sex. Neither! I'm not falling for that one again, wife."

9) Andrew Lawrence: "I admire these phone hackers. I think they have a lot of patience. I can't even be bothered to check my OWN voicemails."

10) DeAnne Smith: "My friend died doing what he loved ... Heroin."