Are we medically distressed?

January 09, 2007
Andres Laxamana
Community Editorial Board
Toronto Star

I remember walking into the daunting emergency room of a Los Angeles county hospital in 1996. It was my first day of a year I would be spending at UCLA completing my second year of surgical residency.

"This is where it all happens," my chief resident snorted, motioning to the huge crowd in the waiting room. "These are America's medically indigent," he added with a smirk. "Oh – but you don't have to worry about things like that in Canada. Don't you have socialized health care up there? Doesn't it take a year to get a CT scan? I can never imagine having a health-care system like yours."

I cringed at his description of the people that the county hospital served and I hated his uninformed assumptions about the Canadian medical system.

As the year passed, I learned about the diversity of the people I treated: migrant workers and their families; the homeless; struggling single mothers and their children; college and university students; young working adults who never expected to get sick; and seniors on a fixed income who couldn't supplement Medicare.

Spending a few months rotating through a private facility, I found it unconscionable that patients needing urgent medical care were turned down at the door if they did not have medical insurance. I spent as much time treating lacerations and gunshot wounds as arranging immediate transfers to county institutions. I found it disturbing that the richest country in the world had a medical system that favoured only the wealthy and insured.

At the end of my year at UCLA, I ran into my senior resident after he had written his qualification exams. I knew he had passed, so I was surprised by his sullen mood. He told me that his wife had recently become sick and needed the expertise of a particular surgeon, one that his HMO refused to cover.

During my long drive back to Toronto, I was excited about completing the final years of my residency at home. I looked forward to the prospect of being able to triage patients based solely on their medical condition, rather than their financial capacity to pay. I was excited to rejoin a medical system that genuinely cares for all its citizens.

When Tommy Douglas first introduced equal medical access to Saskatchewan in 1959, few at the time could predict its success and integral role in defining part of our Canadian identity. But even with this history of success, our system seems to be under constant attack from critics in the public and more insidiously from within the uppermost ranks of the Canadian Medical Association. The inaction of Stephen Harper's government and the track record of his health minister demonstrate a genuine lack of commitment to this ideal.

We possess a health-care system worth fighting for. We need to take control. We need to wrestle it out of the hands of those who cast doubts and spread fear and would sacrifice a system that benefits all Canadians so that a select few can profit. Our health-care providers are arguably the best trained in the world and our infrastructure attempts to deliver these services to all Canadians in a timely fashion.

Remember, we all share responsibility for maintaining Canada's health-care system:


Health care is not free, but because we never pay directly out of our own pockets, there is a tendency to treat it as such. Our hard-earned money, in the form of taxes, funds almost every aspect of its delivery. Use it ethically and responsibly.


Be proactive instead of reactive regarding your health. Regular exercise, good nutrition, adequate sleep, smoking and alcohol cessation, and regular hand-washing are all inexpensive measures that, in the long run, will save our system a lot of money.


The environment is directly linked to our health. We all need to take personal responsibility for its preservation.


With impending federal and provincial elections, make your voice heard and your vote count. Remind politicians and decision-makers that there is no compromise or middle ground when it comes to universal health care.


Remind politicians and decision-makers at every level of government that women's, children's, community and social service, and educational programs all have a direct impact on our nation's health. Funding cuts to these programs undermine and jeopardize the health of our collective future.


Recognize and reward sincere efforts to improve our system, like the joint effort by the Ontario provincial government and the Ontario Hospital Association to reduce wait times for investigations and procedures.
Thinking back, it makes sense that my chief resident couldn't understand a medical system like ours. Growing up in California, he could not comprehend a system that provides the highest standard of care to all its citizens regardless of socio-economic status with decision-making unfettered by third parties like profit-centred insurance companies and HMOs.

We need to continue our proud medical tradition in this country and I hope there will never ever be a "medically indigent Canadian."

India's Growth Paradox

A former president of New Delhi's Foreign Correspondents' Club liked to startle newly arrived American and British journalists by telling them to begin work on their big India book at once. If they protested that they had just landed and would need at least a year to write a book, he insisted that they had got it exactly wrong. "The first day in India," he would say, "every foreigner is convinced he can write a book about it. After a year of living here, he realizes he can't write a meaningful sentence about it."
Fortunately, Edward Luce was not put off by this advice. The South Asia bureau chief for the Financial Times from 2001 to 2005, Luce is the author of In Spite of the Gods: The Strange Rise of Modern India, a recently published work that is the latest in a line of tomes seeking to explain how the erstwhile land of snake charmers and flying carpets has become the world's newest economic power. It is also, far and away, the best.

Like many foreign observers of India's economic emergence, Luce starts by laying out the basic problem: the "curiously lopsided" way in which India's economy has boomed. Why does a country that is home to advanced high-tech and manufacturing companies still have about 400 million illiterate people and high unemployment? In so many aspects of its economy, Luce notes, "India finds itself higher on the ladder than one would expect it to be," yet "most of its population are still standing at the bottom." Many articles and books on India end here, but Luce explains the reasons for India's interminable paradoxes, arguing they are the logical outcomes of illogical polices.

Since the country's independence in 1947, Luce notes, India's policy planners have invested limited resources both on universities and on primary schools. That's produced a class of English-speaking engineering graduates who can compete with anyone in the world. But the flip side of diverting a big chunk of the education budget to create and run sophisticated universities is that millions of Indians have been left without basic education. Another puzzle is why only 7 million Indians?as opposed to 100 million in China?are employed in the formal manufacturing sector. A major reason is that state laws make it very difficult for factories to lay off workers, Luce explains. As a result, Indian capitalists invest in advanced, efficient manufacturing facilities, which allow them to maximize production while minimizing employment. This is good for profit margins, but not for the millions of desperate job seekers.

Luce is strongest on economics, but he's also a savvy observer of the social and political environments that alternately nurture and throttle India's growth. With equal aplomb, he tackles topics such as the surging political power of India's lower castes, the rise and (apparent) decline of Hindu nationalism and the decline and (apparent) resurgence of the Gandhi-Nehru dynasty. Luce also takes a stab at explaining the big regional differences in economic development within India. For example, a senior bureaucrat in the southern state of Tamil Nadu candidly tells Luce that about 30% of public funds meant for promoting literacy, roads and electrification in his state are "diverted"?embezzled by bureaucrats?versus 70% in the north. The result: half of Tamil Nadu now lives in cities, where the standard of living tends to be higher, whereas 90% of the population of the northern Indian state of Bihar still lives in villages. And if you're wondering what life in an Indian village is like, Luce describes it vividly: "The tubercular hacking cough is as common a sound in the north Indian village as the lowing of the cattle or the ringing of the temple bell."

Luce offers some remedies for India's pervasive poverty and uneven development: fix labor laws, improve rural infrastructure and social services, and preserve and strengthen democratic institutions. India also must stop the spread of AIDS, he says, and protect its environment, which is decaying fast as the economy heats up. This is all perfectly sensible, but not all of Luce's arguments are rock solid. For example, he laments the stupidity of labeling all of India's diverse Muslim groups as fundamentalists, yet he brushes off the threat from Islamic fanaticism too casually. Its reach may still be miniscule within India, but it is spreading, and the terrorists who blow up trains in Bombay are at least as great a threat to India's economic future as any that Luce lists. For the most part, though, In Spite of the Gods: The Strange Rise of Modern India is an exceptional book, and that's because its author is unusual: he's a foreigner who gets India.

From the Novemeber 27, 2006 issue of TIME Asia

Made Like a Gun (re-post)

The first motorized vehicle that I owned was a brand new, black, 1993, Yamaha RX 100. I can still remember the day. It was September 13, 1993. I was in 12th grade, and like every other guy of that age, in Punjab at that time, had long wished for a motorcycle. No, a scooter wouldn't do ! Before that, I used to ride a BSA Mach 1, a sports bicycle. A few years later, while at medical college, I decided to graduate to a bigger motorcycle, one which I had longed for much more than I had for any other. It was a metallic silver, 1998, Royal Enfield Bullet 500. Though, I don't remember the exact date, I bought that brand new in January 1999.

All the three bikes that I owned, including the BSA Mach 1, had a special place in the existing young, urban, Punjabi culture of their times. Owning each one of these, put one in a different class of pride, prestige and personality. Though, the Mach 1 and RX 100 were popular amongst a particular age group, at a particular time in history, and were limited to the urban population, it is the Royal Enfield Bullet which, for long, has transcended these boundaries.

The first chapter, in the story of the "Bullet", as it is popularly known in India, started in mid 19th century in the tiny village of Hunt End, near the town of Redditch, Worcestershire, England when George Townsend & Co. opened their doors as a firm specializing in sewing needles and machine parts. A few years down the road, during that period of industrialization in Europe, the firm ventured into the trade of pedal-cycles, and was soon manufacturing its own brand. It was in 1893, that their cycles began sporting the name "Enfield", and the trademark "Made Like a Gun". Little would have they realized, that it was the beginning of a legend which would transcend centuries and borders.

The first Enfield motorcycle arrived in India, in 1949, when Madras Motorcycles won an order from the Indian Army for the supply of motorcycles. The motorcycle was the 350cc Bullet, and the beginning of the second chapter in the story. Over the years, several models were introduced, including a Mini Bullet, one which you might have seen in several Hindi films of the 70's and 80's, and the world's first diesel motorcycle to go on production line, the Taurus. However, the design and mechanics of the original Bullet remained pretty much unchanged until the turn of the century. The Bullet 500 that I owned was first introduced in 1993, and went on to become the most desired, a green in the eye.

In context of its role in the culture of Punjab, the Bullet can best be regarded an icon. The "dugg, dugg" of its engine is just as much part of Punjab and the lives of its people as "lassi", "makki di roti","saron da saag", "gidha", and "bhangra". Ever since the urbanisation of Punjab, a "dodhi" or the milk vendor has been integral to the very existence of life in Punjab which had earlier been a predominantly farming state, and 90% of its urban population can trace their backgrounds to some "pind". People might have moved on to live in towns and cities but there is still a vital link that keeps them connected to their roots, and that is the "dodhi", and the unmistakable "dugg dugg" of his Bullet.

Punjabis belong to a strong, robust, machsimo race which is crumbling to the unhealthy eating, working, and living conditions of urbanisation. A Bullet, for these urban Punjabis, is the best reflection of their lost personalities. For some others, it is a stamp of authority. For some, it is sign of being macho amongst peers. For a few others, its a "magic wand" when it comes to winning over girls ! Above all, whatever their respective reasons, every Bullet owner prides in owning a piece of history, and the respect it commands !

par excellence

This post is dedicated to an extremely talented photographer from Amritsar, India. I came across his work via Flickr. I find it more interesting because his works are a very earthy depiction of life in Punjab. Click here for more.

Why eating feels good?

The need to eat is initiated, in part, by a hormone known as ghrelin. Although ghrelin is known to be produced in the gut and to trigger the brain to promote eating, it remains to be determined precisely how ghrelin affects different parts of the brain. Now, in a study appearing online on October 19, in advance of publication in the December print issue of the Journal of Clinical Investigation, researchers from Yale University, have shown that in mice and rats ghrelin triggers the same neurons as delicious food, sexual experience, and many recreational drugs; that is, neurons that provide the sensation of pleasure and the expectation of reward. These neurons produce dopamine and are located in a region of the brain known as the ventral tegmental area (VTA). Tamas Horvath and colleagues showed that ghrelin bound its receptor on neurons of the VTA and triggered their production of dopamine. Importantly, infusion of ghrelin into the VTA of rats increased their food intake. Conversely, infusion of inhibitors of the ghrelin receptor into the VTA of rats decreased the amount they consumed after a 24-hour fast. This study identifies the VTA as a site of action for ghrelin to induce food intake. As this region of the brain is also triggered by many recreational drugs and is known to produce the expectation of reward, the authors suggest that ghrelin stimulation of the VTA might be involved in diseases of food abuse.

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TITLE: Ghrelin modulates the activity and synaptic input organization of midbrain dopamine neurons while promoting appetite AUTHOR CONTACT:Tamas L. HorvathYale University School of Medicine, New Haven, Connecticut, USA. Contact: Karen Honey Journal of Clinical Investigation

Its been quite a while....

since I posted something on the blog. As expected Residency wouldn't allow me the time and sanity to do so. On top of that, I added to my own woes by choosing to do Internal Medicine and Neurology during the intern year. I just finished my first rotation in Neurology which went past smoothly. Prior to that was a week long 'orientation' which was somewhat overwhelming as most of it was about medico-legal and ethical issues, something most of the incoming residents, if given a choice, would want to give a pass ! Though utterly important in the context of medical practice today, honestly, for me, 'How to save my skin ?' and 'How to become a good business man ?' were the last thing on my mind. But, sadly, they are no longer !

We started moving our stuff to Buffalo in the first week of June. However, we still haven't really settled down. We have been back in Brampton on almost all but one weekend since then. Buffalo, however, is a nice town. Particularly the area that we live in called Amherst. Its the 4th safest town in the whole of the US, and has one of the best school districts in the whole country ! There is a lot to explore in and around Buffalo which I hope we will be able to do starting next summer when I move to my own department that is Psychiatry. People we have come across have all been nice so far both at work and in the neighbourhood. Though, Amherst is 95 % white, in our apartment complex and at my work its very multicultural with majority South Asian and Chinese (as you would expect!). This year's approximately 180 incoming residents at the University at Buffalo represent 37 different countries ! Yeah you are right, and there are just as many South Asians as Americans !

African Safari Collage