Address During The Inauguration Of 53rd Armed Forces Medical Research Conference(Afmc), Pune

Let my Brain Remove the Pain

I am delighted to participate in the inauguration of 53rd Armed Forces Medical Research Conference organized by the Armed Forces Medical Services. I greet the specialist doctors, scientists, technologists, pharmacologists, medical support personnel and distinguished guests participating in this conference.

I have been closely involved in the collaborative research activities between the life science research scientists of DRDO and armed forces research team. During the last two decades this team has contributed in improving the health and operational efficiency of the soldiers. During the next two decades, the crucial development will take place in science and technology, particularly in life science area. Fortunately DRDO?s Life Sciences Research Board has given due importance to various present and future requirements of the armed forces. In today?s discussion both the Armed Forces Medical Research Committee and Life Sciences Research Board of DRDO are to consider certain priority areas and focus their developments. The results should be useful and beneficial for our soldiers.

Health care of Armed forces is quite complex in war time and also in peacetime. War time the type of injuries mostly head oriented and also below the hip, the typical problem immediately would be attended are protecting the eye, brain damage and bone repair. Attending the cardio vascular system in right time. In peace time attending the orthopeadic reconstruction, retina replacements and liver damage. Right type of blood availability and timely blood transfusion and revival. In long term transplantation of liver, eye, plastic surgery.

Keeping this in mind, I would like to talk to you on ?Let my Brain Remove the Pain?.

Coronary Artery Disease profile

As per one of the studies, only 8% of the world population has access to heart surgery delivery systems. Out of the 6.5 lakh surgeries taking place in a year, 4.5 lakhs are performed in USA alone, only 2 lakhs are performed in the rest of the world. In India, fifty to sixty thousand operations are performed every year, whereas possibly 2.5 million people may need heart operations in India. Even though armed forces personnel are less susceptible for cardio vascular ailments, but injuries in the heart regions due to war time operations and also due to reduced physical activity in the peace stations the incidence of cardio vascular diseases are noticeable. Another observation is that the occurrence of coronary artery diseases in India is taking place between the age group of 35 and 55, whereas in the western world, it generally occurs after 55 or 60. The main reason for this in India is attributed to the urban life style and intake of rich food having high cholesterol. It is also found that the occurrence of cardiovascular cases is 4% in rural area as against the 10% found in big cities in India. Whereas the world statistics says that the incidence is only 3 to 4%. The genetic predisposition of Indian population for cardio vascular diseases needs to be given special attention. A research is essential for establishing the reasons for occurrence of heart ailments among Indians at a young age and also the reduced occurrence of the disease in rural areas. The results of the study will assist in national planning for combating the heart ailment.

Stem cell research

Many Indian laboratories and hospitals are working in Research and Development of Stem Cell production. Advancement in Stem cell research in the country has brought confidence among expert doctors to take up its clinical application in heart, eye, pancreas, liver, neural, kidney diseases and spinal injury.

(a) Stem cell therapy for future heart ailments: Newer knowledge emerging out of research on stem cells from abroad and India has to be taken note of and studied. Drawing of tens of thousands of stem cell - immature cells that are capable of transforming themselves into almost any kind of tissues from the suffering patients and inject them into the heart to stimulate heart repair. In one case, it is reported that the pumping efficiency has increased from 25% to 40% over a period of four months. In 2004, successful stem cell procedures that resulted in measurable boost in blood pumping capacity have increased substantially in many countries across the globe. This holds a big promise for effective heart repair for ailing people.

(b) Experience in stem cell: During my visit to various laboratories, I happened to see the beginning of stem cell research for different purposes including brain research. I would like to share with you an important stem cell research application in the field of cardiology. When I met Dr. P. Venugopal, Director, All India Institute of Medical Sciences (AIIMS) a famous cardiovascular and thoracic surgeon, he told me about his experiences. He said in one of the cardiac diseases, where conventional medical and surgical treatment were ineffective because of the affliction of the heart muscle, use of autologous bone marrow stem cells implantation into the diseased heart muscles had been applied in order to improve the function of heart muscle. This kind of application of this procedure is the latest and very few cases have been done in the world, such an application has been done for the first time in India. This is expected to open new frontiers in the treatment of patients for regeneration of heart muscles, thereby giving new hope for the patients suffering from terminal stage heart disease.

The New Scientist (dated 25th September 2004) has reported another remarkable recovery of a heart patient at the John Wolfgang Goethe University at Frankfurt. Of course for the first time, I have come across a warning, stating that risk is very high. Against stem cell solution for every aspect of human disease, it is reported that large amount of animal tests is needed before applying it on humans.

Stem Cell for Restoration of Vision

The recent identification and characterization of progenitors with stem cell properties has opened new avenues that may be useful for treating functional impairments caused by the death of specific cell population. Stromal and neuronal degeneration are the causes of debilitating visual impairment associated with many ocular diseases, such as degenerative diseases of cornea, retinitis pigmentosa (RP), age related macular degeneration (AMD) and glaucoma. The stem cells may help restore vision in patient who has these diseases, by repopulating or rescuing the damaged ocular surface cells or retinal cells from further degeneration.

The stem cell team of LV Prasad Eye Institute, Hyderabad has administered stem cells in the affected region of the eye for over 200 patients and all of them are performing very well. Apart from India, patients have come from Bangladesh and Nepal. The research in this frontier area is facilitated by quality research publications.

Stem Cell research ? focus

On 4th January 2005 during the Indian Science Congress, I had a discussion with the researchers and clinical physicians who are working in Stem cell area. They are working in different areas of stem cell, such as Cancer treatment, ophthalmology, spinal cord, cardiology etc. Details of some of the success stories and experience were shared.

Dr. Bhan, Secretary, DBT and Dr. Ganguly, DG-ICMR is working together in promoting stem cell research. They are evolving a road map for stem cell research through three areas such as adult stem cells, umbilical cord stem cells, and embryonic stem cells. A focus has been given to stem cell research so that a mission mode operation can soon commence. I was happy to note that the clinicians are driving the research; this will enable easy technology transfer and fast diffusion of technology. I understand that the Armed Forces have already started work in stem cell areas in two of their institutes and have created infrastructure both for research and clinical operation. I would suggest the members of Armed Forces Medical Research Committee to participate in the National Stem Cell Research and Application Programme.

Research in Gene Chip

Indian population is highly susceptible for coronary heart diseases that too at a relatively young age irrespective of where they live. As you are aware, Gene Chip arrays have tremendous potential to reach goals from identifying genetic variations associated with heart disease for discovering new drug targets.

Recently, I was in Chennai at Dr. Cherian?s Medical Centre. It is known as, International Centre for Biomedical Sciences and Technology (Research & Applications). There I interacted with Dr. Emmanuel, who is working in the area of Gene Chip. He says the Gene Chip can be used for finding the existence of genetic diseases including coronary artery diseases in the baby during a certain stage of pregnancy itself. The Armed Forces Medical Services can consider incorporation of the gene chip mandatory test during the prenatal screening which I am told is regularly being done for all antenatal cases.

As many as 50 different mutated genes are identified as responsible for heart problems in Indian population. If a person is not having any of these harmful mutated genes, then he may not suffer from heart ailments. The Gene Chip is one which on contacting with the blood, immediately identifies the mutated genes in the person. Based on this information, proper guidance can be given to the patients and parents. The chip could also be modified to suggest to the patient?s system to develop those chemicals which in turn will help the patient recover from the present situation.

It is reported that gene differences between humans and most animals are very nominal. More than 90% of our DNA is similar. This property is a boon to researchers since animal models can be subsequently used for curing human diseases based on trial data. It has also been found that Gene Chips can be used for early diagnosis of tumors and their treatment. Integrating molecular biology, cytogenetics and bio-chemistry, bio-chip technology is regarded as one of the greatest inventions in the research of gene functions. It is far superior to molecular biological technology in terms of speed and accuracy. I would recommend the medical researchers assembled here to work in this area for finding the application of Gene Chip as a diagnostic tool and as a treatment regime for many diseases.

Research for Treatment of Parkinson ?s disease

Recently I met Prof. Vijay K Varadan of Pennsylvania State University, USA. He shared his experience on the possible line of treatment for Parkinson?s disease and Epilepsy. The primary symptoms in Parkinson?s Disease as you all aware are tremor or trembling in hands, arms, legs, jaw, and face, rigidity or stiffness of the limbs, slowness of movement and impaired balance. Prof Varadan has devised a wireless system for monitoring and control of Parkinson?s disease. The system consists of an implantable DNA insert (CNT probes) in the head region for generating a pulse to the nerve system; controlled either by a modified pacemaker or smart hat having passive polymer based gyro sensors, which are implanted in the tremor location. The sensor gets the power from the Pacemaker and the Pacemaker then reads the tremor motion to generate pulse in the implanted device in the head to control the tremor. This appears to be a promising line of treatment for such diseases. Prof. Varadan also has reported that a few patients affected by Parkinson?s disease had full recovery. Such medical intervention is also being done by Jaslok Hospital in Mumbai and AIIMS at New Delhi. Can the medical community explore the possibility of using a combination of stem cell and gene chips as a line of treatment for Parkinson?s disease or epilepsy. During military operations it is possible that some of the soldiers get head injury affecting the brain in many ways and they need advance treatment through convergence of technologies like the trio of bio, nano and information technologies. I would suggest Armed Forces Medical Specialists to have collaborative programme with All India Institute of Medical Sciences (AIIMS) and other medical institutions working in this area for promoting rehabilitation treatment for our soldiers.

HIV/AIDS Vaccine

One of the important areas, where I would like the Armed Forces Medical Community to concentrate is on the containment of HIV/AIDS. Efforts are being made all in the West to develop not only the retro-viral drugs for combating the disease but also to develop a vaccine for the prevention of HIV/AIDS. Here again, countries like India would have to fend for themselves because, I am told, that the AIDS virus which is prevalent in our country is of a different strain from that which affects the West and Africa. As such, our research institutes and professionals would require developing their own drugs and vaccines to combat these strains of AIDS/HIV virus. As far as India is concerned, I am told that the anti vaccine for HIV/AIDS is in the advanced stage of development and getting ready for clinical trials. This programme needs highest priority from multi work-centres including armed forces hospitals in a mission mode. We may need to explore developing a vaccine which will have therapeutic application against a wide spectrum of HIV strains prevalent among Indian population. I am happy to know that the Armed Forces Medical Services has been sensitive and pro-active to this dreaded disease and have created their own surveillance criteria as well as a very comprehensive information, education and communication network. In addition, the Armed Forces I am told have many firsts in the fight against HIV/AIDS and is the first organized sector in the country to have introduced ART (anti-retro viral therapy) for all the personnel and their families as well as 100% screening during the antenatal checkup. This has resulted in the containment of the virus among the troops and today the number of cases reported annually is on the decline. In the anti HIV vaccine development and the clinical trials, AFMRC needs to become a partner.

Rehabilitation of Disabled Personnel

During military operations a number of people are disabled and immobilized. Also, immobilization takes place due to adverse environmental conditions. It is essential to carryout research on special rehabilitation methods to provide near normal performance efficiency to the soldiers, sailors and airmen affected by enemy action. Major loss is of the limbs. In line with this, I have been informed that the Armed Forces have an artificial limb centre established at Pune which has done pioneering work to provide better, stronger, lighter and more durable appliances for the soldiers and the citizens of the country. In addition to this, the personnel posted at high altitude, counter insurgency and other isolated areas experience psychological problems. We have to design special debriefing techniques for personnel returning from difficult areas so that we can assess the psychological conditions and provide them counseling and other psychological support for enabling them to lead a normal life in the society. This is an inter-disciplinary area requiring active research by physiologists and psychologists. I am told that AFMS has already developed a comprehensive capsule for managing combat stress. This activity has to be intensified for continuously improving the rehabilitation package for the soldiers.

Health Repair

The Human system is an example of a perfect design in the biological evolution. It has been designed with high precision. The mankind is attempting to reach the precision of human system in mechanical system design and electrical system design. This may become possible with the advancement in nano-science and technology. With this approach the future in medical science will lead to health repair instead of being healthcare. There will be more and more replacement of damaged system and parts, both artificial and naturally grown through the use of implanted stem cells. Some of the examples are Cochlear implants for hearing impairment and televised signals for eye impairment through vision cameras to reach near normal enablement. Also, the medical science is advancing to target the medicine with precision through bio-nano-robots which will treat the patients and finally the robot will get digested. The medical research community has to work in these frontier areas for improving the life style of the mankind needing such reconditioning.

Organ Bank

During military operations a number of casualties takes place, much ahead we have to have a biological organ bank. We have to adopt a system and work out a drill so that we can collect the healthy organs from the casualties with speed and store it in a bank for use by needy patients. Example bone marrow for high radiation treatments, umbical chord stem cells for tissue regeneration. Such banks will help to restore vision, transplant of liver, kidney for the cure of patients in an effective way. AFMS may consider creation of such biological organ bank and carryout research for long term storage. For example, I understand that Wisconsin University has succeeded in finding a new solution which can preserve the harvested liver for 24 hours instead of the present 5 to 12 hours. Our researchers need to take note of this development and work for increasing the preservation time of the harvested liver.

Networking of Multiple Medical Centres

Our Armed Forces have a number of hospitals and healthcare units spread in many parts of the country. They have specialists in almost all areas of medical science. I understand some hospitals have installed tele-medicine facilities. I would recommend creation of network of all hospitals through tele-connectivity and conferencing atleast once in a month, so that the clinical data pertaining to various ailments and diseases, can be shared by all the hospitals and specialists. In addition, it will be useful to have presentation of case studies by different specialists when they find special type of ailments and provide innovative treatment to the patients. This research committee can also encourage service personnel to ask questions through the tele-medicine systems to the panel of specialist?s doctors and find a solution to their problems, particularly the health centres and mobile clinic centres of armed forces which are located in the operational areas should be tele-connected to share in real time. This will enable the patient to have the benefit of advice from doctors with varied experience and arrive at a treatment regime for complex cases. I understand the AFMS have already networked the healthcare establishment in Northern Command with Army Hospital Research and Referral in Delhi. This facility can be extended to all the military hospitals in the country in a phased manner.

DRDO ? Armed Forces Medical Research Committee Partnership

DRDO has over ten laboratories working in life sciences area. They work in different areas such as nuclear medicine, thyroid, nutrition, bio-medical systems, virology, agriculture, clothing and shelter for high altitude and difficult areas. Although there is a good working relationship at the institutional level what is needed is connectivity between the working scientists, practicing doctors and the clients without the organizational barrier. This intensified association will provide an opportunity to have close interaction between researchers and clinicians which is vital for the development of drugs and fast clinical trials for application of drugs to provide better healthcare to the mankind.

New Pharmaceutical initiative of DRDO

DRDO has successfully developed an antigen based typhoid detection kit, which can quickly diagonise with in about 5 min, the typhoid organism, where as convetional kit takes 3 to 5 days, since it is antibody titre based. This technology has been transferred to excyton for upscaling and commercialization. Similarly, for cancer treatment analog glucose (2-de-oxyde-glucose) developed by INMAS as radio sensitizer has been transferred to Dr. Reddy?s laboratories for production and commercialization. Since the product patent policy implementation is at our doorsteps, such indigenous efforts are mandatory to ensure availability of affordable healthcare to our population.

Conclusion

Research requires persistent effort. One of the problems faced by AFMS is the constant posting of doctors from one station to another and one type of hospital to another. This, to a certain extent, comes as a problem for maintaining the continuity in research. What is needed is a system by which the doctors can work from any station any time by having tele-education connectivity between all hospitals and work centres for continuing medical education, training and research. The complex operations taking place in different medical centres can be broadcasted through tele-medicine link to the trainee doctors. This is now possible with the availability of our own satellite for education (EDUSAT) and broad band connectivity available till the block level across the country. This facility must be made operational in mission mode to overcome the problem arising out of periodic posting of medical community. This facility will also enable better interaction between the AFMS and corporate, private and government hospitals leading to the enhancement of the scope of their association and contribution to the medical science. In addition to the existing research programmes, AFMRC in partnership with DRDO can consider undertaking a multi-disciplinary, multi-institutional mega programme for management of infectious and water borne diseases. I am happy to inaugurate the 53rd Armed Forces Medical Research conference and wish the members all success in thier research missions.

May God bless you.