Address and Interaction With the Students of Kurnool Medical College on the Occasion of Its Golden Jubilee, Kurnool

Removing the pain is a great Mission

"Medical professionals are in God?s mission"

I am indeed delighted to participate in the Golden Jubilee Celebrations of Kurnool Medical College and interact with the students and faculty members. I congratulate the Kurnool Medical College community both present and past who have built a robust educational framework for medical education during the last five decades. My greetings to the principal, faculty members, doctors, nurses, para-medical personnel, support staff, medical students and distinguished guests.

Dear Graduating students, when I see you all, in front of me, a scene of our country appears which links the new doctors and their role in the national mission. What is that scene? In our country, 700 million people live in 600,000 villages equivalent to 200,000 panchayats. We have 2020 Vision Document prepared by TIFAC, which mentions about the typical disease pattern which will be faced by the country in 2020. It is expected that HIV/TB combination, water borne diseases, cardiac diseases will be the predominant diseases and we have to find solutions for diagnosing and treatment. Also there are challenges for researchers for discovering molecule leading to drugs for various diseases such as diabetics, cancer, allergic diseases, inflammatory diseases, and certain type of new pattern of diseases in the tribal sector such as sickle cell disease. Many of you may take up practising healthcare in various fields and some of you may opt for research and development. The opportunities for you in the country, will be challenging equally both in the urban and rural areas. With the development of electronic connectivity and knowledge connectivity, and the spreading of health care centres and quality education we should be able to provide quality health care to our rural citizens. I am sure many of you will find working in rural areas to be really challenging.

For example, tele-medicine is a new area, you may find being used in large number of places for diagnosis and advice. Another area which is knocking at our doors is preventive healthcare. Some of you may participate in the research, development and use of vaccines against HIV, malaria and even against the cardiac diseases. There are several other avenues such as application of stem cell therapy for many ailments like treatment of heart failure and diabetics. Students should be aware of such developments taking place in the country and elsewhere. I have selected the topic for discussion "Removing the pain is a great Mission."

Tradition of Research and Vision

Recently, I met Dr. Charles Cummings, of the Johns Hopkins University Board and his team. I asked him, a question which was in my mind, ?Dr Charles, What made Johns Hopkins a world class medical research institution in addition to its cherishing societal missions?? His answer was, ?it is due to a great tradition, and it started with a number of visionaries simultaneously with value system, focused missions and the nature of working together. The most important aspect is the research, research base and the quantity of clinical data added everyday. This tradition continues even now?. Indeed it is a great message from Dr. Charles. I am sure, every medical institution in the country should imbibe this culture that comes out of research tradition, leading to the results of the research reaching the people in the form of medi-care, medicines or vaccines. I recall, in India one of the leading institutions in Hyderabad L.V. Prasad Eye Institute has set a tradition of providing quality eye care particularly with social commitment of 1:1. 1:1 implies one free eye care service for every paid eye care service provided by the Institute. Also, they have a tradition of excellent research in Ophthalmology and they are spreading the mission to various parts of the country particularly their research in stem cell which has led to the restoration of eye sight to 300 patients with burn affected eyes.

Health status of India

India has made considerable progress in its health status since its Independence and particularly during the last fifteen years. At the time of Independence, the life expectancy of an Indian was less than thirty years. Between 1991-2006, the life expectancy of Indians has gone up from 58 to 64.35 years, infant mortality has come down from 87 to 60 deaths per 1000 live births and population growth rate has decreased from 1.9% to 1.4%. Still infant mortality is very high. We have to bring infant mortality to less than 1%.

I would like to briefly talk to you on some of the diseases and actions proposed and future need. Our experiences will definitely be shared with the third world developing nations in order to provide healthcare for all.

Drug for faster cure of tuberculosis

The entire country has been brought under the Revised National Tuberculosis Control Programme (RNTCP). This will ensure that maximum number of Tuberculosis cases are detected every year and brought under direct surveillance. The treating agency must ensure that at least 80% success in fully curing the disease is achieved within the year. If this regime is followed continuously for over ten years our tuberculosis load will come down to less than ten per one lakh of population. It is essential to work faster on the development and clearance of new drugs which are in the pipeline. Educational institutions should also participate in this mission.

India has also made significant contributions in developing drugs that are critically required for India. One of the achievements comes from a laboratory of the Council of Scientific and Industrial Research (CSIR). CSIR lab has developed a new therapeutic molecule for Tuberculosis. This molecule has shown the potential to cure TB in around 2 months, as against the standard treatment of 6 to 8 months. This breakthrough is very important. After completing the pre-clinical studies, the molecule transformed into a drug called Sudo-terb is undergoing clinical trials in humans. This development has been done as a public-private partnership involving the Lupin, the three CSIR Laboratories, namely, Central Drug Research Institute, Indian Institute of Chemical Technology and National Chemical Laboratory, and the University of Hyderabad. It is hoped that the drug will be in the market soon after the clinical trials. In addition to the above, there is also a need to develop a more effective vaccine against tuberculosis. The combined action of surveillance, detection and disciplined treatment have to work together to ensure faster cure of existing cases. Prevention of future cases has to be achieved through R & D efforts of developing new breed of vaccine and medicines. The collaborative action is needed between healthcare personnel, academicians, doctors, researchers and the pharmaceutical companies both in the private and public sectors to accomplish this mission.

Malaria

Incidence of Malaria has reduced from 22 lakh to 18 lakh in the period 1998-2006. However, the death cases has increased from 644 to 943. I understand that the conventional medicine used for treatment of Malaria namely Chloroquin has become resistant to Falciparum which causes cerebral Malaria. Our scientific community has developed and produced a drug named Arteether from Artemisinin which has been found to be an effective cure for cerebral Malaria. I understand that this drug is being exported to over forty countries. Also, Ranbaxy has acquired a malarial drug molecule and they are progressing towards clinical trials. The fully developed drug will be available in the market soon. This will be another important milestone in the treatment of Malaria.

Over the years, I find that in spite of our efforts there is no rapid reduction in the occurrence of Malaria cases in the country. While taking up new projects, it is essential to have multi-faceted inter-sectoral collaboration between various partners so that the impact assessment of the project on new type of diseases can be foreseen and suitable preventive action taken to contain the disease. In addition to this, we have to improve the surveillance, develop rapid diagnostic kit and use the conventional prevention methods of spraying to control the vector. International Centre for Genetic Engineering and Bio-technology in collaboration with Bharat Bio-tech has developed a vaccine for Malaria which will go for toxicity trials on animals. There is a need to speed up such projects so that they will benefit the entire community who are affected by Malaria in different parts of the world. KMC can participate in such missions. Now, I would like to present HIV /AIDS control.

HIV/AIDS Control

Today in our country, all age groups put together have an incidence of 5.7 million HIV cases. 163 out of 611 districts in the country have a high proportion of HIV cases. The scientific community had a very important mission of determining the genetic nature of HIV that will lead to its cure. The genetic nature when studied had some surprises. The retro virus is RNA based and not DNA based. Most retro viruses have only three genes, whereas the HIV virus had nine genes, with 9200 base pairs. With this understanding of the genetic nature, a number of drugs have come in at least to control HIV in as it is where it is condition. This intervention extends the life of HIV affected persons. The typical drug which has been developed and produced abroad is AZT, based on DNA synthesis. It halts the spread of the disease. Another medicine found is INDINAVIR with equally good results. A foreign University has tried a combination of AZT-INDINAVIR and 3TC, for some patients, which gave unique results fully suppressing the HIV AID virus. Of course research is continuing. I am sharing this with the young students, to convey that there is a possibility of controlling HIV and extending the life of patients. However, the cost of the medicine was so far prohibitive. Indian companies have already brought down the cost of first line treatment to an AIDS patient from 12,000 US dollars to 300 US dollars per year. Similarly, the cost of second line treatment has also been brought down through the development of medicines such as Viraday a substitute for Atripla from 12,000 US dollars a month to 110 US dollars a month. Medical community assembled here should make use of these medicines so that further cost effective methods can be evolved.

Development of Anti HIV Vaccine

Apart from the HIV control protocol, the most important mission for the country today has to be the prevention of the spread of HIV further. There is no other way other than developing and leading to production an effective anti-HIV vaccine.

Phase one clinical trials of an imported Adeno-Associated Virus based HIV vaccine was initiated at the National AIDS Research Institute, Pune in early 2005. Thirty volunteers that were enrolled in the study and given HIV vaccine will complete follow up in January 2007. The vaccine has been tolerated well by volunteers and safety is good. Immunogenicity studies were carried out during the follow up. Results will be decoded and analyzed after follow up of the last volunteer is completed. In the event of the successful completion of Phase-I trials, technology transfer to an Indian company will take place. Another Phase-I vaccine trial was initiated last year at the Tuberculosis Research Centre for the Modified Vaccinia Ankara (MVA) based vaccine developed from the Indian HIV-1 sub type C virus genes. This vaccine has been developed by Indian Scientists in collaboration with a US company under the ICMR-NACO-LAVI programme. These two anti-HIV vaccines have to be completed with a time bound mission mode, as it is very important for India?s HIV control programme. It is also essential to take up a third fully indigenous anti-HIV programme as a collaborative work between educational institutions like KMC, research laboratories and traditional medicine practitioners.

Management of Cardiac Diseases

Multi-dimensional solutions are available for management of the diseases based on my discussion with experts. The solutions include medicinal treatment using Statins, which lowers the cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver responsible for making excess cholesterol. However one has to be careful about the side effects and take adequate precautions while treating the patients. The second is through angiography and angioplasty using stents. I understand that very soon we may have bio-degradable stents. The next generation stents may be nano-stents. If the heart blockage is severe, valve defect and death of cells in the heart due to less blood supply etc. surgical intervention will be necessary or it may lead to treatment using stem cells.

Non-invasive treatment for Coronary Artery Disease

Today, I find that cardio vascular treatment moving towards a totally non-invasive treatment using EXTERNAL COUNTER PULSATION (ECP), a truly non-operative, non-pharmaceutical, safe and effective treatment which is being used in many countries. In India also a few centres have come up. This is a ripe area for research of the faculty members and students of KMC, Kurnool.

Conclusion

Human disorders can be classified into three broad categories. They are genetic disorders, disorders due to cellular function deficiency and disorders arising out of certain pathogens. I recommend intensive research for developing and producing cost effective treatment regime for the above categories of disorder through

(a) Gene therapy and gene chip research

(b) Stem cell research and

(c) Combination vaccine and pathogen specific antibiotics

This could lead to cost effective and safe treatment for the needy and improve the quality of life of mankind on this planet. KMC can be a partner in some of these research areas.

Recently, there was a meeting of cured patients, their doctors and a few social workers. One important point emerged during the interaction was that the relationship between the patient and doctor extends to patients? family. This in turn, transmits effective messages from one family to another family on advice to prevent diseases, necessity of periodic checks, the dietary habits and the need for life style changes including exercise for good health. Actually, I believe this good contact between the doctor and patients is very valuable. I request every doctor of KMC to play the role of a teacher in advising every family on disease prevention and methods to lead a healthy life. This message should also be given to all the students graduating from KMC so that they will find time to put this noble action into practise during the medical career.

Giving quality health care through continuous acquisition of knowledge, upgrading diagnosis and treatment, providing care and counselling particularly to the unreached should become the life time mission of each one of you graduating from KMC. Thus you will contribute effectively to the mission of developed India 2020.

My greetings to all the members of KMC Kurnool during their Golden Jubilee Celebrations and my best wishes to the students and faculty members of this college in their mission of developing quality healthcare professionals for nation building.

May God bless you.

Five Point Oath for Medical Professionals

1. We the medical professionals realize that we are in God?s mission.

2. We will always give part of our time for treating patients who cannot afford.

3. We will treat at least 20 rural patients in a year at minimum cost by going to rural areas.

4. We will encourage the development of quality indigenous equipments and consumables by making use of them and assisting in enhancing the quality and reliability of the products.

5. We will follow the motto "Let my brain remove the pain of the suffering humanity and bring smiles".

Question and Answer Session

1. How can we promote the interdisciplinary sharing of knowledge to bring out the best in the Medical Field as far as India is concerned.

- Dr. J. Raghu, P.G. Student in M.D. (Pulmonary Medicine) , Final Year Kurnool Medical College ,Kurnool

Ans: Hospitals need to create a culture of sharing which alone will promote inter-disciplinary of sharing knowledge among the professionals. To promote interdisciplinary sharing of knowledge, it is necessary to have a common meeting of all the doctors of different specialities in the hospital. In addition, there can be a common website in which the special cases of diagnosis and treatment are brought out by different specialists in a hospital. This will promote sharing of interdisciplinary knowledge. With the electronic data base storage, all the doctors can be connected and share the knowledge about a particular patient based on their specialization. This is also another tool by which inter-disciplinary sharing is possible. For integrated healthcare, it will be useful to have doctors from Allopathy, Homeopathy, Siddha, Ayurveda and Unani in the samehospital. They can collectively examine the patients so that the patient can get the advantage of best from all systems of medicines. Such a scheme I have found in taking place in some parts of India.

2. May I know from you various modalities by which we can encourage youth of India to take ?Research as career option? so that India becomes a Superpower.

- S.V. Naveen Prasad, Internee, Government General Hospital, Kurnool.

Ans: I have already suggested a science cadre be created which will enable the prospective students and their parents to appreciate the importance research as a career. Also, there is a need for the senior scientists to emphasize the value of science among the students right from school. Thirdly, the students must be made to enjoy the bliss of science in small doses so that he can get attracted to science as a life time mission.

3. May I know how we can apply advances in Technology in the field of ?Genetic Engineering ? without affecting the ?morality? of the people?

- Dr. G. Hareesh Kumar, 9th semester U.G. Student, Kurnool Medical College, Kurnool.

Ans: When we go for high technology, we have to draw the lines through a well defined legal framework and conventions so that we do not intrude upon individual privacy.

4. May I know your vision for Medical filed & recent advances in the field of Medicine.

- Dr. K. Keerthinmayee, P.G. Student in General Surgery, Final Year, Kurnool Medical College, Kurnool.

Ans: Some of the recent advances I have already discussed in my talk. Stem cell research and convergence of technology(IT, Bio-technology and nano) will play a major role in the field of medicines during the 21st century.

5. May I Know from your Excellency , How can advances in Nanotechnology be made a useful tool in Medical Field.

- S. Lakshmi Sravanthi, Internee, Govt. General Hospital, Kurnool.

Ans: Nano-technology in Drug delivery has already shown promising result in directing the drug to the affected spot in the controlled doses. Nano-technology can be used for cancer treatment in such a way while destroying cancer cell, life cells are preserved. There are several uses of this nature on which researchers in India and abroad are working.

6. Your Excellency, how the advances in Technology can be applied for the betterment of rural health care?

- Dr. M.Swarnabala, 5th Semester, U.G. student, Kurnool Medical College, Kurnool

Ans: Mobile clinics can reach the rural areas and provide health care at the door step of the rural citizens. For higher level of healthcare tele-medicine, tele-ophthalmology, tele-radiology are technological tools which can enable the diagnosis and advice to reach the rural area with the help of experts located in district and state level hospitals.