As headlines scream shortage and photos of hapless relatives standing in long lines are on front page,
public impression is that scores of people are dying as this life saving elixir is in short supply.

Nothing could be further from truth.

A thread.
If remdesivir was the fabled "Sanjivani buti" we wouldn't see millions of deaths all over the world.

After initial enthusiasm in Feb/March 2020, well designed clinical trials put question mark on superiority of Remdesivir over standard care.
As even more data gathered, clinicians suspected that a small subset of patients may benefit from remdesivir. (There are enough papers to support every claim and more)
Now most sensible clinicians agree that remdesivir should be given to patients who have mild to moderate lung involvement (as seen on CT) and can not maintain adequate O2 levels on room air breathing.

And this is recommended by guidelines as well.
It is obvious that such wooley boundaries of decision making are complicating real life situations.

So far we were talking about science, now let's talk about a wonder called India.
As soon as remdesivir was mentioned in international literature india responded by -

1. Indiscriminate use in patients who have tested positive. Have no symptoms or only mild, non respiratory symptoms.
2. Stockpiling, black marketing and profiteering.
3. Govt steps in !
All it takes to buy this drug now is -
A positive report, doctor's prescription, Aadhar card.

After a positive test, rest 2 are a piece of cake.

No doctor can refuse writing prescription of Remdesivir even if their clinical judgement is against it.
They will be lynched.
So we have a situation where people who have no active disease or minimal disease taking remdesivir BY DEMAND.

And when India demands, it is a stampede. It is blood bath. It is misery. All around.

We have a medicine that is one more small arrow in our quiver, but is touted as Ram-BaaN.

So more people are getting hurt trying to get one than lack of getting one.
This is what happens when healthcare is private, open to all pressures and general public that has abandoned ideal mentioned in constitution - "scientific temper".

That's all.

Take care,
Wear mask,
Keep distance.

Stay safe.
Pl unroll @threadreaderapp

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More from @docbhooshan

12 Mar
This thread is about -
1. harm caused to doctor-patient relationship due to corporatisation of healthcare
2. corruption in govt machinary and
3. laws that govern practice of medicine.

It is about my father who passed away few days ago.
Few months ago when my father was diagnosed with autoimmune vasculitis on top of his chronic kidney disease secondary to lifelong diabetes, we knew his days are numbered. He knew it too.

Doctors gave us a very clear idea about seriousness, complexity and prognosis of it all.
So when he stopped eating solid food in adequate quantity and remained in his bed all through the day, we knew where this was headed.

Two months in and out of ICU, alternate day dialysis and high level of care given to him by family, nurses and doctors wasn't going to make
Read 24 tweets
22 Feb
Back to roots.

Psychiatry is presently not as ostracized as it once used to be, confined to asylums.

Now a days you may even find psychiatrists invited to public functions.

A welcome change but likely to be short lived.

Read on -
#stigma has always been a huge problem for psychiatry.

We got mental health away from Shamans but managed to get stigma in the process.

Persons with mental illness were always feared and hated. Hence confined to asylum, away from sanitized life of people.
Anything perceived as threatening (mentally ill, free thinking women, disenfranchised minorities, political opponents, sexual minorities) was labelled as "madness/character flaw/unsoundness" etc and sent to asylum to spend rest of their life.
Read 12 tweets
21 Dec 20
#Healthcare #India
#BMR ( Basics में राडा) (chaos at basic level)


2 essential components of healthcare are a doctor and a patient. Everything depends on how this fundamental relationship works. Similar to hoe mother-child relationship defines humanity (or mammals)
All knowledge and further directions of prevention, cure and healing; all other healthcare personnel and other agencies exist to support this most fundamental relationship that is the reason of existence of everything "healthcare".
So it is natural that we put a proper label and work category to this relationship. This label will decide everything that goes into and around it.

This is FIRST PRINCIPLE of healthcare.
Read 16 tweets
9 Dec 20
Appropriate anger has already been expressed about this comment in all media and suitable explanation and retraction done already. But I want to look at this as citizen.

North America and Europe have democracy for long time. They had chance of rebuilding their countries through two devastating world wars.

Their building was done before world became aware of rights of endogenous people, environment protection and corporate giants.
Only large country that managed scorching pace of growth and pulling population out of poverty in modern times is China. They are not democracy and there is no word for human rights in their language.
Read 10 tweets
7 Dec 20
Perspective changes decision making.


18 month old child is brought in by parents as they suspect autism.
Pediatrician saw the child 3 months ago and advised them to wait till second birthday.

Parents were worried so they self referred to me.
Should the parents consult me without knowledge of their regular pediatrician?
(Hearing test is already done. Normal.)
When I meet the family, child has definite delay in speech related milestones. All other milestones are fine. signs of autism are absent.

Parents ask a pointed question - "are you sure my child does NOT have autism?"

What are my choices -
Read 14 tweets
27 Oct 20

First year of psychiatry residency teaches some valuable life lessons.

Here is a real life story about fighting delusions and living with them as it applies to today.
I worked in a municipal hospital during my urban internship stint. There was once a week Psychiatry OPD started by resident medical officer Dr Shirole and visiting consultant Dr Thombare (unfortunately, both have now passed away). I had already expressed my interest in Psychiatry
So I was allowed attend this OPD.
Dr Thombare wanted me to learn about symptoms of mind so he asked to talk a patient in detail. He allocated a middle aged man as my patient.
He was on treatment for years and was considered a "stable" patient.
Read 15 tweets

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