Thread: #SuicidePrevention
I promised to tell you abt research on a new treatment which ↓suicides by 60%.
It's from Brazil & Indonesia, 2 countries ~ similar to India in development indicators. India has ~250k suicides /yr so ↓ 60% could save 150,000 lives.
Brazil first ..1/n
The Brazil study covers 50% of the population with information on 114 million ppl followed up for 12 yrs. Impressive, isn't it?
About half, 69 million received the new treatment & rest were controls. Those receiving the treatment had 61% lower suicide rate than controls ....2/n
and the effect was higher in women & young people.
Another study from Indonesia covered 10% of the population and found the same treatment reduced suicides by 18%.
I am not aware of any other Rx with such large effects on suicide prevention at population level..3/n
It is a universal prevention intervention. That is, it's not just targeted at those potentially at risk of suicide but at populations. Importantly the effects don't wear off over time.
What is this wonderful treatment, you will ask. Why is it not being made available to all? 4/n
Conditional Cash Transfers.

The treatment with amazing impact in ↓ suicides. No mental health treatment comes even remotely close to it.
Proof that social interventions have outsized benefits, frequently > conventional mental health treatment...5/n
If you are disappointed reading this, bcoz you expected a miracle drug, you need to re-examine your assumptions. Ask yourself what matters more 2 you? Ideology or saving lives?
@SanityByTanmoy recently wrote about the Brazil research. do read here:
sanitybytanmoy.substack.com/p/the-miracle-…
6/n
"Bolsa Familia" program started in 2003 by President Lula pays ~ US$ 17/mth to poorest families
The Indonesian study is here:
econpapers.repec.org/article/tprres…
Why is this important?
Covid pandemic is likely to lead to ↑poverty (it has already happened in India) & possible ↑se in suicide rates in the coming years. After the 2008 financial crisis, Greece saw ↑ in suicide rates from 2009-2012.
We don't know whether suicides have..8/n
↑/↓/remained same in India bcoz the NCRB has not released the data.
India has 16% of world population, but accounts for nearly 30% of world suicides.
And no one in India keeps data on attempted suicides. In other countries, attempts are 4-20 times suicide nos...9/n
By this count, India has anywhere between 1 million to 5 million suicide attempts each year.
This is year on year, for past many decades.
So, as a concerned citizen what will you do with all this information you just read?

Poverty kills in more ways than you imagined...10/n

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More from @netshrink

7 Aug
Short story of the impact of pandemic on ordinary people who are not on Twitter.
A few days back, Arjun (name changed) called my wife & asked to come & meet her.
Arjun is someone I have known for ~ 2 decade. An owner driver, I have used him for my frequent travels..1/n
to Mumbai & nearby places. He is honest, hardworking guy who my family & I trust a lot. He has ferried my kids when they were as small as 5-10 yrs old to Mumbai to my sister's place all alone with no adults in tow.
A devout God fearing man. Over the yrs, he got married..2/n
had two daughters & got himself a small place for his family.
I had no travel last 15 months, so he would call once in a few months to ask if I had any travel planned.
When he came to meet my wife 2 days ago, the most noticeable thing was how thin he looked. Asked him..3/n
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17 Apr
Thread: Indian understanding of quality & effectiveness of medicines.
Many moons ago, I was contacted by a father from Bihar for his 35 yr old son. Had schizophrenia for nearly 15 years & not getting better since many years. Had seen many Drs but no benefit. He had heard ++
of me from a relative in Pune. "Can I please get my son to see you" he sounded desperate. I normally dissuade people from making such long journeys esp when they have already seen so many Drs + chronic illness. Don't want to raise their hopes. In this case, the father ++
a senior government official was quite insistent. He also had relatives in Pune to stay with for few days.
He took an appointment & arrived (with his wife & son) a few weeks later.
We did our usual assessment for new patients incl checking past treatment papers & current +++
Read 11 tweets
4 Apr
THREAD: My personal experience working in India's public health system.
Regular readers of this timeline will know I am a supporter of a public healthcare system.
So naturally I get asked, why don't you work in the public health system, if you think it is so good?
Here's why ++
I trained in a public medical school Seth GS Medical College & KEM Hospital 1982-91 & left in 1991 to go to UK having completed a MD (Psychiatry).
I worked in the NHS in UK from 1991-1999, when I returned to India.
During my time in UK, I got to see first hand & closely ++
what a treasure the NHS is. From the millionaire to the homeless, everyone got the same treatment - free of cost at point of delivery & based on medical need. The primary care GP system was amazing. Anyway, I was determined that when I return to India, I would ++
Read 19 tweets
21 Mar
Thread: I tweeted about Ekalavya & this Assistant Prof Savitribai Phule Pune University tweeted the reply below.
So let me tell you my own experience. I think 1st person accounts are important.
Disclaimer: I am not a savarna nor am I a Dalit. Honestly, I don't know my caste ++
I grew up in Mumbai in 70-80s studied medicine at G S Medical College (KEM Hospital). Proudly got in there with "merit". Reservations & caste really did not impinge on my life except occasionally when savarna classmates said I had "wasted" a seat by not taking admission++
under OBC category. I didn't much pay attention to it Had many savarna friends. I do remember a group of seniors referring to students who had come in through reservations as "bhangis" & laughing. To me this was all irrelevant. Didn't bother me at all. I had some great +++
Read 17 tweets
19 Feb
Thread: This is a long thread about my wife's grand-father: Vinayak Apte.
Born, brought up & lived in Pune. Aptewada, Sadashiv Peth. Qualified as an engineer in 1920s or so. Married around same time.
I promise you this is worth reading, so settle down with your cup of tea....1/n
Around 1921, young Vinayak writes to Mahatma Gandhi expressing his desire to join Bapu & work for freedom struggle.
Bapu writes back saying sending money for the ticket (₹5) & get your backside up here (not exactly these words, but you know what I mean!).
Bapu adds a PS...2/n
"If you change your mind, please return the ₹5 by money order to Sabarmati Ashram" Typical Bapu, you might say! Careful with money.
Vinayak quits his job & decides to go to Sabarmati. Entire extended Apte clan is horrified. Joining that fakir? Giving up your job? Ostracised.
Read 15 tweets
21 Nov 20
I find ppl have difficulty understanding #evidencebasedmedicine (EBM) & how Science works.
EBM doesn't try to "prove" anything but is focused on REFUTATION. Let's say u have a new medicine which you believe works better than previous medicine/no medicine. Thats your theory...1/n
#EBM sets out to refute this theory. Hence all trials start with a null hypothesis: New Treatment A is no better than placebo/treatment B.
You then use statistics to find out whether the difference between the two was likely to happen by chance. P < 0.05 only means that...2/n
there is less than 5% chance that the difference (if any) between the 2 treatments was likely to be due to chance, & is a real difference.
In this case, you reject the a priori Null hypothesis ( that there is no difference between 2 treatments) You accept...3/n
Read 4 tweets

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