Here's my understanding of Electoral bonds. Where the answer is my personal opinion, it is marked [O]. What is an electoral bond ?

It's a tool to donate money to political parties anonymously. You get it in various denominations from ₹1000 to ₹1,00,00,000. The bond itself doesn't carry your name or the name of the political party.

Someone had asked whether sampling for thyroid function test should be done in fasting only in the previous tweet. It has a short answer and a long answer.

1. Short answer - Not necessary for all
2. Long answer - this 🧵 Thyroid hormone levels aren't static throughout the day. There's short term day to day variability and longer term seasonal variability. This rhythm also varies between individuals - some have strong rhythmicity, others don't. So the impact of timing varies between individuals.

It was the 1950s. India was a fledgling new democracy. Madras was a Mecca of Medicine, home to some of the brightest minds and ablest hands. Those were the days before MRI or steroids. In this backdrop, a small band of trailblazers under the leadership of Prof B Ramamurthy were carving out a niche for #neurosurgery. Their scalpels hadn’t severed the umbilical cord of the new branch which was still attached to general surgery. Almost all were driven men.

I am a conservative and my moral compass wouldn’t allow recommending such a lifestyle. However, instead of saying it’s wrong I will explain why we think differently and how it is a bad idea . A 🧵 Liberals and conservatives differ fundamentally in our moral palettes . For a more scholarly read, consider this book by Jonathan Haidt

The Righteous Mind

A liberal has a two channel palette

1. Harm / care
2. Fairness / reciprocityamzn.eu/d/6zpPn66

I have always wondered why patients choose quackery, even when the cost is the same or higher than standard of care. Here are some of the reasons in my experience. A 🧵 1. Lure of cure - because they aren’t bounded by the rules that govern us, quacks can promise the moon and the stars. For a chronic disease, the lure of cure is irresistible.

Saw a man with Hypogonadism today ( means he is not able to produce normal amounts of testosterone). He was in his forties, pretty old to find out you don’t have testosterone. So I asked him why he didn’t consult anyone before. He said he went to a famous academic institute the first time. He was kept as a demo case - for students. He felt like a human Guinea pig and that experience traumatised him so much he never stepped into a hospital for 15 years !

A few months back I met a patient who had come for treatment of Sheehan s syndrome. It was just a refill of her pituitary hormone replacement therapy. Her Tamil sounded different. While superficially resembling a Kerala accent, the word choices and pronunciation were distinct. I asked her where she’s from. She said “ Srilanka .. I came here in a boat decades ago as a refugee”

I had seen a young woman , a few months back. At 27, she had been diagnosed with diabetes, a few months after her marriage. Her A1c was 11.3 %. Her happy-go-lucky ways seemed like distant past. Granted, diabetes isn't as scary as some other illnesses - but she was just finding her rhythm in Chennai, having grown up in a village. The inlaws home had some 'laws' - or conventions, which she had a hard time adjusting to.

When I was young, my mother used to say "Blessed are the parents who have a girl child". To me and my brother, it seemed like a cryptic barb. One that we got despite doing everything right. We were like human clay, yielding ourselves to moulding - and wondered "what on earth does she need a girl for ?". Anyway we shrugged our shoulders and got back to books or games. And like all mothers, she knew what we needed and gave it to us at the right time.

A few years back, I went on a trip to Vaalparai/Vazhachal/Athirapally with friends. The Athirapally falls was breathtakingly beautiful. It was also a little dangerous and so the cops had erected barricades to prevent tourists from entering some unsafe areas. Though I was good at swimming, I had the good sense to avoid tempting fate.

During my second year MD, a man in his late fifties came to our casualty with chest discomfort in almost at midnight. He was the relative of a staff. He seemed fairly ok and claimed he had taken parotta for dinner. We did an ECG and it was normal. He had diabetes, which was fairly controlled. Had occasional alcohol, but otherwise an unremarkable history. We sent for Troponin and CPK-MB ( was done in those days) and asked him to rest. Meanwhile the staff, an old lady herself , waited with him.

Saw a young man who works in retail - 6 days a week, standing 12 hours a day. He had taken the one day off to bring his mother to hospital. The guy hardly spends anything on himself, sending home almost all his meagre earnings. His only complaint - his parents aren't satisfied He had for instance, spend over 20k for his mom's dentures, just so she could chew and eat better. She didn't like it and never used it. The edentulous mother, resorted to taking more of liquid calories and ended up with high sugar - for which he had again come to the hospital.

Genius, even diabolical genius, is a pleasure to behold. The card for vote scam in Karnataka , if true, is a class act. Why? Because it not just co-opts the voter in corruption, but gives him skin in the game Simply distributing cash means parties have to rely on outspending competition. Even then they can’t be sure - since there’s nothing stopping the voters from taking money from everyone and voting for whoever they please. Thus cash for votes is a leaky strategy

Many people blame doctors as looters. When someone points out, “not all doctors” The usual response is “yes, but it’s always a doctor” . Let’s assume the latter is true for the sake of discussion. How do we move forward? 1 . Use govt hospitals. Demand better healthcare from govt. Vote wisely

2. Go to a no frills hospital

3. Lobby for regulation - this sounds attractive on paper , but comes with its own issues. Read on…

Recently met a young doctor at a CME. He’s several years my junior, a nice chap. Said he’s getting married. I wished him well. A few sips of soup later, he said “we have laws against dowry, not against reverse dowry”. And proceeded to narrate his arrange marriage experience.. From demanding farm houses to foreign vacations, luxury cars to specific super specialty courses he had seen it all from the girls and their parents. I hoped he was kidding, but sadly he wasn’t. That he chose to talk about it with me told me how rattled he was my the whole thing

If you find it difficult to arrange a few lakhs instantly for emergency ( this includes most people in India), then the best option is govt hospital. If not, you should have adequate medical insurance cover. What is adequate varies from city to city. I am not a health insurance expert - but this is my basic understanding. @AdityaD_Shah please correct if wrong. Most medical insurance claims are under 5 lakhs, but the illnesses that cause serious damage are in the ballpark of 10-25 lakhs.

A few days back, hardly anyone outside of Tamilnadu would have heard of the word "#Sengol". Nor would many, Tamil or otherwise, would have heard about its actual existence, tucked into relative obscurity, lost to the pages of history. Yet today, the whole of India knows the word. The ornate Sengol has become a Rorschach test.

B12 deficiency and diabetes - should all patients with diabetes be given multivitamin tablets ? If not, who should get Vitamin B12 ? A 🧵 Vitamin B12 is a water soluble vitamin and its deficiency is pretty common in diabetes. How common ? Depends on the study we look at - but a rule of thumb is 1 in 10 random patients with diabetes may have vitamin B12 deficiency.

Indian doctors know that all 4 pillars of Indian democracy are at best indifferent and at worst hostile to us.

1. Legislative
2. Executive
3. Judiciary
4. Media

A 🧵 to show how deep the rot runs. An attempt to create a separate law to severely punish miscreants assaulting doctors was shot down by health minister (after discussing with experts apparently) - reason cited -> it will lead to others like bankers asking for the same - even though doctors are at highest risk

Many Keralites are sharing some heart warming stories of communal harmony and say that’s the real Kerala story. These are true happy stories. But they hastily dismiss the testimony of parents of victims shown in Kerala story as mere propaganda Similarly they think many women who have since released videos are out to defame Kerala, even though these are all native Malayalis with no incentive to do so.

Recently I saw a man in his early forties with "drug induced" liver failure posted for transplant. His story taught me a lot about communication and moving on. A thread 🧵 A couple of years back, the man had covid, during the second wave. Even during admission his liver enzymes were a bit raised, but nothing alarming was found. After discharge, he continued to feel tired. The doctor told him, it was common and the tiredness will go away soon