Wednesday, December 19, 2012

Kids and Pregnancies and Men


I am trying to imagine all the men in my world as being pregnant. How might RK, for example, be?

He would get in his complaints, I think, but try to do so while pretending that he actually was not. He would talk about it like it was some kind of a scientific question, but pepper the statement with all his aches and pains.

"Oh, yeah, I think my deep throbbing knee pain is really due to the fact that my ..ahem.. lateral patellar retinaculum is being stretched. I wonder if there have been any studies done on how inflamed this muscle can get in pregnancies. I mean, I'm sure...ha ha... that I'm not the only pregnant man in the world to be in such great agony"

"You laugh, Varsha, but you don't know the stress! It's very stressful to not be in control of your own body! I don't know just how I manage it, but I must say, I have some incredibly good coping mechanisms. Hmm... you might do well to try some of them"

Or my dad:
"My motto in life is to grin and bear it.
Bloody hell! Where the h$##$$# is my $%##$$ towel? Who in bloody #$### moved the TV remote? Arrrggghhhh... if that truck doesn't move out of the street already, I'm going to PUNCH the damn ##$### wall!"


PG (thesis adviser, for those of you who don't know him):
"You know. It's interesting. They have all this technology, but they just cannot take a LITTLE vial of blood without clotting up your whole arm. I must tell Wishwa and ask him what kind of education these doctors get these days. Of course, these days, doctors don't do any kind of procedures. They only want to get more and more specialized"

LOL
This is fun. Now every time I meet a guy, I'm going to imagine him pregnant.
Not too many guys at MWRI, but quite a few at IDM- imagine the great Don Burke, or better yet, the skeletal Paolo. Snap! Just like that, they are all pregnant, at least 2 trimesters along, waddling down the corridors.




Friday, December 14, 2012

A hard week

I have wept a bit this week. I attribute part of the reason to hormones. Apparently, hormones rage during the 2nd trimester. I'd like to know, when do hormones not rage? Teenagers, menstruating women, menopausal women, pregnant women, lactating women- everyone appears to have hormones that rage. Why don't hormones just do their thing quietly and leave?
And really, why haven't more hormonal studies been done in men? I'll bet my bottom dollar that men in their 30's, men in their 40's, men with 2 kids, men with no kids, men who are bald, men with big bottoms and men with sweaty handshakes are also afflicted with indiscreetly fuming hormones.

Other possible reasons for my general state of weepiness:

a) Lack of support from that esteemed spouse of mine in the specific area of housework: really, my man, could you PLEASE, for crying out loud, move that ass away from that computer and help me a bit? Or at least, spend some time while I am doing housework so I don't feel alone?

b) Incredible support from my lovely little son: the more Ani spends time with me and tries to help with whatever I am doing, the more weepy I get, because really, what a big heart on such a small kid!

c) Lack of sleep: thanks to those indiscriminate hormones, I suppose. Am too big to sleep on my tummy, too nasally-obstructed to breathe easily, and too prone to vivid dreams in which I have to eat the frogs that come out of Ani's nose.


What I need is an escape from my real life. Romance novels don't cut it anymore. I'm like the druggie who needs coke, and not marijuana, for a real fix. What I really need is...

....a Hindi movie, luridly romantic, incredibly silly, laugh-out-aloud funny, with a heart-stoppingly handsome hero and a stunningly beautiful heroine.

There's a scene at the end of the song "Bol Na Halke" where Preity Zinta (who satisfies my criterion for a beautiful heroine) and Abhishek Bachchan (Yuck. Double yuck.) walk in front of the Taj Mahal with their grown-up kids. The sun is setting behind them, everyone is dressed simply but oh so elegantly, and you can't see Bachchan's face (thankfully), but his physique is perfectly hero-material. The music is splendid, the evening is indescribably beautiful and the scene is perfect. Zinta and Bachchan have done their jobs of bringing up their kids and now can spend time gazing at the Taj Mahal without a care in the world.
Wow.
They probably have a couple of maidservants to take care of the house and a cook for their meals.

That is where I want to be.

Monday, December 3, 2012

Books and Authors- My Latest Discovery

Deanna Raybourne has written a series of mystery novels in the Lady Julia Grey series.
The first three books of the series are pretty gripping: great language, imaginative plots- if slightly twisted, and great protagonists.
The suspense and plots fall a bit flat after the protagonists get married, but the books are still good for a lazy afternoon's read.

The series reminds me of Lindsey Davis' Marcus Falco series, with a few key changes:

The Falco series is written in the voice of Falco, a man and a detective who marries above his station and whose wife helps him with his work; the Grey series is written in the voice of Julia Grey, an aristocrat who falls in love with a detective and wants to help him with his work.

The Falco series is set in ancient Rome- a period that is not particularly well-known among most readers and as such, the author has a lot more freedom to play around with creating this world with regards to the place of women in that society, societal rules and constraints, descriptions of male-female interactions and so forth. So Davis endows the females of her books with relative freedom of speech and action, the right to inheritance and so forth.

The Grey series is set in England in the mid 1800s- a period that has been 'done to death' in hundreds of novels in multiple genres and is much better known to the average reader: females from this era are expected to conform to much more rigid rules and are not expected to question or challenge men; and ought to pay sufficient attention to clothing.

In that respect, the Grey series portrays an interesting evolution of Julia Grey, from a "Dresden shepherdess" (her description), meekly following, to one who struggles with and challenges the limits that society places on her and finally reaches for what she wants regardless of what is expected from a woman in her position. The man Julia loves and wants to marry, Nicholas Brisbane, is half-Gypsy, and poor and is "in trade" as a private investigator. Julia has to overcome the economic differences between herself and Brisbane, her family's horror of non-aristocrats and tradesmen, and the social consequences of being seen around a Gypsy.

As I mentioned before, once she does overcome all these struggles and gets married to Brisbane, the series goes downhill a bit. Frankly, one can't help feeling that they ought to get themselves to a marriage counselor pronto.





Tuesday, November 13, 2012

What's the big deal?

http://www.chicagotribune.com/news/chi-petraeus-allen-sex-scandal-20121113,0,29930.story

David Petraeus had an affair with his biographer. The affair came to light when the biographer supposedly sent anonymous and threatening emails to some other woman whom she thought was also sleeping with Petraeus. Somehow, through some convoluted rigmarole that hasn't yet been unearthed, the investigation into these emails not only revealed the affair between Petraeus and the biographer but  has also pulled some other Army chiefs into suspicion.

Tell me again how someone's extramarital affairs has any role on their functions as a professional? Why did Petraeus have to resign just because his extramarital affair became public? Seriously, other than families closely connected to the protagonists of this drama, who cares?

Indiscretions by people in high positions have become the rule, not the exception. And even among the ranks of sexual indiscretions indulged by those in power, Petraeus' seems rather mild. Petraeus didn't tweet pictures of his wiener, like Antony Wiener did, didn't patronize a prostitution ring, like Eliot Spitzer did, didn't solicit male partners in a public restroom, like Larry Craig, and didn't even, like Arnold Schwartznegger, have a secret "other" family. He slept with someone who wasn't his wife. So what? Why should this become media fodder and why should we be subjected to sordid details about who did whom and when every single moment of our waking lives?


Can anyone in this day and world be puzzled and appalled at adultery? And why confine ourself to this day and world? In the history of the world and yes, even the Christian American world, you puritanical hypocrites, adultery is fairly common. The only difference between this age and all the previous ones is that we are so incredibly quick to leap up on our moral pedestal and sneer at someone. And I think we secretly sneer not at the act, but at the discovery.






 


Thursday, November 1, 2012

Ranking of the Pittsburgh hospital cafeterias


Hospital cafeterias in Pittsburgh (to the best of my knowledge):

UPMC Presbyterian
UPMC Montefiore
Magee Women's Hospital
Children's Hospital of Pittsburgh
Allegheny General (how many?)
West Penn Hospital (how many?)


I'll rank them using the NIH scoring system (given below, lifted directly from a presentation by Freeman and Friedman on Developing Competitive Grant Applications)




















I'm a vegetarian. So I'm biasing my scores towards how vegetarian-friendly these cafeterias are. You may have different opinions about these places. Go write them on your blog, if you feel strongly enough about it.


Hospital
Score
Reasons
Magee
1
Delicious, healthy food; plenty of options of vegetarians and others with diet restrictions; creative in use of ingredients.
CHP
2
Great food. However, sometimes, only options for vegetarians are pizza and burger. On good days, plenty of choice.
Presby
9
Absolute nightmare. Menu has not changed in 4 years.  Terrible choice of soups and desserts. Exactly 1 vegetarian entrĂ©e (“Mediterranean Veggie Wrap”) per week.
Montefiore
?
Have only eaten here once. Greasy, overly salty food. But I’ll give it the benefit of doubt and put it down to a bad day.
Allegheny General
?
Need to assess
West Penn
?
Need to assess






So what brought this on? My new job is at Magee Women's Research Institute, a short walk away from the Magee cafeteria. I can't help comparing the quality of my noon meal at Magee to what I subjected myself last year, when the closest place to eat was the Presby cafeteria.

I lost about 10 pounds last year while subsisting on Presby food, because all I could eat was the salad- the sole dish that was not floating in oil. Compare that to yesterday's vegetarian entree at Magee (quinoa with baked butternut squash. Yummy!) and today's (vegetarian chili with succotash and rutabaga on brown rice. Lovely!)

So, I hope that the Presby chefs take some ideas from the Magee guys. Then again, who cares? I don't have to ever eat there again!






Tuesday, September 4, 2012

Thank you, IBGP!

There are many things I need to thank my graduate program, the Interdisciplinary Biomedical Graduate Program at the University of Pittsburgh School of Medicine, for. But definitely, topping that list will be Foundation Conference, a mandatory 4-credit course taken in the first semester of the 5-year program.

Foundation Conference gives a callow, nervous first-year the guts to take a paper like "IRE1a Induces Thioredoxin-Interacting Protein to Activate the NLRP3 Inflammasome and Promote Programmed Cell Death under Irremediable ER Stress",  and tackle every single sentence, data point, every aspect of a figure and figure legend. And the experience is so useful that even today, 7 years later, I remember what that course taught me about reading a paper: read the title, read the abstract and the introduction, then skip the results, read the discussion, come back to the introduction, read the results, go through the materials and methods and re-read the discussion. An incredibly long process that can make you want to tear your hair out, but a very, very useful and a solid way of tearing apart a paper. And if done right, you probably will not forget any aspect of the paper ever again.

Despite its obvious advantages, Foundation Conference is only offered by the Med School. The Graduate School of Public Health, for example, although offering PhD programs in related biomedical fields, does not have anything like it. GSPH offers a first-years-only journal club, but this is a joint session for all first years and by that nature, cannot offer what Conference can: separate groups of 4-5 students per faculty member, individual attention by senior faculty, a forum where every single student has to present his or her understanding of the paper every single week and is forced to read a  paper thoroughly because the faculty randomly pick people to answer questions beyond just the whats and hows of a paper. In our batch, we were 45 first-years. So the school would have had to come up with at least 10 interested and dedicated faculty members who would be willing to plow through each assigned paper, and not to mention, all the written reports by the students, for a whole semester. It's intense.

So thank you, Foundations Conference. I need to read the above-mentioned paper by noon today and although I might grit my teeth and groan out aloud, I think I'll get through it.






Tuesday, August 28, 2012

A Risky Venture?

Which job to choose? One which is safe and known and has a clear connection to what I want to do in the future, or one is which is unknown but promises to be very exciting, future goals be hanged?

Thursday, August 23, 2012

To Tell or Not to Tell

I have been pondering a lot about pregnancy and women in the workplace. When I was first pregnant, nearly three years ago, I had conflicting emotions: happy and excited when I was with my husband or parents, but incredibly nervous at the thought of telling my thesis adviser.

My adviser is an awesome guy- supportive, friendly, excellent mentor. But he was not pleased when I told him I was pregnant. His first look was almost accusing- 'how could she be so irresponsible' were probably the first words in his head. And indeed his first reaction was, "Well, Varsha. I don't know how you'll be able to manage finishing your PhD. Hopefully you have an easy time of the pregnancy" and then he went to expound upon the many girls he knew who became pregnant while at school (not high school, grad school!) and who then had to shelve their dreams of doing research or going ahead in their careers because of their various pregnancy-related ailments. I can remember my emotions during my pregnancy swinging between guilt, shame, embarrassment, giddy happiness and excitement. 

Looking back, I can say that graduate school is probably the best time to become pregnant. There's a steady source of income, there's support from co-workers, school administrators, and yes, even thesis advisers ultimately, and the work is flexible. As long as your PI has enough grant money to fund you for six months more than he originally expected, life is good. 

A not-so-good time to become pregnant is when you are looking for a new job. And that's when the quandary arises: do you tell your prospective employer during the interview that you're pregnant or do you wait for the job offer and then gently break the news? 

Both my thesis adviser (to whom I asked this question) and my husband thought they would not reveal the news until later. My adviser said, "Well, you have to protect yourself. Ask yourself this: if you were a PI with some finite source of funding, would you hire a highly productive person, or would you hire someone who has uncertainty in her future. And make no mistake: pregnancy and childbirth are uncertain events. Who knows what might happen when and for how long?"
RK said, "Every woman has a right to reproduce. And every person has a right to protect themselves against discrimination. If there is a chance that pregnancy can lead to a person not being hired, then it is only natural that that person not reveal anything that leads to discrimination" 

On the other hand, Facebook CEO Sheryl Sandberg says pregnancy is not a time to be apologetic and freaked out and unsure of yourself; it’s a time to be your most ambitious http://www.youtube.com/watch?v=18uDutylDa4.


Well, it so turned out that all these questions arose in my head because this is exactly my situation: I am pregnant and I am job-hunting.

Postdoctoral positions in the biomedical sciences are notoriously underpaid and highly stressful. Principal investigators (PIs) look for productive scientists (and the most productive postdocs are single men or women; married postdocs are also relatively productive, though they do expect holidays once in while; male postdocs with kids are less so, but the least productive postdocs are females with kids. Family systems being what they are, females are the ones most likely to take days off to take care of sick kids, to take a morning off to drive the kids to a doctor's appointment, the ones least likely to stay back late at lab finishing up an experiment). But of course, here I am equating "productive" to "ability to spend large amounts of time in lab". They are not the same at all. And in fact, female postdocs with kids usually end up making the most efficient use of their time in the lab with minimal interruptions and breaks. But it is nonetheless a pretty stressful life: expectations are unclear or unrealistic, job security is low, and egos can be fragile. 

What is the value of this training? This will warrant a whole new blog-post. 

So let me tell you what has happened so far: in my postdoc interviews, I have been clear about expectations regarding time: I will not spend hours beyond 9-5 in the lab, and I am not likely to come to lab on weekends, unless I deem it absolutely necessary. And (more relevant to this post) I tell all my prospective postdoc advisers about my pregnancy. My outlook on pregnancy has undergone a pretty drastic shift from the last time I was pregnant. I do not see it as something to hide or shy away from. I am thirty. If I don't have kids now, when the heck will I? I hope that the persona I project is as strong and honest as I want to be and the message I want to convey is this: I am a great scientist. And I am a mother. If you have a problem with this, then I do not want to work with you. If you hire me, you will get a hardworking and imaginative problem-solver, but you are not going to get a slave. 

So far, it seems to have been successful. Only time will tell to what extent.



Tuesday, August 7, 2012

Curiosity might join Opportunity tonight!

The NASA spacecraft to Mars, appropriately named Curiosity, will land tonight, if all goes well. This is exciting on many levels.
For one thing, our nearest neighbor has a lot more stories to tell than we originally expected, as the data collected by NASA's previous spacecraft, Opportunity, indicates. Mars used to have water, and therefore might have once contained life (as we know it). Curiosity, in fact, has been targeted to one of the sites that scientists consider likely to have harbored water and life aeons ago.
For another thing, Curiosity is an engineering marvel. When the rover Opportunity landed on Mars 5 years ago, it was dropped by its spacecraft cucooned in a nest of airbags. It hit the ground and bounced to a stop, still packaged in its protective airbag covering, intact, shaken but not stirred, for which NASA no doubt was fervently thankful for. Curiosity packs a lot more punch: it is nuclear powered and carries an impressive number of instruments including an atomic spectrometer, an X-ray diffraction and X-ray fluorescence machine, a large suite of instruments to analyze gases and solid matter, metereological package and ultraviolet sensor and a total of seventeen cameras, not to mention its array of devices for communication with Earth. It is understandable that NASA feels leary of using its trusty old airbags to protect this giant.
Hence, NASA engineers have come up with a pretty darn ingenious system of lowering the rover onto Mars (Mission Impossible-style):
The spacecraft itself will use heat shields and parachutes to slow down its descent. About a mile from the ground, it will lower the rover down by unspooling a set of cables until the rover's wheels touch the surface.

***************__________________************************___________

This was on Sunday. I couldn't complete this post or publish it because I was interrupted by my son who woke up crying when a bolt of lightning hit close, Sunday being a day of thunderstorms in Pittsburgh.

Anyway, as all the world knows now, Curiosity did land beautifully and has already sent a bunch of images! Hurray for science! Hurray for NASA!

No matter how bad the budget deficits and bureaucracy, it is reassuring to know that NASA is still at the top of its game.


Saturday, June 30, 2012

The Marcus Didius Falco series

Lindsey Davis started this series sometime in the late 1980s. What makes this stand out among zillions of mystery and suspense novels?

For starters, it is based in Rome. And not the pasta-pizza Roma of today, but the Rome closer to the one brought to such comic life in the Asterix novels of Goschinny and Uderzo. Asterix's Rome is, of course, based in the times of Julius Caeser. Davis's Rome is nearly a century after that, in the time of Vespasian, but equally peppered with centurions, corrupt and cowardly, senators, gladiators and arenas with hungry lions and wolves. There's something very lovely in the music of those Roman names, be they as descriptive as Tremensdelirious or Tortuousconvolvulus (these are from Asterix, of course) or as stately as Decimus Camillus Verus or Lucius Petronillus Longus (from the less tongue-in-cheek, but equally entertaining Falco series).

The series is so superlatively good not just because of the story lines, but because of the amount of loving, intricate research that has gone into recreating that world for us. 1st century AD Rome is very familiar, but just foreign enough to keep a reader constantly making notes and comparing. Davis provides a detailed picture of the Roman class system, with the various snobberies associated with each class, by making her hero, Marcus Didius Falco, a lowly plebian, fall in love with Helena Justina, a girl from the patrician class. Falco's character is fully developed, not in the least bit one-dimensional like so many of the private detectives on TV today: he is an investigator, a great buddy, devoted husband and a really good father to his daughters. One of the scenes that captured my heart had him and his two-year old reviving a bumblebee with honey. Take that, Jack Bauer. True heroes make time for their women.

That's my review for the day. It's the Marcus Didius Falco series. Grab any book (there are 20 so far) and let 1st century Rome and its attractions and dangers envelope you.

Embarrassing Illnesses

No, no. Fret not. I have no STDs.

But I do have something which, when I first described it to my husband over the phone, made him sit up and take notice and think of them.

It all started off innocuously enough. Fever, sore throat, chills. I took my ibuprofen, took a surreptitious nap while at work (unlike my graduate-student days, I can no longer slumber away, drooling, at my desk, in front of all and sundry. Postdocs, for some reason, are expected to behave with some more dignity). I stuck it out till the end of the day and then lurched back home where not even the prospect of Alex Trebeck and Jeopardy could keep me from stumbling straight into bed.

The next day began with a incessant, insistent itching on my palms. I examined them blearily and spotted three little bumps on one palm and two little bumps on the base of my fingers on the other. Shingles? I wondered in a panic. Surely not? I took pictures of the various bumps and sent them away to the man. Once he checked out the pictures, he called back and said "It looks like hand-foot and -mouth disease".

So yes. I have managed to get a disease that usually only affects little kids... in fact, not even little kids, more like infants and toddlers. Ani's daycare has had a couple of cases, but I haven't seen Ani with any of the symptoms (yet).

The first appearance of the bumps on my hands were 3 days ago. Since then, every day has brought with it a set of new symptoms, which in obedience to the name, do proceed from the hand to the feet and then, most painfully, to the mouth. And no, it is not because I kept touching these parts with my blister-filled hands. And the blisters are PAINful. And the itchiness! It is enough to drive one crazy. It's a unique torment, because you can't scratch at the blisters for they are tender, and at the same time, you can't think of anything but scratching at those itches. In those two days of torment, I felt like Tantalus in his pond of water. What did help was a concoction of castor oil and turmeric. I would pour some of this on my hands and keep rubbing it in gently into the blisters- the turmeric, in addition to being an antiseptic, acted as a gentle abrasive which served the purpose of scratching those itchy blisters.

Anyway, because I was quite immobilized (and mute. Blisters in the mouth and throat are the worst), I read books constantly. I have recently discovered the ebooks- section of Carnegie Library and spent all day and most of the nights downloading different books, reading them and returning them online. Technology! How perfectly lovely it is! My new finds are Lindsey Davis's Marcus Didius Falco mystery series and the book "Watching my Language" by William Safire. More on these in later posts.

Monday, February 6, 2012

UN-effing-believable!

http://www.washingtonpost.com/local/when-it-comes-to-tardiness-shouldnt-the-punishment-fit-the-crime/2012/02/06/gIQAC4VUuQ_story.html?hpid=z3

I don't get the author's ultimate point, but this is the main thing that she's talking about:

If kids are late to school, their parents get hauled off to court! Apparently, this is the norm in this country! Can you get any more ridiculous than this???

This prompts such a visceral reaction in me because I am always late for everything. And what's more, I'm pretty damn proud of some of the excuses I have thought up of.

This is such a totally wrong approach to deal with tardiness. Instead of punishing the people who are late, they should reward the people who are on time.

From the article, it seems like the reason the parents get hauled off to court is because the deal is that each and every kid in school will spend the same amount of time in school. What about the kids who go early to school or who stay back in school for a bit longer, then? Shouldn't they be punished for spending too much time there? Why focus so shortsightedly on quantity instead of quality?

This stupid custom is going to go right down there with whipping kids on their butts or hitting them on the head. Just like we are appalled today that kids were made to undergo such punishments, sometime in the future (hopefully soon) we will be appalled that parents of kids were subjected to such trials and tribulations.

But... *deep breath*.. good thing is, I don't think Pittsburgh is on board with this stuff yet. For one thing, I don't think the courts here have the money to go around holding ridiculous trials like this.

People of whichever idiotic state goes about criminalizing its hapless, tardy parents: go spend that money on capturing some real criminals, okay? By hauling these parents off to court, you are losing money not only on the trials that you conduct, but also on all the time that those hardworking parents have lost at their places of work.

Thursday, January 19, 2012

Fighting for a Feeling of Self Worth

One of those weeks which leave me battered and bruised.

My ego's taken a severe beating this fortnight: a series of failed experiments in lab, failed because of my carelessness, a so-so presentation by me about my work at lab meeting, halfway through which I realize the lack of multiple important controls in the experiment and have to come up with mediocre explanations for the same, someone at home admitting that he didn't feel comfortable there because it was too disorganized and untidy for him, and so on and so forth.

Ouch.

I have become expert at shoving unpleasant thoughts to the back of my mind and forcing them there till I can forget about them. Until they come crowding in all at once and catch me unawares.

It's 20F outside and I need to leave soon to pick up Ani from the day care and carry him back home. Haven't given the poor kid a bath in two days (though, hey, he did get his teeth brushed everyday. That's gotta count for something).

Okay, let's focus on the positives:
a) Ani's smile at he waved goodbye to me in the morning at daycare
b) I taught someone how to think through the preparation for a PhD Comprehensive Exam and I think she was pretty inspired and impressed.
c) My friendship with my labmates- in this lab and in my previous one. So see? SOMEbody likes me, I'm not all terrible.
d) Hmm... positive stuff in the sphere of scientific research that I have done... aaaarrgghh nothing that I have done recently, but my journal club presentation was pretty good.
e) Something positive in the home front... let's forget about tidiness and laundry and clutter now... Oh, hey, you know what? I have been cooking great, healthy, reasonably tasty food at home every single day (and many times, more than once a day) for 4 straight months now. I have made sure that everybody who is at home gets something decent to eat. There. Okay, so that's my answer to whoever sticks their nose up about the state of the house. Which actually, by the way, is pretty damn good. If you're going to be hyper-sensitive, and want everything to be spic and span, don't come home.

So...I think I do a darn fine job of holding everything together...for now... somehow...

Friday, January 13, 2012

The ACCORD study

Am attempting to increase my knowledge about the field of diabetes research by scanning the top journals for all their articles on beta cells and diabetes. Came across the ACCORD study (Action to Control Cardiovascular Risk in Diabetes), which concluded prematurely in 2008 because the treatment arm of the clinical trial ended up with greater numbers of deaths than the control arm.

The writeup in Science is found here: http://www.sciencemag.org/content/319/5865/884.full.pdf?sid=2b4ab30f-345c-4a91-8c91-537ac10f410b

This is the gist of it:
People with diabetes are at an increased risk of cardiovascular diseases and can die of heart attacks.
The hypothesis was: if you control diabetes, you should be able to reduce the number of fatalities due to heart attacks or other cardiovascular diseases (CVD for short).
Therefore, aggressive lowering of blood glucose levels should protect against CVD.

So to test this hypothesis out, they got about 5000 people in the treatment arm (so these guys were diabetics who were considered high risk for dying of CVD and who had their blood glucose lowered by aggressive treatment with a variety of drugs) and another 5000 people in the control arm (also diabetic, but no treatment, other than their usual regimen)

Then they found that there were greater numbers of people dying of heart attacks in the treatment group, compared to the control.

Uh oh.

Questions to be asked:
a) What was the blood glucose lowered to? How was this being measured? - They measured something called hemoglobin Ac, or HbAc, as a surrogate marker for glucose in the red blood cells

b) Is the HbAc measure a suitable surrogate to monitor blood glucose?
-Apparently so. Lots of people use it in clinics and hospitals.

c) Is there a relationship between HbAc levels and risk of cardiovascular disease?
- Very important point. And tellingly, NO! Nobody has shown that HbAc levels correlate with risk of CVD. Also, one may not have diabetes, but have an HbAc value of greater than 6.

So, it seems to me that firstly (and frankly, this is probably the most minor point) the wrong surrogate marker was used.


Secondly, what about the drugs used to lower the HbAc? Assuming that phamacologists went through the drug list and found that these drugs did not interact adversely with each other, might they not have side-effects that would increase CVD risk?

Thirdly, and this is a great point made by one of the researchers who was arguing against this hypothesis from the beginning: the population under trial have had diabetes for a long time, and are considered high risk for CVD. This means they probably already have plaques in their blood vessels. Lowering the blood glucose may loosen these plaques: apparently, plaques contain sugar and it is the sugar that thickens and strengthens the plaques. If you were to lower blood sugar drastically, these plaques may not stick around on the walls of the blood vessels anymore, but begin to float around and eventually get stuck in the heart, causing a massive heart attack.



Very interesting, no?

There is a possibility that things become worse before they come better. That is to say, that perhaps if they had continued the study for a few more years, and continued monitoring the people who got the aggressive treatment (and survived it), they would have seen better prognostic markers, (and indeed this has been shown in smaller studies), but who knows? For the safety of the people involved, the trial was stopped 18 months before it should have.

Perhaps a gradual decrease of blood glucose, instead of a drastic one, might have less numbers of fatalities?

More relevantly, how sustainable is this approach? I mean, assume that this trial really had showed that aggressive treatment lowers risk of CVD. So what? Wouldn't this person have to take those medicines for the rest of his life anyway? And who is to say that those drugs in turn do not cause some other kind of damage- liver failure or renal issues? What then?
From the little I know about this issue, it seems to be that the long term risks outweigh the benefits.

So I would have to say that it's a good thing that trial showed what it did and forced everybody to think a lot harder about what that glucose in the blood is really doing.

Sunday, January 8, 2012

My book

I am going to write a book. I am fairly sure it is NOT going to get published in Mills and Boon, which is where I will first send it to because they have some kind of audition going on to find India's next great Mills and Boon writer (did you even know India had a Mills and Boon-India edition? I didn't. Checked out the books that have been published under its aegis- exactly the same story lines as the British/Aussie ones, except with Indian names... and maybe with brown skin. I say maybe, because that really is not a sure deal with these things- for all you know, the heroine will be described as being "tall, fair with green eyes", with a name like Ashtanga, so that non-Indian readers will be familiar with it).


My mother-in-law and I had a conversation about this some time back when she was here in the US. We share a deep love of romance novels. I had mentioned to her that I wished there were at least one book with an Indian hero. The only romance stories with Indian heroes in them are the truly ghastly ones in Women's Era and frankly, I get completely sidetracked with the spelling and grammatical mistakes and can't pay attention to the story, which is probably pedantic and pedestrian anyway. That's one thing my story will not have: spelling and grammatical mistakes. I might throw in a few split-infinitives here and there (because I don't know what they are, but believe that they are not in vogue), but I make a solemn promise here and now: my book won't make any self-respecting person who likes words and grammar cringe or wince. Of course, it may make its readers cringe or wince for other reasons, but that's something I do not promise not to do. See? I keep achievable goals for myself.

So where was I? Oh right, I was whinging about the lack of truly great Indian romantic heroes and my mother in law said, "Well. What do you expect? Your hero will probably want curd rice and pickle for dinner, and he'll keep shedding hair all over the place and burp and fart and expect his wife to do pretty much everything around the house" (she didn't say those exact words, but you get the picture). Hmm... she had a good point. But then again, novels are fiction, not fact. And in my novel, I can pretty much make my guy into whatever I want. He will be the epitome of a romantic hero- courteous, considerate, courageous, compassionate, funny and handsome... hey, kind of like my husband, without the burps and the farts and the shed hair!

Actually, our great classical books and stories have some pretty damn good heroes, except they are not in the modern mold. I just have to pick up a convenient one and tweak him here and there. Let's see: I don't think I would pick Arjuna or Bhima, for obvious reasons. Maybe Yudhistira, but he's a gambler and those guys are always a bad bet. Maybe Nakula or Sahadeva, about whom I know nothing except they were good with animals (... not bad... maybe I'll make my guy a veterinarian). Or how about Harishchandra- the king who valued truth above everything else... maybe after his stint as a grave digger? Or maybe Chandra Gupta, with his daring and cunning and political machinations... or am I thinking of Chandragupta Maurya? Who was the king who was made king with the help of Chanakya? Can't remember whether he was a Gupta or a Maurya. Or... a truly radical thought... I could just go right up to the heavens and pick Krishna... all the elements of the great romantic hero are in Krishna: he's handsome, affectionate, funny, wily, enigmatic, loves everybody and everybody loves him. Too much of a playboy, perhaps? There's good potential there.

Anyway, lots of decisions to be made and lots of writing to be done. I love being busy with such projects!