Friday, August 23, 2019

Mera Bharat Mahan 7: The story of Maharaja Sibi

Dr KK Aggarwal

Sibi is a king in Hindu mythology. He became very famous as a protector of surrendered souls and a donor of charities.

Indra, the King of heaven once took the shape of a pigeon-hunter bird (eagle), and Agni, the fire-god, took the form of a pigeon. While being chased by the eagle, the pigeon took shelter on the lap of Maharaja Sibi, and the hunter eagle wanted the pigeon back from the King.

The King wanted to give it some other meat to eat and requested the bird not to kill the pigeon. The hunter bird refused to accept the King's offer, but it was settled later that the eagle would accept flesh from the body of the King of the pigeon's equivalent weight.

The King began to cut flesh from his body to weigh in the balance equivalent to the weight of the pigeon, but the mystic pigeon always remained heavier. The King then put himself on the balance to equate with the pigeon, and the demigods were pleased with him.

The King of heaven and the fire-god disclosed their identity, and the King was blessed by them.

The story has deep scientific and spiritual meaning behind it.

Explanation in Advaita Philosophy

To attain high level of spirituality, in an extreme parasympathetic state of mind, one needs to be disconnected with desires, expectations, ego and attachments to the worldly desires. The same is evident by Amarnath Ki Yatra where both Shiv and Parvati first leave Nandi (desires), then the moon (expectations), then Shesh nag (ego), Ganesha (relatives) and finally the five elements before they lose track of time (tandav nritya). These are the stages when one shifts from sympathetic to parasympathetic state of mind.

This is also true of the story of Dasura in Yoga Vasishtha, where sage Dasura to get detached with his father’s death first offers his organs in the fire one by one and later sits on the tendril under the Kadamba tree and performs Gomedha, Aswamedha and Naramedha before getting enlightenment.

Cutting your organs denotes detachment with the organs one by one and then by yourself in an extreme parasympathetic yogic state of mind.

Sitting on the tendril means that you are in a state when you have forgotten about your body and merged with the sukshma sharira.

Gomedha, Ashvamedha and Naramedha mean totally getting control of your chitta, sense and the body.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

FICCI-ELICIT guide to improving end-of-life care & decision-making

Dr KK Aggarwal

Advance Medical Directives (AMD) are now legal in India following the landmark judgment of the Supreme Court of India in the matter of “Common Cause versus Union of India, 2018 (5) SCC 1”. The treating doctor who in good faith abides by an advance directive will not be held liable under criminal law.

The Federation of Indian Chamber of Commerce and Industry (FICCI) and End of Life Care in India Taskforce (ELICIT) have come together to release an information guide to improve and facilitate execution of end-of-life decisions for doctors and hospital administrators.

ELICIT is a joint initiative of the Indian Academy of Neurology, Indian Society of Critical Care Medicine (ISCCM) and Indian Association of Palliative Care (IAPC) formed in 2015.

Here are excerpts from the “Action Plan for end-of-life care and decision-making”.

·         “Respect a competent patient's decision: When the patient who is competent refuses treatment this should be honored. Respecting the patient's decision is required by the law. This decision should be respected even if the patient's family members express a different opinion regarding Foregoing of Life Support (FLS).

·         Opt for shared decision making, if overriding an AMD is in the patient's best interest: If the patient is incompetent but has a valid AMD, this must be honored as far as possible. If there are valid grounds to override the same in the best interests of the patient, a consensus through shared-decision making should be arrived at, between caregivers and surrogates, which should be duly documented.

·         Base the decision on wishes of the patient as well as the prognosis, when no AMD is available: If there is no AMD available, decisions between care givers and surrogates must be based on the 'values and wishes' of the patient as known to the family as well as the prognosis and best interests of the patient as judged by the treating doctors. Only under exceptional circumstances, such as when a person is in a persistent vegetative state, can the Court-recommended procedure be implemented. For example, in a case of terminal cancer with imminent death, decision not to put the patient on a ventilator needs to be taken within hours or few days. In the common scenario, the FLS decisions must be based on refusal of consent for either initiation or continuation of life sustaining treatment in such cases. All decisions must also be duly documented to ensure transparency.

·         Certify and document Brain Death in accordance to the Transplantation of Human Organs and Tissues Act, 1994: Brain death should be certified and documented in the manner laid down in the Transplantation of Human Organs and Tissues Act, 1994 irrespective of whether there is consent for organ donation or not. This is in conformity with internationally accepted definitions of death. This position in Law was further reiterated in the Aruna Shanbaug judgement. When brain death has been so certified, the patient can be disconnected from life support unilaterally after informing and counselling the family.”

The Transplantation of Human Organs and Tissues Act, 1994 has defined a "deceased person" as a person in whom permanent disappearance of all evidence of life occurs, by reason of brain-stem death or in a cardiopulmonary sense, at any time after live birth has taken place

(Source: FICCI-ELICIT information guide to facilitate execution of end-of-life decisions - for Doctors and Hospital Administrators)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Thursday, August 22, 2019

Mera Bharat Mahan 6: Chitragupta or the quantum computer

Dr KK Aggarwal

The ancient Hindus imagined a person with a supercomputer with Hindu God Chitragupta, which means Mind Fold-Secret.

Chitragupta (चित्रगुप्त, 'rich in secrets' or 'hidden picture') is assigned with the task of keeping complete records of actions of human beings on the earth. He is the God of justice. Upon their death, Chitragupta has the task of deciding heaven or the hell for the humans, depending on their actions on the earth. As per Padma Purana, Chitragupta was Manasaputra of Lord Brahma.

Advaita philosophy believes that the God is in me and hence Chitragupta is in me.  

Any human is made up of body, mind and soul. The soul is omnipotent, omniscient and omnipresent. Fire cannot burn it, air cannot dry it, ice cannot freeze it and weapons cannot cut it.

All the qualities of Brahma, Vishnu, Mahesh, Yama and Chitragupta are present in this soul.

Today, scientists are in process of mimicking the soul powers by way of super computers and as of date they have now been able to compute a quantum computer with most of the properties of the soul.

The computer properties and quantum software of Chandragupta for instant data storage, competition and analysis mimic qualities of today’s quantum computer, which uses quantum-mechanical phenomena such as superposition and entanglement to perform computation.

The quantum computer today can explain a super-computer that records and retrieves at the appropriate time every single thought, word, and deed of every single human. The computer also can classify these in every case into a positive and negative column, i.e. that it can also evaluate the data.

Quantum entanglement is a physical phenomenon that occurs when pairs or groups of particles are generated, interact, or share spatial proximity in ways such that the quantum state of each particle cannot be described independently of the state of the others, even when the particles are separated by a large distance.

The principle of quantum superposition states that if a physical system may be in one of many configurations—arrangements of particles or fields—then the most general state is a combination of all of these possibilities, where the amount in each configuration is specified by a complex number.

The quantum mechanics, quantum field and strings can explain most features of the soul and spirit.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Switching to electronic health records run the risk of information being lost or missed during the transition process

Dr KK Aggarwal

A 63-year-old retired worker was referred to a cardiologist (Dr C) after his ECG showed atrial fibrillation, who believed the fibrillation to be of recent onset and put him on amiodarone. Over the next month, amiodarone was reduced as sinus rhythm had normalized. Six months later, the patient visited his PCP and Dr C with isolated complaint of a rapid heart rate and a full feeling in his chest. He continued to take amiodarone and daily aspirin. 

Six years later, the patient visited his hematologist for raised hemoglobin and complained of occasional epigastric pain with activity during one visit. The hematologist asked the patient to see Dr C thinking that the symptom could be related to the heart. A year later, the patient visited Dr C, who put the patient on a Holter monitor and the next day had him perform a stress test/ECG.

Dr. C's exercise echocardiographic report authored that second day stated that the patient was "being evaluated relative to the current status of his coronary anatomy, left ventricular function, and cardiac rhythm." In that dictated report, Dr. C's impressions were: no chest pain with exercise, no significant ST changes or arrhythmias, normal left ventricle systolic function and response to exercise, and no evidence of myocardial ischemia. The patient was considered stable and advised to return after 3 months by Dr C.

But, the patient suffered an embolic stroke two months later leading to weakness in the left arm and leg and facial droop. The patient and his wife sued Dr C, alleging that he did not appropriately manage his atrial fibrillation.

During his deposition by the plaintiff's attorney, Dr C testified that his focus on the patient's return to his office after the long absence was to rule out coronary disease, not to follow up or rule out atrial fibrillation.

During that deposition, however, the plaintiff's attorney showed Dr. C a history and physical report from the first day of that consultation. That H&P, an electronically generated record (with Dr C's electronic signature), stated at the outset: "The patient is a 70-year-old male who presents for evaluation and management of atrial fibrillation." The H&P also noted that the patient thought he was having a recurrence of the fibrillation twice or three times a week.

Apparently, Dr C's office was transitioning to electronic records at that time, and the first day's H&P was the only record relating to the patient's care by Dr C that was placed into the office's new electronic record. That electronic record was produced in the course of a copy-service request for the patient's chart made by the plaintiff's attorney prior to litigation. Dr C resolved the litigation with the patient informally.

(Source: Gordon T. Ownby. Malpractice case: dangers when transitioning to electronic records - Medscape - Jul 23, 2019)

Electronic records offer several advantages such as quick and easy access to patient data as information is available at the touch of a finger or a click of mouse; improved efficiency and quality of care by minimizing risk of errors. They also save on storage space.

But, there are downsides to technology; most important being privacy and security violations, inaccurate or incomplete information, all of which pose potential risk of medical malpractice.

But, most importantly, electronic records leave an audit trail i.e. a record of the changes that have been made to a database or file.

An audit trail can be defined as a “record that shows who has accessed a computer system, when it was accessed, and what operations were performed” (Brodnik, Melanie, et al., Fundamentals of Law for Health Informatics and Information Management. Chicago, IL: AHIMA, 2009, 215). 

Like the paper records, electronic records too are subject to scrutiny; audit trails are asked for in malpractice litigations even though they are not part of the patient records.

The Electronic Health Record (EHR) Standards for India 2016 have outlined the principles of data change.

“The data once entered into a health record system must become immutable. The healthcare provider may have the option to re-insert/append any record in relation to the medical care of the patient as necessary with a complete audit trail of such change maintained by the system. Alteration of the previously saved data is not permitted. No update or update like command shall be accessible to user or administrator to store a medical record or part thereof. Any record requiring revision should create a new medical record containing the changed/appended/modified data of earlier record. This record shall then be stored and marked as ACTIVE while rendering the previous version(s) of the same record being marked INACTIVE. The data will thus in essence become immutable. A strict audit trail shall be maintained of all activities at all times that may be reviewed by an appropriate authority like auditor, legal representatives of the patient, the patient, healthcare provider, privacy officer, court appointed/authorized person, etc. as deemed necessary.”

Medical records are the best defense for the doctor. Poor records spell poor defense and no records mean no defense.

World over, health care establishments are changing over to electronic health records from paper charts. But, the information has to be manually fed in the software and there is the risk of information being lost or missed out during the transition process.

Therefore, it is safer to also maintain paper records, as a safeguard, until the new EHR system is fully functional and/or until people get used to the new system.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Wednesday, August 21, 2019

Lancet must withdraw its editorial on Kashmir immediately

 Dr KK Aggarwal

On August 17 (Volume 394), The Lancet published an editorial titled “Fear and uncertainty around Kashmir’s future” following the nullification of Article 370, which granted autonomy to the state of Jammu & Kashmir by the government of India on August 5.

Calling it a “controversial move”, the editorial says that the presence of army in the region “raises serious concerns for the health, safety, and freedoms of the Kashmiri people”.

It further writes “…The protracted exposure to violence has led to a formidable mental health crisis. A Médecins Sans Frontières study in two rural districts affected by conflict stated that nearly half of Kashmiris rarely felt safe and of those who had lost a family member to violence, one in five had witnessed the death firsthand. Therefore, it is unsurprising that people in the region have increased anxiety, depression, and posttraumatic stress disorder.”

Has the journal conducted a mental health survey in the region?

The Indian Medical Association (IMA) has strongly objected to this editorial and has questioned the “credibility and the malafide intention behind the uncalled for editorial”.

In a letter addressed to Lancet’s editor-in-chief Richard Horton, it says that “It is unfortunate that the reputed medical journal The Lancet has committed breach of propriety in commenting on this political issue. It is amounting to interference into an internal matter of Union of India. The Lancet has no locus standi on the issue of Kashmir. Kashmir issue is a legacy that the British Empire left behind.”

The Lancet is among the most prestigious and most well-known medical journals. It is also one of the oldest medical journals in the world; the first issue was published on Oct. 5, 1823. Therefore it is held in high esteem by the medical fraternity world over including in India

However, of late, apart from publishing research articles The Lancet along with BMJ has been publishing series of articles related to healthcare, and the focus of these articles has been India. And, none of these stories paint a flattering picture of India. Most of stories published by Lancet as well as BMJ on India are negative.

In March this year, The Lancet Commission on Tuberculosis report said that India’s goal to end the epidemic of TB by 2025 was too “ambitious", “unrealistic", and, therefore, unattainable (LiveMint, March 21, 2019). Between 2010 and 2017, alcohol consumption in India increased by 38 per cent -- from 4.3 to 5.9 litres per adult per year, said another Lancet study (TOI, May 8, 2019). 

These are only few examples.

But this editorial has to be by far the most bizarre of the articles published about India, which is entirely political and questions India’s sovereignty.

The Lancet claims to be a peer reviewed journal. Was this editorial peer reviewed?

It is a medical journal and not a political platform. The Lancet must withdraw this editorial immediately.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

Mera Bharat Mahan 5: Can quantum field explain the characteristics of soul?

Dr KK Aggarwal

The Bhagavad Gita talks about the characteristics of soul in Chapter 2.

नैनं छिन्दन्ति शस्त्राणि नैनं दहति पावक: |
 चैनं क्लेदयन्त्यापो  शोषयति मारुत: || 2.23||

“nainaṁ chhindanti śhastrāṇi nainaṁ dahati pāvakaḥ
na chainaṁ kledayantyāpo na śhoṣhayati mārutaḥ”

na—not; enam—this soul; chhindanti—shred; śhastrāṇi—weapons; na—nor; enam—this soul; dahati—burns; pāvakaḥ—fire; na—not; cha—and; enam—this soul; kledayanti—moisten; āpaḥ—water; na—nor; śhoṣhayati—dry; mārutaḥ—wind

This means that weapons cannot cut it, fire cannot burn it, water cannot wet it and wind cannot dry it.

अच्छेद्योऽयमदाह्योऽयमक्लेद्योऽशोष्य एव  |
नित्य: सर्वगत: स्थाणुरचलोऽयं सनातन: || 2. 24||

“achchhedyo ’yam adāhyo ’yam akledyo ’śhoṣhya eva cha
nityaḥ sarva-gataḥ sthāṇur achalo ’yaṁ sanātanaḥ”

achchhedyaḥ—unbreakable; ayam—this soul; adāhyaḥ—incombustible; ayam—this soul; akledyaḥ—cannot be dampened; aśhoṣhyaḥ—cannot be dried; eva—indeed; cha—and; nityaḥ—everlasting; sarva-gataḥ—all-pervading; sthāṇuḥ—unalterable; achalaḥ—immutable; ayam—this soul; sanātanaḥ—primordial

The soul is unbreakable and incombustible; it can neither be dampened nor dried. It is everlasting, in all places, unalterable, immutable and primordial.

Can this be explained scientifically today, the age which demands evidence?

The answer is yes!

At absolute zero, as per the standard physics model, the consciousness must freeze and cease to move.

But this is not the case and both Bhagavad Gita and Yoga Vashishta say that the soul can even migrate from one universe to other universe where the temperature may be lower than absolute zero.

Normally, there needs to be a change in temperature in order to see a phase transition from liquid to gas or solid. But there are some phase transitions in which the temperature cannot change, because they occur right at absolute zero (Kelvin’s - 273.15 C).

Quantum physics states that it is impossible for a particle to be fully at rest in a specific location.

Heisenberg's uncertainty principle tells us that position and momentum cannot be ascertained with total precision at the same time. Therefore, a particle's position and momentum can still change at absolute zero, even if classic thermal fluctuations are no longer present. These changes are known as quantum fluctuations.

It further proves that consciousness is present in energised information state in the universe at whatever temperature the universe may be.

So, when it is too cold for classic shaking movements, quantum physics ensures that physically interesting things still occur.

It solves the mystery about the consciousness, that air cannot dry it, water cannot wet it, fire cannot burn it or cold cannot freeze it.

Thus, the soul never dies and is immortal. 

While the internet or electromagnetic communication may stop, soul to soul communication will continue irrespective of where you are in the universe.

In Kena Upanishad (3.6, 3.10) also when the Brahman (GOD) asked Agni and Vayu Devta to burn or move the straw / dried grass like a thread they could not burn it or move it. This again means even the string state of the Sukshma sharira ( a state before the soul) which cannot be dried by air or burnt by the fire. 

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA