Election news 2004 - 01

The first communication that we have received this year is from Dr. K. Prabhakar Reddy who is standing for re-election for the post of Secretary General.

There is no news yet as to who else is standing.

There is no news till date regarding the candidates for the other posts.

Please see our disclaimer regarding the elections.

Election news 2004 - Disclaimer

As and when we get information about candidates standing for specific posts and any other information regarding the elections to the IRIA, we will publish them.

We would like to make it very clear, that the REF is not pro or against any candidate. The only interest here is to present the facts that are available to us, usually from the mailings that we get, either from the candidates themselves or the IRIA / ICRI.

Our only plea to the candidates however is that they should have a clear vision of what they want to achieve during their tenure as office-bearers and they should know how to achieve this vision. There is a lot that needs to be done by the IRIA for the radiologists and we hope that the candidates will find the time and will to do so.

A time to live and a time to die

The British Medical Journal this week carries a personal communication from a patient's wife. It is about her husband, who a year ago had an episode of massive intracranial hemorrhage and is now on a feeding tube in a nursing home. He has always been blind as well.

In this personal review, she talks bout how she and her sons were never allowed the luxury to participate in decisions regarding his treatment. He has a percutaneous gastrostomy, which has allowed him to live, but with a quality that is abominable. She would have preferred to let him die with dignity, rather than live like an animal.

I wonder if there are answers to these questions. If close relatives say that they do not want a particular treatment that would extend a patient's life but not enhance the quality of life, especially in situations of brain damage, the medico-legal implications of helping these relatives can be enormous. It needs just one relative to complain and the whole thing can blow up in one's face. I completely agree that people need to live and die with dignity and if I were to be in Michael's situation, I would rather not live. But looking at it from a doctor's perspective, I am not sure I would give up on Michael as well.

My uncle has published part of his will in a local language newspaper where he has categorically stated that if anything happens to him, he is not to be taken to a hospital, and he should be allowed to die at peace, at home. My argument with him is the lack of further clarification. If he has a massive stroke or a pontine bleed, fair enough! But if he has a subdural hematoma from a head injury, which is completely curable with surgery, would we, his close relatives fulfil his wishes? Obviously not!

It may be easy for non-medicos to talk about euthanasia and compassionate dying, etc. But once you are a trained doctor, our personal views and empathy and our interaction with patients can often be in conflict with each other...and I don't think there are straightforward answers.

Luckily, as radiologists, we don't really have to take decisions that affect the immediate survival of a patient in the terms described above. But I don't envy intensivists and oncologists, especially pediatric oncologists, their jobs, where they have to make "life-and-death" decisions almost on a daily or weekly basis.

Post-doctoral certificate course in Interventional Vascular & Neuroradiology at SRMC

There is a new course that has been started at SRMC (Sir Ramachandra Medical College) in Chennai in Interventional Vascular & Neuroradiology. This course has a one-year duration and is a certificate course.

There is an entrance exam on 30 June for this. More information is available here, and the application form is also available here. 14th June is the last date for submission of a completed form.

SRMC now joins the league of SGPGI, Lucknow, Nimhans and Sree Chitra, which also offer post-MD fellowships and courses in neuroradiology and vascular & interventional radiology. Congratulations are due, to SRMC and specifically Dr. Santhosh Joseph, the head of the interventional radiology department for furthering the cause of education in these subjects.

Definitive evidence for the use of breast MRI in malignant lesions

Mitchell Schnall, representing the International Breast MRI Consortium, recently presented the results of a breast MRI study on 1000 women, at the Association of Clinical Oncology meeting being held currently.

Basically the study shows that MRI detects more lesions than mammography in patients who are being evaluated for a suspicious lesion. "Of the 428 women who had breast cancer, MRI detected additional cancerous lesions in 56 women, while mammograms detected additional lesions in only 17. In statistical terms, MRI was more than 2 times as effective than mammography in detecting multiple tumors."

This makes a difference in those patients who are contemplating any sort of surgery short of a mastectomy, since the only modality today that can show multifocal lesions and additional lesions conclusively is contrast enhanced MRI.

If this modality is used by breast surgeons routinely for staging prior to breast conservation surgery, it will increase the number of patients being referred for breast MRI.

Access to full text articles

Ellen Lewis, the editor of www.radiologyweb.com writes an editorial titled "The Left Corner". Sometime back she wrote an article about the problem that Atif, a resident radiologist in Pakistan, was facing in obtaining access to an article that he needed from European Radiology.

He had internet access and was able to get onto Pubmed, but his university did not subscribe to European Radiology. Ms. Lewis describes in detail how difficult things are where Atif works, with just one radiology journal in their library and very few books as well.

Her main issue of course is about the whole argument for open access, which from our point of view would be a great thing, i.e. all articles in all journals should be available free of cost to anyone who wants to read them. Obviously this is contrary to what the publishers desire, since they tend to make money from journal subscriptions. A contrary argument is that the articles are written by authors who should actually be the copyright holders and not the journals themselves, and if this was to be implemented, it would make no sense to restrict access to the journals.

Having said that, things have improved somewhat. Radiology, Radiographics and AJR now have full-text access for all articles more than a year old. European Radiology and Clinical Radiology however do not yet have this facility, probably because they are published not directly by the societies themselves, but by professional publishers (Springer & Blackwell, respectively).

All BMJ publications, the New England Journal of Medicine and Annals of Internal Medicine are free if accessed from India and other "poor" third-world countries.

There are other ways though of getting access to full-text articles.
- there is always someone who has a subscription to these journals, esp. the RSNA, ARRS and ECR journals. One can always request them for a photocopy.
- with a little more enterprise, if the subscriber has learnt how to obtain online access, one can always go to his office and use his computer, etc. to get the .pdf of the article or ask him/her to get it and to email it
- in the worst case, the articles are available for a small fee and can be downloaded after a credit card payment
- residents can always pool in information about the journals available in their universities and use the university library subscription to gain full-text access to all journals subcribed by the library. In fact, in a city like Mumbai, among the four major medical colleges, there is no way that a particular journal would not be available.

Radiology in blogs and Morparia

I had a little free time and decided to search for other radiology-related blogs in the blogosphere using Google. In the second page, I found a link to a satire magazine called Jaal, which runs its all small, primitive blog, in which there was a reference to Morparia's radiology cartoons, with a link to....guess what ...his refindia work.

Talk about circular references....

Hunting for board-certified radiologists

I received one more email yesterday asking for a list of US, UK or Canadian board-certified radiologists, working in India.

Obviously there is no such list and I emailed this person back telling him so. He then wanted help in locating any such radiologists. Except for Arjun Kalyanpur and his team members, I really don't know any.

Let's face it! If you were US board-certified, unless you had a desperate reason to come back to India, why would you leave a potential job situation that could pay at least 500,000USD these days? Even if you wanted to live in India, it would make sense to work for at least a few years in the US, make all the money you might possibly need and then come back.

This is what I keep telling all the companies who come down here looking for board-certified radiologists, but they just don't seem to get it. It is a different issue looking for such radiologists in France, Switzerland, Israel and Australia where the living conditions are reasonably similar. The differences between India and the US are so stark that, except in special situations, it makes no sense for someone certified in the US to come back to India.

More about statins...now in acute coronary syndromes

Statins have already been shown to be extremely useful in the prevention of coronary artery disease and have also been recommended in the prevention of stroke, as I had mentioned in an earlier blog on exercise and coronary artery disease. A new study reported in this week's issue of the Annals of Internal Medicine shows that statins seem to make a difference to the management and outcome of acute coronary syndromes as well. (Incidentally the article is available as free full text for those visiting the site from India).

The study shows that patients who were already taking statins when they presented to the hospital were less likely to have ST-segment elevation or myocardial infarction. Patients who continued to take statins in the hospital were less likely to experience complications or die than patients who never received statins. Patients not previously taking statins who began statin therapy in the hospital were less likely to die than patients who never received statin therapy.

Though the conclusions are cautious, the authors and editors state that it is very likely that by altering the pathophysiologic processes during an acute coronary syndrome, statins may likely affect management. They have suggested the need for larger trials to show this benefit more clearly.

Fetal ultrasound problems in Australia as well...

In Australia two major radiology firms have stopped giving videos of fetal ultrasounds to their patients, fearing litigation after birth, if the fetus turns out to have defects that were not initially picked up on the ultrasound studies. This news report discusses this issue in detail.

In our country, giving out videos is also fraught with medico-legal issues due to the "Act" (I am still being advised not to name the act, but I am sure everyone knows what I am talking about).

Just like the earlier report in this blog about the problems with 2nd trimester abortion in the US, I believe that more and more, fetal medicine is becoming a problem area for doctors to practice in. This is reflected by the decreasing numbers of doctors entering obstetrics and the increasing numbers of doctors in the US and Australia leaving obstetrics. In the Western countries the problems are with malpractice insurance and law-suits, but the end-result is still the same - poorer quality of obstetric care.

There are many gynecologists in Mumbai and India as well, who have stopped practicing obstetrics for a variety of reasons - luckily we don't have major lawsuit issues as yet in our country, but there are other problems that are inherent to our social structure. Many radiologists have also expressed the opinion that if the law and "Act" get too restrictive, they will just stop practicing fetal ultrasound and stick to abdominal and small parts ultrasound. The eventual loser?....the patient...