Predictive testing for markers is extensively used in Medical Genetics and Cancer Therapy. There is a long list of such molecular markers having high sensitivity and specificity.

Now, we also have markers in various other disorders.

Pre-eclampsia: In their review, Anne Katherine Staff stressed that- Angiogenic factors, such as PlGf and sFlt1, and PP13 seem presently to have the best predictive test values for preeclampsia, but sensitivity and specificity is still too low to prove useful in a population screening setting. Biomarker testing can be extended for research. Biomarkers could provide useful in selecting high-risk women for prophylactic trials as well as identifying pregnancies that could profit from closer follow-up. Many funding agencies in India and abroad are looking for well designed project.

Prematurity: In India there is marked reduction in IMR in last 2 decades. This can be attributed to the awareness, national health programs and better living conditions. However, if we see the trend, there has no further significant reduction in IMR and majority of deaths are due to Low Birth Weight (LBW) or due to prematurity. Despite technological advances in perinatal care, we are unable to prevent prematurity and LBW. It is now high time to find out markers in early pregnancy where we can take of pregnant women and help them deliver a well baby. Even some scientists have patented the technology to be available commercially this year. Until now cervical length was considered as the marker on USG.Metabolomics is the study of the thousands of low-molecular- weight molecules found in biological fluids and tissues of different individuals, whether normal or afflicted with disease, which reflect changes in biological functions. These markers can help predict preterm birth. Researchers have found cervico-vaginal secretions as useful predictor for high risk.

I will be back with further markers in other conditions soon. Please keep visiting the blog.

Disclaimer: Medical information and technology is changing fast. What may be considered standard today may become obsolete tomorrow. Please be informed about current changes through scientific literature in medicine. This blog is for information purpose only and cannot be quoted as a scientific evidence.

Dr Kuldeep Singh, MD, DM

Professor and Head, Pediatrics

Sri Aurobindo Institute of Medical Sciences (SAIMS),

Indore

Doctors can be good managers with the help of skill set of analysis, quick decision making, effective interviewing and pattern recognition. I have written about it somewhere in my earlier blog. But that has been proved true yet again by young doctors from Karnataka who have created a chain of preventive health care in remote rural areas named Vaatsalya. Earlier in India Dr Reddy had taken an initiatie of setting up Apollo Hospital chain. Many a time questions are raised as to why doctors change their profession. Some of the answers can be obtained from this link. And also by visiting What's Up With These Docs?. Back in the buzzing city of Indore, a group of doctors have started a Hospital specially for children and their mothers named Dolphin Hospital and Research Foundation. A good work of harmony. There are quotable example from Raipur, Bijnor (UP) and Pune.

Dr Kuldeep

Medical Research and Society

Dr Kuldeep Singh,

Professor Pediatrics

Consultant Genetics Expert,

Shri Aurobindo Institute of Medical Sciences,

INDORE

The basic principle of Medicine is to “Do no Harm” and is as old as our civilization. Medicine is a science but in contrast to other scientific fields its effects are slow to be seen. Science can be disruptive which means they can bring about technology more accessible to large population and is simpler to use- the most common examples are internet and mobile phones. Broadly there are two types of these disruptive technologies-one which considers primarily business and economic aspects of disruption, and the other which considers the broader societal issues of disruption at the level of the health care system. While the former is primarily dependent on technological developments, the latter is fundamentally dependent upon societal developments. Primary business type of disruptions are difficult to anticipate. However, society impacting disruptions can very well be predicted with current knowledge. In fact, they depend on explicit recognition of the joint technology/grid systems. Since these are accessible to upstream ethical and regulatory reflection in a way that low end technological disruptions are not, these should be the focus of attention of our health research. That’s why medical technology takes a longer time to be accessible to the public. Society should understand that medical technology will gain confidence only when it is acceptable and harmless. Medical doctors do inventions and discovery but they are not directly applied to the mankind until their definite superiority and harmless nature is proved by different experiments. Medical science depends both on experience as well as on scientific experiments. Time tested remedies are readily accepted e.g., Paracetamol has found to be safe for any age and with all genetic make-up. Developed nations have evolved techniques which markedly reduce the time to test. India is rich in its Herbs and even few Baba’s have claimed their curative nature on cancer. That’s a very good thing for our society. But claim is not enough- it should be proved beyond doubt that they are totally harmless not only for person with cancer but to the whole society. These require different experimentations. By the term “To do no harm”, not only signify physical damage but also safe to the religion, culture and mental health of our society. Developed nations have over a period of time developed stringent regulatory system and control to look after such claims as some of trials have touched the human lives differently and even remotely. An intelligent person usually learns from mistakes of others rather than with their own experience. We are in a position to learn from the West and adopt guidelines suitable to our regional, ethical, language and cultural diversity. Medical research is never instantaneous. We can even see historically that penicillin and streptomycin discovered long back took decades to be practically available. Similarly, enthusiasm associated with gene therapy and deciphering of whole genome is taking much longer time than predicted. Therefore, time has come to understand research in medicine through long term impact on society.