AUTHORITY: DR SHRINIWAS JANARDAN KASHALIKAR

Disciple: Master! my friends from US and UK laugh and ask, "What authority do you (Indians) have; to preach NAMASMARAN; when majority of you; are drowned in abysmal poverty, ignorance, irresponsibility, corruption and so many such evils?"

Guru: My son! Their argument is correct! Admit to them that:

"Like the whole world (plagued by sectarian, individualistic, petty, exploitative and such many sick trends); we (Indians) are also sick, though with somewhat different infections, signs and symptoms.

Being sick; we kept on either opposing NAMASMARAN (and thus pamper our petty ego) or practicing it (and thus pursue personal gains under the guise of liberation, salvation etc) and failed to realize the vital and pivotal role of NAMASMARAN in individual and global blossoming!"

Today; we are (not preaching); but sharing (even though we are sick) what we have begun to appreciate about NAMASMARAN for individual and universal welfare!"

At times treating a patient of cancer in abdomen can be a nightmare for the surgeon. Multiple operations and radiations performed as a treatment for cancer changes the anatomy and physiology of abdomen. Now in this situation if a patient comes with a perforation in the bowel becomes a tough challenge to the surgeon.
I recently has to operate such patient. He has sever pain and his bowel had perforated due to radiation effect.There was no virgin area left due to multiple operations. I had to find a relatively safer place to enter my thin laparoscope for visualization of inside mystery. Gradually I explored his abdomen and located the perforation. I made a small incision on his skin to deliver the diseased bowel out. I sutured the hole in the small intestine and placed it back.
This way a major opening up was avoided. The patient's sister who happened to be a doctor was very happy that I could solve the problem with minimal cutting. The recovery was uneventful and patient resumed his previous lifestyle very quickly. This was his quickest recovery compared to all his multiple previous surgeries.
- See more at: http://drbcshah.com/post-radiation-bowel-perforation/#sthash.prZ9VOOL.dpuf

India is a developing country and 80% of the population of our country cannot afford expensive healthcare. The facilities provided by the govt are miniscule in front of the giant problem. Shortage of doctors, basic infrastructure, paramedical staff and expensive medicines makes healthcare even more out of reach for a common man. That is the reason we are still struggling with the certain communicable diseases and now added to that is the burden of non- communicable diseases .India is going to be the world capital for heart disease in 2030 as per the WHO report. Diabetes is rampant and there is total lack of awareness about, prevention lifestyle management, hygiene levels, sanitation and the healthy living with the result we have huge load of patients whether it is communicable or non-communicable disease. Added to it is the shortage of man power to treat these patients. As per one study our country has only 20

doctors/10000 population as compared to 650/10000 population in U.S.A. The budgetary provisions for healthcare are so low that even the primary healthcare cannot be delivered efficiently with the result the rural population is the worst sufferers .That is how there is mushrooming of quacks and invaluable lives are at risk.
In such a dismissal scenario only alternative to improve upon the services and making each step in health care delivery more justified and economical we need to look at an evolving healthcare delivery system all over the world and even in developed countries like USA and that is Valve Based Medicine. So far we have been practicing Evidence Based Medicine where in based on the evidence of the disease, we treat it with the most costliest way of treatment. It ignores the logistic of benefit vs cost ratio whether it is concerned with writing costly medicines or adopting the most costliest intervention.
Valve based medicine concept is different from the evidence based medicine concept in the sense that we are treating human being and not symptoms or investigations. The treatment planned has to be based on the effective control of the disease with respect to the perception of the patient and his family in terms

of benefit ratio as compared to the cost involved in it. Let’s say in heart disease a patient having coronary artery disease in two or three vessels can be treated with bypass surgery as well as ballooning and stenting. Now whereas stents will cost him a big money and will also not even be durable so bypass surgery becomes more economical and more durable. So what patient wants here is effective quality of life improvement with an economical and durable procedure .So of course bypass surgery is the best answer here. Similarly a sore throat can be effectively treated with low end antibiotic treatment, supportive therapy instead of expensive and high end antibiotics.
Valve based medicine is a mean to compare all health care interventions on the same scale and a measure that can be combined with the cost of an intervention to arrive at a cost utility ratio . It provides most effective assessment of the patient perceived worth of an intervention. It also measures quality of life and/or length of life. Irony of healthcare industry is that it is one of the few industries where purchasers or the patients are unable to measure the valve of that they purchase.


So Value Based Medicine allows highest quality care, maximization of healthcare rupee and incorporation of patient based perception of quality of life. The goal of Value Based Medicine is to promote what is best for the most important people in healthcare i.e. patients. It provides transparency backed by scientific opinion, communication by personal attention, no scare or fear by involving empathy, economics and 24x7 availability.
Similarly if we come to procedures, Beating Heart Surgery is value based medicine. Minimal invasive surgery goes a step further in that direction as it makes the patient up and about early and patient does not lose productive days of earning and is back to work at the earliest with less stress on the body. Also in terms of logistics there is less ICU stay, less hospital stay, less use of blood products. Value based medicine also incorporates all the forth coming evidence which is percolated to the patient level and helps in decision making for the patients. Now coming to Stent vs Surgery two major trials one in 2009 Syntax trial and the other in Nov, 2012 Freedom trail have clearly established and concluded that is multi-vessel disease and diabetes Bypass Surgery scores over drug coated stents in terms of death, second heart attack and second or repeat intervention.

And all patients with multi-vessel disease should be offered Bypass Surgery as the first option for durable economical treatment. So in this scenario Value Based Medicine promotes that when it come to coronary artery disease each and every patient should meet the surgeon with his angiography report to reach to a conclusion whether he needs to go for stents or surgery. The other thing which our country needs to incorporate into VBM is the availability of cost effective medicines, disposables and equipment. Still most of the equipment, disposables used in high end surgeries is being imported and thereby making huge loss and leading to escalation of prices of these essentials. The government has to encourage use of generic drugs availability of which should be free and easy and encourage manufacture of disposables and equipment our own country .It will do away the huge profit margin taken by the multinational companies when middle men and the dealers add to the cost. There are very innovative products available in India and effort should be done to produce them at mass level and promote it at all levels .In fact all hospital should be told to use them as the first priority.
The infrastructure resources for the primary ,secondary and tertiary healthcare delivery are very less so a policy need to be made where in govt. and private

sector should join hands in making the total available infrastructure at the disposal of all the patient population group. There should not be any differentiation and all available beds should be utilized to the maximum by one and all. It will help in reducing the waiting list and huge queues seen in govt. hospitals today. All it needs is rationalization of compensation to private sector .Today also many govt agencies are utilizing the private resources for tertiary care by reimbursing them the subsidized cost of treatment. Why not it can be applied to primary and secondary care? Public private partnership is another good concept of upgrading and brining secondary and tertiary care in all cities and rural areas. To promote health care delivery in rural area the doctor should be encouraged by arranging for them a good housing ,transport ,and good schooling for their children .In fact the concept of rural dispensaries should be abandoned and what we need is a good primary/secondary health care centre within a radius of 20 kilometers and that area on daily basic should be covered for OPD service by mobile vans with fixed hours backed by strong ambulance service which most states have already adopted. This will help getting the medical and paramedical manpower stationed at these centers as they will get basic facility and necessities of life for themselves and their family and doctor will able to deliver better

healthcare with better facility in terms of equipment and beds in an upgraded hospital environment .It will also help in running the various preventive healthcare programs in true earnest. And then these primary/secondary centres are backed by tertiary care centres whether in private or government sectors at treatment cost rationalized by a committee of experts consisting of knowledgeable people from government and private sector. We need to understand that health is the ultimate necessity of life and is very important for the economic growth of this country. Till we get developed this concept of value based medicine will see us through in building a healthy and capable society which in turn will produce a workforce which will work hard to take this country forward and will make it a world leader.

Scientists Finally Discover The Function of the Human Appendix
It has long been regarded as a potentially troublesome, redundant organ, but American researchers say they have discovered the true function of the appendix.

The researchers say it acts as a safe house for good bacteria, which can be used to effectively reboot the gut following a bout of dysentery or cholera.

The conventional wisdom is that the small pouch protruding from the first part of the large intestine is redundant and many people have their appendix removed and appear none the worse for it.

Scientists from the Duke University Medical Centre in North Carolina say following a severe bout of cholera or dysentery, which can purge the gut of bacteria essential for digestion, the reserve good bacteria emerge from the appendix to take up the role.

But Professor Bill Parker says the finding does not mean we should cling onto our appendices at all costs.

“It’s very important for people to understand that if their appendix gets inflamed, just because it has a function it does not mean they should try to keep it in,” he said.

“So it’s sort of a fun thing that we’ve found, but we don’t want it to cause any harm, we don’t want people to say, “oh, my appendix has a function”, so I’m not going to go to the doctor, I’m going to try to hang onto it.”

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Attractive theory

Nicholas Vardaxis, an associate professor in the Department of Medical Sciences at RMIT University, says the theory put forward by the Duke University scientists makes sense.

“As an idea it’s an attractive one, that perhaps it would be a nice place for these little bacteria to localise in, a little cul-de-sac away from everything else,” he said.

“The thing is that if we observe what’s been happening through evolution, the higher on the evolutionary scale we are and the more omnivorous animals become, then the smaller and less important the appendix becomes and humans are a good example of that.

“The actual normal flora bacteria within the appendix, as well within our gut, are the same, so we’ve lost all of those specialised bacteria.

“So it doesn’t have that safe house type of function anymore, I don’t think.

“It’s a vestige of something that was there in previous incarnations, if you like.”

Koala appendix

Unlike the human, the koala is famous for having a very long appendix.

It is thought to aid digestion on a diet made up exclusively of eucalyptus leaves.

Professor Vardaxis says that is not likely to change any time soon.

“Unless of course we have a massive blight and we get the eucalypt on which the koala thrives dying, then we may find some mutant koalas out there perhaps that will start eating other things, and as they start to eat other things, then over generations and hundreds of thousands of years of time, then surely, yes, the koala’s appendix will shrink as well,” he said.

Professor Vardaxis says it is possible that at that point, koalas might be afflicted by appendicitis and have to have it taken out at times.

नामस्मरण क़ा चैतन्य: डॉ. श्रीनिवास कशालीकर

मेरे अंदर अंधश्रद्धा है, संशय भी है; ढोंग है और सचाई भी है, भावुकता है और तर्क भी है; डर है और साहस भी है; लाचारी है और स्वाभिमान भी है; बेईमानी है और ईमानदारी भी है; धर्मकी जरूरत है और स्वैराचार की भी चाहत है; आलस है और उत्साह भी है; संकुचित स्वार्थ है और उदारता भी है! इसलिए यह सब द्वन्द्व समाजमे भी है!
नामस्मरण ( जाप, जप, जिक्र, सुमिरन, सिमरन, ईश्वर या आत्मतत्व क़ा स्मरण) से; मेरे और समाजके द्वन्द्व; सच्चिदानंद ( विश्वकल्याण और आत्मकल्याण) मे परिणित होने लगते हl

THE POWER OF NAMASMARAN:
Inside me; there is superstition as well as inquisitiveness, hypocrisy as well transparency), sensitivity as well as logic, timidity as as well valor, meekness as well as self respect, treachery as well as loyalty, ethics as well as rebelliousness, lethargy as well as enthusiasm and pettiness as well as nobility.

(Besides, there is atheism as well as theism, hatred as well as sympathy, violence as well as nonviolence, indiscipline as well as discipline, dishonesty as well as honesty, lust as well as love, cruelty as well as kindness; and so on)

Hence all this conflicting duality is in the society as well!

Through the practice of NAMASMARAN (JAP, JAAP, JIKRA, SUMIRAN, SIMARAN i.e. remembrance of TRUE SELF or God) and the propagation of its universal benevolence; the conflicts within me and the society culminate in SACCHIDANANDA (The self realization and universal emancipation)!