Experts from the address by his Excellency, Dr. A.P.J. Abdul Kalam, President of India, at the judicial Colloquium on Science, Law and Ethics at National Judicial Academy, Bhopal (Through Video Conference) From New Delhi, on February 19, 2005.

            I am delighted to participate in the judicial Colloquium on Science, Law and Ethics organized by National Judicial Academy, Bhopal. I greet the Hon. Chief Justice of India, Hon. Justices of Supreme Court and High Courts, distinguished legal personalities, the Director of the National Judicial Academy, scientists, technologists and other participants. During the last two hundred years there has been considerable advancement in science and technology. Certain things, which were considered possible in science, have not happened, whereas certain other things not considered possible have become a reality. Considering the rapidity of these developments and their impact on mankind and society there is an urgent need to have a re – look at the system in an integrated way on science, law and ethics. As said by a legal luminary, it would be tragic if the laws and ethics are so petrified that they are unable to respond to the unending challenge of evolutionary and revolutionary changes in our society. In that respect this judicial colloquium on science, law and ethics is a very important event which provides an opportunity for scientists, technologists and legal experts to work together and draw a roadmap for the changes which are needed in our legal system in an integrated way taking into consideration both technological progress and ethics to have a balanced social system.

LIFE SCIENCES AND LAWS:

            Cloning of human organs for repair of organs such as eye, liver, kidney and heart etc. is an important requirement and also stem cell research must progress. Recently, I came across an article in which the stem cells recovered from the umbilical cord of a new-born baby was found to be a rich source of stem cells. This area is a fertile research ground for the stem cell research community and a number of umbilical cord stem cell banks, which will emerge in the country. The legal and scientific community should be prepared for regulating this situation. Also there is a need to have a re – look at the Indian Human Organs Transplant Act of 1994 to make it donor friendly and, more importantly, patient friendly to help those who are in dire need. In this connection, here, I would like to mention an experience of an Indian scientist who was waiting for a British liver in UK, whereas as per law, the priority for transplantation has to be given to a native citizen first (details in the following article).

            Excerpts from the address by his Excellency, Dr. A. P. J. Abdul kalam, President of India, at the convocation of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, on January 14, 2005.

            I am indeed delighted to participate in the Convocation 2005 of Sanjay Gandhi Postgraduate Institute of Medical Sciences. I greet the Director, professors, faculty members, doctors and staff for their contribution in shaping young doctors as super specialists in different fields of medicine. I take this opportunity to congratulate the student doctors of this Institute for their academic performance. This Institute has the major responsibility of enriching the students in societal missions. I am happy to note that this Institute has a tele – classroom that has been connected to a number of advanced centers of medical education. I was thinking about what thoughts I could share with the enlightened members of this beautiful Institute. I have selected the topic for discussion – “Healthcare through Fusion of Multiple Technologies”.

            The time has come for the medical community to work towards enhancing our abilities in the field of bio-science, bio-informatics, bio-technology and nanotechnology and their convergence for providing cost effective medi care to the entire mankind, especially those living in far-flung rural areas. Now I would like to discuss with you a case study of my friend who is now walking with a British Liver. It is essential that India have high reliability centers for successful liver transplant.

WALKING WITH A BRITISH LIVER (CASE STUDY):

            Early Symptoms: Since 1995, my friend had an upset stomach and mild fever. He ignored it and relegated it to something associated with frequent travelling, meetings beyond regular office hours, taking food at odd hours. He consulted many physicians at the instance of his family members and they also gave the same opinion. They diagnosed it as related to water and food changes and that he had amoebiasis and prescribed medication like Tiniba-500. This used to bring relief for a month or two, but the problem reappeared. Since he was an intensive scientific worker, he ignored the low-grade fever, which persisted for many months. He lost 11kg of weight in four months’ time and his blood profile indicated that the sugar level was in the upper limit. Around this time, his face also started turning a darker shade. He attributed the change to age and epidermis damage and frequent exposure to UV rays in the hot desert during field trials.

First Investigation: at the instance of his friends and family members, he underwent thorough pathological testing at the King Edwards Memorial (KEM) Hospital in Pune in May of 1999. All possible tests under the sun were conducted – liver function test (LFT), ECG, Barium meal test, and ultrasonic exam of stomach, endoscopy and X-rays. To his utter delight, all the test results turned out to be normal with no major abnormalities. The only noticeable change was the increased bilirubin level, which was 1.2 against a normal value of less than 1. Liv-52 tablets were suggested for a few months. However there was no noticeable change in his physical condition.

Recurrence in 1999: Later in 1999 my friend got an infection while attending a conference in Russia, which led to sever loose motion and high fever. With great difficulty he got back home after four days and was confined to bed for a whole week. A month later he had severe stomach convulsions, a nagging pain and swollen lower limbs. He felt and looked very weak and sought the opinion of a leading liver expert at Hyderabad. All the tests for different types of Hepatitis were conducted and the test results turned out to be negative. Though the live was found to be negative. Though the liver was found to be of normal shape and size the symptoms were definitely that of liver disease and he was prescribed a few medicines. He took the medicines for a month but there was no improvement.

Alternative Treatment: finding no improvement in Allopathy he turned to Ayurveda. He started taking a concoction of lentil and rice and bitter herbal medicines and in this process his condition deteriorated further and he started having, in addition to mild fever, tender and swollen stomach and swollen lower extremities. He could neither eat nor sleep or sit at ease.

Acute Condition: In October 1999, he got his "bilirubin" checked at INMAS, which was alarmingly high at six. He consulted Dr.Sardesai at Pune who diagnosed his condition as acute liver problem and prescribed medicines to tone up the liver functioning and avoid infection. He advised him to avoid all strenuous. This treatment worked well for a month and then the symptoms resurfaced. 

In views of the recurrence my friend met Prof Acharya of All India Institute of Medical Sciences, Dehli, on &th December 1999. After examining his tender and swollen stomach, he declared that my friend had a severly damaged liver and advised him to get admitted immediately.

He was put through a series of tests and all liver function test results turned out to be alarmingly high. His endoscopy indicated that he had varices. His RBC count was very low and WBC was high. He was beong injected with plasma medicatiions periodically and he had to undergo fluid removal from his stomach. It was clear that he ahd cirrhosis of liver but what perplexed them was the source of the infection since it did not fall into the category of the patients with a known history of possible infection routines. After consultation with many specialist doctors they surmised it to be Hepatitis C with autoimmune problem. Dr.Achraya explained that strangely my friend's body-defence system had started attacking the body's own organs, in this case the liver.

Decision for Liver Transplant: Hepatitis C is a heterogeneous infection. Its inter-relation-ship with the human immune system is variable and difficult to correlate. However, in some patients chronic liver sisease requires infection for 20 to 30 years. The most common presentation of Hepatitis C is a patient with no complaints. It is reported that 85% of patients infected with HCV will develop chronic inflammation of the liver and of these 20% will develop cirrhosis of the liver. When my friend's condition stabilised, he was discharged from AIIMS in February 2000. His joy of returning  home was a short-lived one and he returned to  AIIMS with an infection in MArch 2000. At this time he went into coma periodically and his kidney also started failing. This resulted in Prof Acharya pronouncing the invitable that liver transplant was the only solution for saving my friend. Of the many medical centers all over world where liver transplants are routinely carried out Prof Acharya recommended at that time (year 2000) Saint James Hospital at Leeds, UK. 

Long wait and Treatment in UK: Saint James Hospital he was wxplained all the pros and cons of the surgery and registered for a compatible liver. He was kept on the waiting list and as per national policy UK citizens would be given highest priority. During this period he met many fellow survivors who appeared to be very formidable people who had handcrafted their own techniques of surviving. One day they were full of hope and the next moment they wondered how long they could hold up. My friend took solace in YOga. He rediscovered the joy of being a family person. After a month's stay my friend got a call from the hospital that they had found a donor. Finally my friend was operated on 13th June 2000 by Dr.Peter Lodge and his gifted team of doctors, one of whom was Prof. Merwin Davies, friend of Prof.Acharya. The operation took seven hours. Later he regained consciousness and saw the people around him who were in smiles after the successful operation.

Post Operative Care: The disease, anxiety and surgery took its toll on the appetite and physical strength of my friend. He was forced to eat and drink more to make up for the loss of muscle and weight. He was surviving on three to four bottles of "Enlives" per day. Finally he left the hospital after seventeen days and weighed only 57 kg when he ws wheeled out. He was slowly pemitted to eat everything except grapefruuit, antifungals and antidepressants. As usual all these medicines caused their own side effects. He remained in Leeds for over three months under the care of expert doctors after the operation and flew back to India with his family. After coming back to India he is permanently on medication involving an expenditure of over Rs.15,000 per month during the first year and Rs.5,000 per month in subsequent yers continuously which is definitely much beyond the reach of a common man.  

I am telling this eexperience of my friend to the medical experts assembled here so that they can address the problem of diagnosing this type of liver disease in the early stage so that it does not become an agonizing experience for the patients and the family. Also, the medical community must carry out intensive research and find lowcost medicines for postoperative lifelong care of liver transplant is that specialised hospitals, which deal with liver, transplant, must aim for at least more than 95% sucess rate. 

CONCLUSION

Whether India has to eradicate leprosy or TB, to prevent spread of HIV by developing anti-HIV vaccine, or to control cariovascular disease by multiple technologies and practices, we in India need something important apart from resource, that is, creative leadership in all fields, particularly in medical field. Who are the creative leaders? What are the qualities of a creative leader? Creative leadership is exercising the task to change the traditional role from commander to coach, from manager to mantor, from director to delegator and from one who demands respect to one who facilitates self-respect. The higher the proportion of creative leaders in the medical field, the higher the potential for success in medical field in diagnosis, treatment and research for discovering new avenues in healthcare.