FOR DOCTORS :BE CAREFUL OF INTERPRETING WHAT YOU READ ON LINE ABOUT MEDICAL INFORMATION

BE CAREFUL OF INTERPRETING WHAT YOU READ ON LINE ABOUT MEDICAL INFORMATION

I receive virtually hundreds of emails containing information about health, disease care, new discoveries and research.

I always remember, what my teacher Dr Howard Lessner once told me: Don’t trust information that you don’t pay for.

There are hundreds of blogs and semi-official medical journals (supported by drug companies) all appearing to present the fact, but a careful examination would reveal that they are distorting the research which had been published.

A GENERAL RULE OF THUMB: IF YOU ARE READING SOMETHING IN A TRADE OR COMMERCIAL PUBLICATION OR SITE ABOUT RESEARCH, FIND THE ORIGINAL ARTICLE AND READ IT.

I am reading an email from Endocrine Society, a professional society that I belong to and considered to be a prestigious one in the USA, and they had this item in their Newsletter.

Defining Pre-Diabetes Based On HbA1c May Predict Long-Term Diabetes Complications More Accurately Than Other Definitions Of Pre-Diabetes, Researchers Say.

MedPage Today (11/16, Kneisel) reports, “Defining pre-diabetes based on hemoglobin (Hb)A1c, an indicator of average long-term blood glucose levels, predicted long-term diabetes complications more accurately than other definitions of pre-diabetes,” researchers found after comparing “five different definitions of pre-diabetes, including two fasting glucose-based, two HbA1c-based, and one two-hour glucose-based definition accepted by the American Diabetes Association (ADA), the World Health Organization (WHO), or the International Expert Committee (IEC)

If you read this excerpt you are inclined to think that HbA1c definition of Pre-Diabetes is better method than the other five different definitions of pre-diabetes.

It was written like this and published by MEDPAGE TODAY.

If you go to their website, they write:

Content on this page was created or selected by the Everyday Health Media team and is funded by an advertising sponsor. The content conforms to Everyday Health Media’s editorial standards for accuracy, objectivity, and balance. The sponsor may select the topic but does not edit the content.

Also the “polls” they publish are not statistically valid since the method used are not scientific, but it does give them an opportunity to say, 56 % of the people polled preferred such and such a drug.

Going back to the HbA1c article, Endocrine society does give you the link to the original article, so as is my custom I checked the original article.

It was from a respectable source and an ongoing research study. Their interpretation differed much from MedPage Today:

Interpretation

Our results suggest that prediabetes definitions using HbA_1c were more specific and provided modest improvements in risk discrimination for clinical complications. The definition of prediabetes using the ADA fasting glucose concentration cutoff was more sensitive overall.

Now, what do you think?

Especially if you are a health care provider?

Would you rather put your trust in a drug company sponsored publication that comes to you free of charge or read the original article and come to your own conclusion.

It is interesting to read this, just a few weeks after another research article cautioning us about using HgbA1c as a diagnostic tool for Pre Diabetes. As I work with Indigenous groups of people, we have so many sociocultural ways of defining who is at risk and plan accordingly. Japanese researchers have cautioned us: On the other hand, for the identification of prediabetes, HbA1c may be inadequate as a screening tool because of its high false-negative results.

PAY ATTENTION TO THE PATIENT AND NOT THE LABORATORY TESTS IS A WISE ADVICE TO GIVE TO THE STUDENTS AND DOCTORS.

THE BEST PLACE TO STAY IN FORT COCHIN WITH A LOVED ONE THE OLD LIGHTHOUSE BRISTOW HOTEL

This photographic essay would convey to you the spirit of hospitality, the ambiance of the Arabian sea kissing your front porch and the great Kerala food served by efficient waiters and the wonderful manager whose motto seems to be: The convenience of the GUEST is the priority.
I stayed here for five nights, it was high season but a twin room facing the ocean was made available to me and my brother.
We enjoyed our leisurely breakfasts with fresh fruit and juice, tasty Kerala fare and attentive service from Sri Nath, Naveen, Raghavan and Ashison among others. We also had dinner twice, both times excellent Kerala seafood or Biryani. The dinner prices are relatively modest comparing the quality of the place and food and service. To give an example, the Kerala fish specialty Karimeen Pollichattu, fish wrapped in banana leaves, cost less here at this upscale place than some of the touristy dining areas, with questionable hygiene along Tower Street or at Fusion Bay. The quality of food here is better than Oceanos Seafood restaurant or Fusion Bay or Fort House Restaurant in Kalvatty road, the other places that we had eaten dinner. The service is the best I have received in Fort Cochin. The fact that we could enjoy a bottle of Grover (under the direction of a French winemaker) Sauvignon Blanc was an added attraction. 
We also used the spa, with an ayurvedic abhyangam total body massage with maitre masseus Manoj which left us both very relaxed the day before we left on our respective long haul journeys.
Always smiling and willing to help were Fatima and Ann Mary at the Front Desk along with Manuel and the Front desk manager, Arvind.
We arranged cars through the hotel, and the drivers Salu and Manuel were excellent and safe drivers, given our usual complicated itinerary.
In short, Rajesh Rajan, the manager,  with his hospitality experience, sets the tone for this delightful place. In our opinion it is the best place to stay either with a good friend to talk to or a loved one to enjoy the romance of the Arabian Sea.
Here are the photos

It was a touching gesture when the staff came out to the patio to say good bye as I left for the Airport. Rajesh the manager on the left, Raghavan from Andhra Pradesh on the right, Fatima who will enril in  Hospitality Management and Ann Mary are in charge of the front desk.

THE JEWISH COCHIN: TWO MIZRACHI BROTHERS IN COCHIN NOVEMBER 2016

This is a pictorial essay of a recent visit to the JEWISH COUNTRY in the COCHIN area in Malabar/Kerala, INDIA.
My brother Eliahu, was born in Bombay of Iraqi and Egyptian parents and grew up in Kobe and migrated to USA where he lives in Portland with his Egyptian Canadian wife and their three children.
We have travelled to Chile, Bolivia, Argentina, Brazil, Singapore, Cambodia twice, Myanmar, Vietnam, Laos in the past. On this trip the highlights were Siem Reap, our third time there together, and an introduction to Malaysia for him and an introduction to Kerala and especially the Jewish Country with its millennial history.
PAROOR OR PARAVOOR, IN THE EX ROYAUME OF TRAVANCORE

in front of the synagogue at Paroor near Fort Cochin

A Hanukkia from Paroor

This is the Jew Street of Paroor, houses on both sides were occupied by Jews. There are no jewish presence now

an earliest evidence of Jewish presence in Kerala, four of the signatories, along with Muslim and Christians, were Jewish and they have inscribed their names in Hebrew. this is dated 849 of the common era and long before Inquisition. Jews of Kerala are mainly of Middle Eastern Origin, from the current day Iraq and Syria with a major infusion from Yemen. In the 1500s a straggling of jewish refugees from Inquisition joined who are referred to as Paradesi or Foreign Jews

It is interesting to note PASTEL which is a sefardic dish which found its way to Cochin.

If I were to show you just the photo below you wouldnt be able to tell to which religion this vernacular architecture belonged to in Kerala, as I have seen this type of architecture going back centuries in Mosques, Churches and Synagogues in Kerala

It is acknowledged that the intellectual centre of Cochin/Malabari Jewish community was Paroor. Joseph Rabban who received the copper plates for the principality of Anjuvanam near Muziris is supposed to have been buried here.
CHENDAMANGALAM
Just five kilometres away is the oldest Hebrew Inscription in India from 1239! of the CE, a tombstone, belonging to a Rachel Bat Israel, thus we are able to date the inland migration of the Jews from the coast.

When I told my brother Eliyahu about this above ceremony among the Mizrachim, he laughed at me. I distinctly remember a ceremony when I was asked to repeat letters and given sweets and instructed  May all your learnings be as sweet as this

Sadly, the cemetery which i had visited as recently as two years ago is completed overgrown by bush and not accessible. I always wondered why the Jews who left for Israel, who had no reason to dislike or hate India, do not make any effort to preserve the synagogues and their burial grounds?

MALA is the saddest place to visit, there is complete neglect of the synagogue and the cemetery despite the valiant efforts of a Hindu professor Karmachandran.

The highlight of the tour is to visit the last practising Jew of Cochin, Elias, who has done a marvellous job of restoring Kadavumbagam synagogue in Ernakulum around which he had grown up. Once he leaves for Israel, the Jewish presence in Cochin, of 2000 years will be forever silenced. 

The area around the synagogue, also called market street and Jew street was full of jewish stores and a photo of Elias' father hangs in one of them, olava ha shalom

a mezuzah at a shop entrance is a reminder than the entrire street was once joyously jewish... now rests only in the memory of one man, Elias

It is a pleasure to meet and chat and learn the TRUE history of the Jews of these parts. Elias has lived in experience of being an observant Jew and the knowledge of this vanished world. The Jewish community vanished a long time ago and its memory would be soon gone too..

PARADESI SYNAGOGUE OF MATTANCHERRY  is the easiest of the synagogues to access and there has bee a tremendous increase in the number of Indian tourists coming to learn about Jews and perchance even to see "one"!

The kind caretaker of the synagogue, a christian by the name of Joy, allowed me and my brother to say the prayers on shabbat after the lights had been lit by the lonely widow of Mr Sammy Hallegua. It was very emotional for both of us to pray, sing in the total silence of the synagogue which has witnessed so much history for the past 450 years!

the cemetery of the Paradesi synagogue is not accessible but is well kempt. reminded me of the Penang Jewish Cemetery of the Iraqi jews of Malaya

The Jews of Mattancherry, the so called White Jews ? who had arrived after 1501 did very well as traders especially under the Dutch and the British. The best known among them last century was Samuel Koder whose house above has been converted into a hotel and restaurant

The Yemeni connection is seen here at this tomb where people of all faiths pray was that of the Kabbalist from Yemen who had lived here in the 17th century. Brother and I lit candles and said Kaddish and prayed for our Mischpochah

women's gallery upstairs can be seen and there is also a second bimah upstairs. This synagogue is a thing of great beauty and hope it will be preserved as such for generations to come. Most of the tourists visiting the synagogue are Indian tourists. very few Jewish or foreign tourists make their way through the streets once thronged with jewish homes and shops which are now the hangouts of Kashmiri muslim tradesmen selling all sorts of tchotkis at inflated prices, irrelevant to the history of the synagogue or Kerala for that matter

as the shabbat was about to enter and we need to welcome it properly, we hurried back to the hotel and did our rituals properly

SHABBAT SHALOM FRM COCHIN