A fateful night that drowned my city

At saturday evening on September 6th, 2014, much to the respite of inhabitants of Srinagar city, rain had stopped after incessantly falling for the previous five days. Sun had started shining bright behind the clouds at the Srinagar horizon moments before the dusk. A pleasantly coloured rainbow had emerged from the western sky. People of Srinagar had started taking a sigh of relief after a painstakingly long spell of rainfall throughout the week. Netizens had joyfully started posting pictures of rainbow and shining sun upon Facebook and other social networking sites with attached messages of hope for a pleasant weather in days to come. Hopes of pleasant weather and sunshine had started rising among the people since the meteorological department had flashed a forecast that the weather was likely to improve over the next few days alongwith an assurance that the “worst was over”. They had predicted sunny days thereafter for more than a week. However an inimical danger was brewing up in the backyards of Srinagar. Due to incredibly heavy rainfall in southern Kashmir districts of Anantnag, Kulgam and Pulwama over the weekend, river Jhelum had swollen beyond imaginable proportions and had assumed a lethal posture sufficient enough to consume precious human lives in tens of thousands. Nobody from the government side was hinting at the alarmingly rising water level in river Jhelum by any possible means. No warnings, announcements or flood alerts had been propagated from any quarter throughout the day until it was 10.30 pm at night. Consequently nobody in Srinagar had any inkling of an impending disaster that was likely to strike during the following night.

At around 10.30 pm during the special radio broadcast Chief Engineer, Flood Control and Irrigation Department stated that next four to five hours are going to be very crucial for Srinagar city since water level had risen considerably above the danger mark in southern Kashmir district of Anantnag and dangerously swollen waters of river Jhelum were proceeding fast towards Srinagar. He stated that it will take these waters around 4-5 hours to pass through Srinagar during which there was a threat of severe flooding in some low lying areas like Rajbagh and Jawahar Nagar and he advised the people residing in these areas to evacuate to safer places. When asked about his advice for other citizens of Srinagar city, he vaguely stated that entire central Kashmir is under threat of flooding but didn’t suggest evacuation in any other area of the city. Meanwhile Irrigation and Flood Control Department on its Facebook page reported water level at the entrance of Srinagar city at Ram Munshi Bagh level measuring gauge at 23.2 feet which was much above the danger level of 16 feet and flood level of 18 feet. This little but dreadful piece of information was sufficient enough to trigger panic waves among those who were tuned to the special radio broadcast or were following the situation over facebook. Within no time warning messages and flood alerts started circulating over facebook.

Even while Chief Engineer IFC dept was asking people of low lying areas to evacuate reports came that Jhelum had already breached the embankment near Chattabal and flood waters had inundated several localities in its vicinity there. At around 11.30 pm news came that Natipora, Budshah Nagar, Chanapora and Mehjoor Nagar areas had been submerged by overflowing Doodhganga rivulet, a tributary of Jhelum. All this had started sending adrenaline rushing throughout my body and there were no signs of sleep even though by midnight I am usually fast asleep. Our own locality was under no threat of flooding at this point of time. At 12 am water level at Ram Munshi Bagh was reported to be 25.2 feet showing an increase of 2 feet within a span of just two hours. This was a clear indication that water level was constantly rising above the danger mark and entire Srinagar was likely to get drowned if it continued to rise at the same pace. Meanwhile I started wondering why there is no labeled demarcation beyond the danger mark. Some height above the danger level should have been labeled as catastrophic or evacuation level whereafter all the people living on Jhelum banks or upto some specific distance from Jhelum should be asked to evacuate irrespective of virtual water level in their own respective areas. At around midnight reports started making rounds that entire Bemina locality, Batamaloo and Qamarwari had been inundated by flood waters overflowing due to several breaches in river Jhelum as well as in the flood spill channel at as many as sixteen places. Barzulla and several areas near Rambagh had already been flooded on the previous day due to overflowing Doodganga whose water had been diverted into the flood spill channel by the local residents after flood gates meant for the purpose failed to open near Barzulla. Flood waters had already seeped into Bone and Joint Hospital at Barzulla due to which all patients there had to be shifted to the Govt. Nursing Home at Gupkar.

It was 1 am in the morning of September 7th, 2014 and I was still awake closely monitoring the flood situation over facebook keeping in touch with a cousin of mine who lives with his parents near the Jhelum bank at Noorbagh locality. He was constantly updating me about the overflowing Jhelum persistently trying to breach the embankment near Malik Sahab, Safa Kadal as well as near Cement Bridge, Qamarwari. Infighting had broken out among residents of Noorbagh and other deeper localities like Shunglipora, Gooripora etc over diversion of overflowing water into their respective localities. People living in these low lying areas were afraid to get completely drowned in case overflowing Jhelum waters were diverted towards their areas. I was also following scary updates of some of my students who were helplessly watching noisily overflowing Jhelum waters near Fateh Kadal and Gaw Kadal areas. Their houses too were situated near Jhelum embankments and constantly rising water level was severely threatening the safety of their lives and property. I was persistently alerting them to remain vigilant throughout the night and shift to some safer areas at the higher altitude as soon as it rises above the maximum threshold level.

Exactly at 2 am on Sunday morning water level at Ram Munshi Bagh crossed the highest recordable level of 26.25 feet and the gauge plate got completely submerged under water. By now several localities of Srinagar city had been inundated by flood waters and their inhabitants were crying for help. Frantic calls were being made for rescue over facebook and its users were asking each other to send rescue teams to these areas without knowing of any other means by which they could be of help. Everyone looked helpless and absolutely clueless about how to help the needy people in the middle of the night. Majority of the population of Srinagar city was fast asleep not aware of the impending disaster. No efforts were made by the govt. at all to make announcements through public address systems even at least in the most vulnerably low lying areas like Rajbagh, Jahawar Nagar etc. This was a total govt. failure of criminal nature. At this juncture phone calls should have been made to the people in these areas, announcements should have been made over loud speakers in mosques, from mobile vans, radio stations etc. However nothing of this sort was happening as if govt. had completely slept and left the city at the mercy of God or perhaps left it to get drowned once and for all. Srinagar netizens were silently watching the devastation and destruction caused by the flood with great sadness and feeling of haplessness. By now there was no doubt that Srinagar was in for a major catastrophe. Only thing that was left to guess work was the extent of damage and the areas most likely to suffer the most. Only thing at that juncture one could do was to pray for God’s mercy. Nothing else seemed to be working at all.

At around 6 am in the morning news came that Jhelum had breached embankments near Shivpora locality on the outskirts of Srinagar city and flood waters had submerged Indira Nagar, Sonwar, Pantha Chowk, Athwajan, G.B. Panth Children’s Hospital leaving thousands of people stranded in their houses struggling against the gushing waters. Oxygen plant located in the ground floor of G.B. Panth Children’s Hospital had been rendered dysfunctional and the children had been shifted to the topmost floor of the hospital with many of them in critical condition. Some reports suggested several deaths during this mayhem. This was the worst form of fury of the floods. Water had terribly logged into these localities and risen upto second stories of the buildings leaving absolutely no chance for the inmates to move out for rescue. Meanwhile Rajbagh, Jawahar Nagar, Chattabal, Karan Nagar, Qamar Wari, Bemina, Nawab Bazar and Lal Chowk areas too had been inundated. Among all the hospitals of Srinagar city, G.B.Panth Children’s Hospital, L.D. Maternity Hospital, SMHS tertiary care hospital, SKIMS Medical College Hospital and Bone and Joint Hospital had been marooned by flood waters and the patients had been shifted elsewhere, God only knows how. With these major hospitals rendered inaccessible and dysfunctional, SKIMS was the only major hospital that was still operational in Srinagar city. A very painful morning had dawned over Srinagar. Srinagar was confronting floods of biggest ever magnitude, a magnitude that it had not witnessed even sixty years back when for the last time worst ever floods were recorded in the history of Kashmir valley. After flooding numerous villages of Southern Kashmir districts of Anantnag, Kulgam and Pulwama, floods had wreaked havoc in Srinagar city and the worst didn’t seem to be over yet as had been predicted by the officials of Metereological department previous night. There seemed to be lot more devastation still in store for the Srinagarites.

Coming days proved to be the worst nightmare for the Srinagar city and its people. All mobile and fixed telephones got disconnected, internet services got snapped, broadcast from all radio stations and telecast from all local TV stations got disrupted, half of Srinagar city got completely dissociated from rest of the state as well as the country. Initial estimates suggested economic losses to the infrastructure and businesses of Kashmir valley caused by the massive floods to the tune of rupees one trillion. By all means it was unmanageable and unbearable. More than 250 precious lives had been consumed in the state. Srinagar was pushed literally to pre-historic times with no essential supplies like food and fuel, no electricity, no water supply, no police officials, no rescue teams, no govt. services, no govt. officials visible anywhere. Complete failure of government machinery compounded the problems faced by the people multifold. Government’s command and control system was thrown completely out of gear. With almost all govt. offices completely inundated, there were no signs of government anywhere, consequently no inflatable rescue boats, no lifebuoy jackets, no inflatable tubes, no rescue ropes, no rehabilitation tents, no relief material was anywhere in sight in any submerged locality of Srinagar for almost a week after the floods. Valiant local youth had taken governance, law and order, transport, rescue, relief and rehabilitation completely in their own hands in absence of any government functionaries. Srinagar had been pushed several decades behind with colossal damage to its infrastructure like schools, colleges, bridges, roads, residential houses, business establishments, communication networks as well as to life and property of the common people.

In the hindsight flood fury proved that the state government was totally lax and unprepared to face a calamity of such a magnitude. Worst ever disaster preparedness and management was displayed by the state government. There was no prevention, mitigation, rescue, relief or rehabilitation plan anywhere in sight. It seemed that the state government out of sheer complacency had never ever thought let alone planned of such a catastrophe. Most criminal negligence on part of the concerned government officials was that they did not divert flood waters of river Jhelum towards Dal Lake before it entered the Srinagar city and wreaked havoc in highly populated areas. Water was diverted towards Dal Lake two days after it had submerged most parts of Srinagar. Had Dal dwellers been evacuated in time and water diverted from Ram Munshi Bagh flood gates on Saturday evening itself Srinagar could have been saved from the inundation that it faced because of govt. negligence.

Worst display of govt. inaction was visible at Sangam Saidapora flood gate whose control was seized by the land mafia brigade of Aanchar who didn’t let the gate open in order to allow flow of flood waters into Aanchar lake which is the natural and destined route of overflowing Dal waters. Govt. failed to take control of this crucial flood gate even for a week and allowed the land mafia to take into hostage a huge population under threat of floods living in the vicinity of Dal Lake, Nageen Lake, Pokhribal, Nala Amir Khan, Khushaal Sar and Zadibal. This kind of government inaction and negligence was totally unseen and unheard of wherein lives and property of lakhs of peoples were put to immense risk for want of administrative control. The damage done to all these areas by flood waters of Jhelum would by no means have been any greater than if the water had been diverted on Saturday evening itself. This was the biggest lapse on part of the government whose price had to be paid by the people of Srinagar city particularly those living in the civil lines of the city. Besides God’s mercy, tradition of constructing three storey buildings and the habit of Kashmiri people to stock sufficient food grains in their houses proved to be the life-saving conventions since majority of flood struck people got trapped in their third floors and food grain stocks proved quite handy to them. Moreover resilience and courage of the Kashmiri people under trying circumstances also turned the tide favourably. These floods were just another litmus test of the courage and conviction of Kashmiri people who passed the test with courage and valour.

Dr Geer M Ishaq

A full term wasted on health front

Recent news reports making fresh disclosures about substandard drugs being consumed by the people in Kashmir are shocking and shameful. One can only express his dismay and deep disgust over government inaction in controlling and regulating the quality of medicines being consumed by the people. The very fact that sale of spurious and substandard drugs is continuing unabated with full knowledge of the drug control officials is proof enough that government is taking Kashmiri people for granted as there is complete lack of accountability on all fronts particularly in matters related to health of the people at large. When Drugs Controller of the state himself admits that people are being supplied fake and substandard medicines and they have utterly failed to curb such consumptions, a deep sense of distress becomes clearly visible among the hapless masses. Who else can save this sinking ship when the savior himself turns disdainfully inept and impotent?
 

Even while present Government of J&K is about to complete its full term of six years and new assembly elections are on cards, it has not only miserably failed in implementing the draft drug policy that was revised with due intervention of the subject experts of the Civil Society Forum Kashmir but has displayed total inaction in fulfilling its tall promises of upgrading drug testing facilities of the state and making alternative drug testing laboratory functional at Bemina, Srinagar for which a detailed proposal was also submitted to the govt. by CSFK. Government’s face-saving measures taken at a time when spurious drug scam surfaced in the state like setting up of J&K Medical Supplies Corporation and streamlining drug procurement on the pattern of Tamil Nadu Medical Services Corporation have proved to be a damp squib and a non-starter in spite of the fact that more than a year has passed ever since this Corporation was set up but it is still quite far from being functional since no sufficient staff or funds have been made available to the said Corporation so far. Same is the fate of other provisions of the draft drug policy like implementing generic drug prescribing and sale within government hospitals and issuing drug licences to qualified pharmacists only. One can safely conclude that the present term of the government has been a complete waste in securing health of its people. Government has miserably failed on every front.
 

With this kind of pathetic state of affairs civil society must come on roads and protest against the government inaction and dilly-dallying attitude regarding this vital aspect of public health. It is high time that the concerned ministry and health authorities of the state fulfill their promises made to the people from time to time and ensure sale of standard quality drugs besides implementing all provisions of the draft drug policy and issuing drug licences to qualified personnel only. Registration of unqualified people as pharmacists and issuing drug licences to them must stop forthwith and qualified pharmacists must be employed in all hospitals of the state. J&K Medical Supplies Corporation must be provided with all requisite facilities and made fully functional besides upgrading the drug testing facilities on a war footing basis.
 

Some other measures that are awaiting implementation since long include employment of qualified pharmacists in various allopathic dispensaries, primary health centers, sub-district & district hospitals and all major hospitals of the state in tune with recommendations of various expert committees constituted at the national level, initiation of quality control and analysis of drugs at all major hospitals of the state, commencement of diploma level pharmacy course at various polytechnics and opening up of a govt. pharmacy college in the state, reconstitution of the J&K Pharmacy Council with due representation to the academic institutions, framing of Education Regulations by the J&K Pharmacy Council for streamlining the pharmacy education in the state, setting up of Pharmacovigilance and Drug Information Centers in the valley, upgradation of the pharmaceutical industrial infrastructure and entrepreneurship development in pharmaceutical manufacture, augmentation of the infrastructure, staff and other facilities at the Drug Testing Laboratories as well as the Drug Control Organization, effective enforcement of the provisions of Drugs and Cosmetics Act related to Cosmetics and AYUSH drugs, centralizing procurement and decentralizing distribution of medicines in the state, allocation of sufficient resources for medicine procurement in the govt. sector and initiation of clinical pharmacy services in all hospitals of the state.

Honesty: Does it continue to be the best policy?

Corrupt people keep climbing on the ladder of success, kissing the feet of those ahead of them and kicking the heads of those beneath. Geer Muhammad Ishaq writes on the modernization and institutionalization of corruption in Kashmiri society

Nowadays corruption has become the way of life. It is more organized and institutionalized than ever. It has penetrated deeply into every sphere of public as well as private life. Majority of people working in public as well as private sector are falling prey to it and those who are opposing or resisting it or staying away from it stand completely isolated and crushed. In keeping with ever changing times and trends, of late, corruption too has undergone modernization and assumed new shape and proportions. Whereas vivid embezzlements and misappropriations used to rule the roost once, now corruption is manifesting itself in a much more sophisticated form. Gratification practices have radically changed lending them more user-friendly and so to say compatible with the existing legal framework. Where earlier there used to be embezzlements of crores of rupees in its crude form by turning to forgery, frauds and tampering of records, due to increasing number of such cases coming to fore and falling under the legal dragnet, now people intend to play safe and keep their records unblemished by resorting to a more disciplined yet equally profitable form of corruption that is based on a fixed slice of commission rather than embezzlement or misappropriation. We Kashmiris in particular seem to have advanced so much in such novel skills and tactics that it would be no wonder in case international organizations seek our expertise in framing proper guidelines for this kind of “legal corruption” for their worldwide adoption by prospective clients.

 

To make things a bit more clear, an example is cited for the interest of readers. Suppose you are heading some department and have an annual budget of say Rs. 1 crore at your disposal to be spent on purchase of goods like equipments, books, glassware, chemicals, stationary etc with a small amount being allocated for repair and maintenance activities.  You don’t have to burn your midnight oil in planning your embezzlements since the methodology has taken a much convenient and smooth shape nowadays. Just catch hold of a few selected, accommodating and hassle-free suppliers, check out uncleared stocks lying pending with them since ages which they are ready to sell at throw-away prices, be it exorbitant equipments, substandard chemicals, redundant glassware, rejected books, outdated instruments or any other useless office supplies. Whip up a deal. Ensure him a damn handsome and unexpected price at the cost of state funds for his dead stocks and in return fix a solid lucrative commission for yourself. Next remains your submissive and obedient subordinate staff, in case absolute worthlessness of the goods you intend to procure makes you feel slightly insecure, get a resolution passed and signed by them that all such stuff is urgently required for the efficient running of the department. For this, you don’t have to plead before them or request them in a kneeled-down posture since most of them too have their own ambitions and aspirations relating to their career, perks, nominations, permanent appointments, deputations etc. They too need to seek your favours whether due or undue from time to time and above all need your personal care and patronage.

 

As such, their consent will never be a hurdle in your way, no matter if that plunges them and their dept. ineluctably into a dismal doom. This way make your exercise authentic and fool-proof and purchase goods worth lacs that are either of no use or of little relevance to the actual field of application.  Doesn’t matter if people suffer on this account, don’t worry if dept. deteriorates and never care if funds go down the drain. You and your family should prosper. Your cash reserves should fatten up and your property both movable as well as immovable should expand. A commission of a meager 10% over an annual budget of Rs 1 crore will fetch you a cool 10 lacs per annum, other lavish gifts and compliments not inclusive. An added advantage that brings you solace being that all your documents and records remain as spotless as freshly fallen snow. Even the most experienced and seasoned auditors can’t pick any holes in your accounts, the most dreaded sections of the Prevention of Corruption Act can’t bother you and the most watchful vigilance authorities can’t even touch you. To absolve yourself of any likelihood of being charged of amassing huge wealth grossly disproportionate to all your known sources of income, keep your property on the name of your non tax-payer relatives. But don’t forget to retain all documents with yourself lest you shall land up in a catch-22 situation. This is the magic mantra by which people have over the years kept climbing up on the ladder of success, kissing the feet of those ahead of them and kicking the heads of those behind.

 

Amidst all this bonhomie if anybody’s conscience does not permit him to remain a mute spectator to the entire debacle and shows up even an iota of resistance or resentment, his action is viewed as a fierce incursion and an open rebellion since people wish to run their departments as per their own whims and fancies and expect everybody else to remain deft and dumb and simply dance at their tunes. In no time, acrimonious retaliatory assault is launched against those who do not comply and those who dare to question, thus triggering an unending trail of internal squabbling within the dept. Such a person is labeled as a spoilsport and made to pay a hefty price for his rationality and integrity of character. Hostility manifolds upon him in some of its most ugly manifestations. He is singled out and isolated, subjected to gratuitous insults and made to suffer at every front until he throws up the sponge. All his past contributions are willfully ignored and achievements sidelined. Controversies are created, new disputes raked up and concocted plots hatched against him in a most abominable and despicable manner. He is vilified, persecuted and forcibly coerced and constrained into subjugation and obedience. If he still refuses to relent, he is persistently excoriated and discriminated, his role being retrenched down to a mere observatory status. He is kept at an arm’s length from all vital assignments and decision-making processes.

 

He is segregated, shunned, criticized, abhorred, secluded, targeted, victimized, harassed, humiliated, traumatized, troubled, terrified, maligned, defamed, suppressed, oppressed, obstructed, disillusioned, discouraged, falsely implicated, confronted, rejected, disapproved and ultimately thrown out of the system. Rot of corruption has infected the entire system to such an extent that those who accept it and become a part of it progress and prosper and those who reject it get rejected sooner or later. One who raises his voice against the corrupt and the corruption is banished and never allowed to grow. He faces hurdles at every step and all his progressive moves are opposed and suppressed. He ends up getting totally isolated in his place of work and is slowly and steadily pushed to the bottom level. Gradually he becomes depressed and disillusioned with the system losing all self-confidence and morale to work and excel since his good work is never appreciated and his small mistakes are blown out of proportion and projected as huge scandals.

 

The role played by his other colleagues too turns opportunistic and despicable. Everyone starts holding the odd man to ransom and a senseless spree of usurping his rights and transgressing his jurisdiction gets unveiled. All this is done in a bid to sycophantically please the boss and to gain a few deserved or undeserved favours from him in return. With his morale boosted to a euphoriant extent, the boss then uses all his overt and covert means to hinder his progress and mar his career. If any unpleasant or untoward events have occurred in the dept., he is blamed for them all. In front of higher authorities too, he is projected as a baddie. All his academic pursuits and endeavors get stuck in the mud. The trail of their atrocities and frenzied rage does not end here. Every opportunity is grabbed to falsely implicate and farcically frame him with dereliction of duty. Conspiracies are hatched against him and he is found guilty of offences that he never committed. Under these trying circumstances, how these fearless young men conduct themselves to ensure their survival in such a precarious and corrupt ambience remains worth watching. For certain, their bewilderment and vengeance arising out of the paranoid and disdainful treatment being meted out to them is bound to lead to some deleterious proposition, quite similar to the one that we have been experiencing over the past several years.

 

During their course of fraudulent activities, a few amongst this breed of corrupt officials present themselves as spiritual saints with hitherto unrevealed  powers. They corroborate their mysterious claims by making frequent references to their previous miracles. Such mischievous gimmicks stand them in a good stead in diverting the attention of gullible sect of their staff as also in shrugging off their genuine apprehensions, winning their trust and confidence and thereby covering up their own misdeeds. Occasionally they even threaten their dissenters of dire retaliation and spiritual reprehension in case they don’t give up their resentment. Enlightened souls albeit don’t give a damn to such abysmal and diabolical threats and claims. The poignant attitudes of such distressfully unenterprising officials desperately beseech an immediate change. They need to be introduced afresh to the rudiments of ethical conduct and professional ethos. Indomitably stubborn and invincibly arrogant, they consider themselves supreme and unimpeachable and forget that there is yet another supreme power watching them all the time whom they have to face on the actual day of judgement and account for all their vices. They badly need to shun their desolate egos and stop feigning omniscience lest they will most miserably face the wrath of time.

 

Whatever is being stated here should not be perceived as a specific reference to any particular department, organization, institution or individual. This is the story of many such establishments whether under state or central administration where this sort of corruption is looming large and men of conscience are being persistently harassed, humiliated and suppressed ruthlessly. Many readers of this column will surely find some resemblance or reflection of such unfortunate men and women combating such conditions of duress, at their own places of work. Any such resemblance is purely coincidental. This is a general trend lately observed as being dominant in govt. and semi-govt. offices whose immediate implications have been telling adversely upon our social, ethical, moral as well as financial upliftment.

           

Instead of devising ways and means to chalk out technological, scientific, administrative and economic development of the various institutions existing in our organizational hierarchy, corrupt officials at the helm of their affairs are busy drawing their mean personal benefits and making their own fortunes at the cost of state exchequer resulting into massive economic polarization of our society and consequently fostering our inabilities and inadequacies further in catching up with the global race for overall progress, social reform, economic and technological advancement. Therefore need of the hour is to stir up their conscience hard enough to arouse them from their hysterically complacent states and make them face the hard world of accountability and transparency in their work and conduct. As said by Allama Iqbal:

Ik zindaah haqeeqat mere seene main hai mastoor

Kya samjhega who jiski ragoon main hai lahoo zard

Integration of Pharmacometabonomics, Pharmacogenomics and Proteomics for personalized drug therapy and optimum therapeutic outcome

ABSTRACT:

Metabonomics is the comprehensive quantitative and qualitative analysis of all small molecules in a system (in samples of cells, body fluids, tissues and so on). One of the advantages of pharmacometabolomics over the other omics technologies is that the metabolic profile represents the phenotype of the organism and reflects the overall biological influences, including interactions between multiple genomes (e.g., genomes from animals or humans and their gut microbiome). Pharmacometabolomics uses the predose metabolite profiling in the biofluids or fecal extracts to predict the responses of an individual to a chemical intervention and to identify surrogate markers for subsequent drug administration.

A primary goal of personalized medicine is to provide the best medical treatment for each individual patient by determining which drug will have the best efficacy and have the least amount of toxicity and/or adverse effects. Furthermore, understanding interindividual variations of response to drug treatment, especially in patients with potential adverse reactions, might lead to biomarkers that can be used to predict the low incidence of idiosyncratic toxicity. Personalized medicine is usually based on the concept of pharmacogenomics that studies the influence of an individual's genotype and/or SNPs on their response to a drug or medical treatment. Despite enormous energy and monetary efforts, pharmacogenomics has had limited success in clinical pharmacology to predict drug response with absolute certainty using single or multiple SNPs as biomarkers. The major reason for the limitation is that the response is dependent upon the phenotype of an individual, which is determined by both genotype and its complex interactions with other environmental factors. These environmental factors include diet, lifestyle, gut microbiome, nutrition, medications (polypharmacy), age and exposures to toxins or dietary supplements, as well as the individual physical and pathological conditions (e.g., diabetes and obesity).

The major limitation of proteomic screens is that they are tissue specific and therefore require tissue to characterize protein variability. Further tissue samples from organs such as lung, kidney, heart, or brain are not easily obtained for proteomic screens. Therefore this paper envisages the need for integration of all omics based technologies like Pharmacogenomics, Proteomics and Pharmacometabonomics for an integrated approach towards personalized drug therapy in order to maximize disease related outcomes and minimize unwanted effects.

Nanopharmacology and Nanotoxicology – emerging new disciplines in drug discovery, development and research

ABSTRACT:

Nanotechnology is concerned with materials and systems whose structure and components exhibit novel and significantly improved physical, chemical, and biological properties, phenomena and processes because of their nanoscale size. Nanomaterials differ significantly from other materials due to two principal factors; the increased surface area and quantum effects. These factors can enhance properties such as reactivity, strength, electrical characteristics and in vivo behavior. Nanopharmacology is defined as application of Nanotechnology for the development and/or discovery of methods to deliver drugs and nanomedicines developed to operate on a nanometer size range (typically less than 500 nanometers) with novel engineered properties that provide medical and pharmaceutical benefits, specifically for the treatment of diseases.

Majority of current commercial applications of nanotechnology in medicine are geared towards drug delivery to enable new modes of action as well as better targeting and bioavailability of existing medicinal substances. Nanotechnologies provide a wide range of new opportunities for developments in pharmacology like targeted drug delivery, applications of nano-containers in drug delivery, targeted influence on the immunity and new vaccine types and new hybrid nano-compounds for cancer treatment. Novel applications of nanopharmacology also include nanostructures that allow transport across biological barriers, use of nanoprobes, nanosensors, nanobiochips for study of pharmacokinetics and pharmacodynamics at nanoscale level and use of multifunctional chemical structures for drug delivery and targeting of disease.

Increased usage of nanotechnology in healthcare system without adequate attention to safety and exposure risks has lead to evolution of another new frontier viz., Nanotoxicology that deals with the study of effects of nanomaterials on humans and environment. Nanotoxicology can be defined as a branch of toxicology that analyzes the risks and consequences of exposure to nanoscale materials on the environment and human health. It encompasses study of three main components such as nanopharmacology, nanopathology and nanophysiology. Although a number of techniques are under development to assist nanotoxicology like nanoinformatics that can contribute in risk assessment and development of safe nanopharmaceuticals.

 

With the advent of new technologies and innovative applications of nanosciences, nanopharmacology and nanotoxicology are increasingly assuming greater importance in the wake of unprecedented pharmacological and toxicological effects of nanomaterials on human beings. Therefore these two subjects are emerging as novel disciplines and are receiving an ever-increasing attention of academics and researchers. These two disciplines will progress with advancing nanomedicine related technologies and are likely to occupy the centrestage in times to come.

Journey of a lifetime - my frantic race against time

One year back I undertook a journey of my lifetime, one with full of shocks as well as pleasant surprises, to Mexico. Even though the story is a year old now, its imprints are still afresh on my mind since it had left some lasting impressions behind. Today I somehow feel like sharing my experiences of that incredible journey once again even though I have partially written about it last year in weekly “Kashmir Life”.

As they say, “journeys help you discover your true inner self”. It was my third visit abroad but was not as smooth and hassle-free as my earlier two trips to Turkey and Australia but it helped me a great deal in having a glimpse of the resolute self inside me (no self-boasting intended). This time I was going to present a couple of my accepted research papers at the 12^th annual conference of the International Society of Pharmacovigilance that was scheduled to be held between October 30^th to November 2^nd, 2012 at Cancun, Mexico – the land of ancient Mayan civilization. Out of around 400 delegates I was one among the lucky six people who had been fully sponsored by the International Society for this trip purely on the basis of merit and quality of my research papers. I could never have afforded to miss that golden opportunity under any circumstances.
 

I commenced my journey from Srinagar and my first stop-over was at Delhi followed by Mumbai. A flight from Delhi was not available when I had booked my tickets. Upon reaching Mumbai while I was quickly rushing towards the immigration clearance section of the Chatrapati Shivaji Airport in order to catch my next flight to New York I got the huge shocker that all flights to New York had been cancelled owing to the threat of hurricane Sandy that was looming large over the East Coast of USA. The queue of affected passengers was horribly long and each passenger was to my great discomfort and annoyance consuming too much time at the counter.

While in the queue my fellow passengers were woefully narrating how this cancellation was going to wreck havoc to their travel and other domestic plans. Behind me in the queue was an Indian-American wife and in front of me an Indian-American husband. Husband in front of me was constantly being scolded by his wife from America on phone, probably for not listening to her or something else and that was leaving him in a very embarassing situation. On the other side Indian wife behind me was rebuking her husband on phone in Gujrati for something that I couldn't understand. Poor husbands were getting the bashing both in India and America and that was the only source of amusement for me at that very time. After a spine-breaking wait of over three hours in the queue I could make up to the airlines counter where I was offered either a rescheduled flight through an alternative sector or a full refund in case I opted to abandon my onward trip. But in spite of quite serious apprehensions of getting stranded somewhere in Europe or America, I chose to go by an alternative route because I didn’t want to return back home looking like a nincompoop without having fulfilled the basic aim of my sojourn.

I was reminded of an anonymous quote, “If you don’t get lost, there’s a chance you may never be found.” They offered me a route in which I had to change four planes between Mumbai to London to Houston to Mexico City to Cancun and my original journey of 21 hours was getting overstretched to more than 48 hours. Since an alternative sector was available, I quickly grabbed their offer and boarded my British Airways flight to London with words of Alex Noble reverberating in my mind, “Success is not a place at which one arrives but rather the spirit with which one undertakes and continues the journey." Flight attendants of British Airways flight were all middle-aged, obese, senior employees with little enthusiasm usually seen in the younger lot and on top of it there was no vegetarian food available to my utter disgust since I mostly avoid non-veg food during foreign trips. All they could offer me was a plate of stale, dark coloured, somewhat bitter noodles that I couldn't even taste properly and had to manage with some soft drinks and biscuits only.

Upon arriving at London Heathrow airport, it was pleasantly cold, slightly misty and drizzling. London Heathrow airport was awfully busy as usual and after we landed I could count at least seven planes hovering in air, lined up in the sky waiting for their turn to land. Before our landing we too had circled many times over London and in the process we could have a detailed glimpse of the beautiful London city from above. I rang up to my home to inform them about the changed schedule. They had heard about the cancellation of flights and were worried about my itinerary and safety. I assured them on both the counts and they took a sigh of relief even though continuous news about displacement of lakhs of inhabitants and cancellation of thousands of flights at East Coast of USA was making me increasingly nervous since my next stop was Houston, USA from where I had to fly to Mexico city. My sole target was to reach Cancun in time.

My transit through Houston was smooth and I reached Mexico City in time. However it took me some extra time to go through my immigration clearance at Mexico City airport because of the huge rush of passengers there in spite of the fact that I was lately given preference due to my connecting flight. I reported at the domestic ticket counter 45 minutes before my next connecting flight to Cancun. Travel agent shocked me there by saying that domestic check-in closes one hour before the actual flight and therefore I won’t be able to check myself in. I had to catch the air train and rush back to the International terminal to contact my airlines agency for the next flight. To my surprise in the entire hall of more than 20 ticket counters, not even a single counter was operational. On top of it no Adam or Eve around was able to speak or understand even a single word in English. By then I had already missed my last flight to Cancun and that had left me really distressed.



View of pristine Cancun beach from my hotel room balcony

After running helter-skelter for some time, out of great difficulty I could locate an official who was busy labeling some baggage, for narrating my ordeal and claiming my baggage. To my utter surprise, he quickly generated a printed ticket for me from his computer and told me to rush back to the domestic terminal for catching the next flight to Cancun scheduled at 10 pm. This time air train was very cruel on me since it was arriving to pick me up only after a gap of 15 minutes which I was not in a position to afford since it was already 9 pm and I had to check in immediately. I almost lost all hopes of making it to Cancun in time. Somehow I reached the domestic check-in counter just fifteen minutes before the flight and after some initial dilly dallying and refusal by the airlines staff that I resisted with some stiff arguments, they checked me in at the eleventh hour and I went rushing to board my sixth and last flight to Cancun.

I managed to board the flight just five minutes prior to its scheduled departure and the first thing I did on board was to ask for a glass of water which was offered to me quickly by a Mexican air hostess who was slightly bewildered to see me gasping for breath. However all hardships were not over for me yet. Upon reaching desolate Cancun airport in the middle of night, I received another blow when I was told that my baggage had not arrived and would be delivered next day at my hotel, J. W. Marriott. Consequently I had to spend the first day of the conference uneasily in my travel attire. However my room-mate Raul Rodriguez Ramos, a Mexican Pharmacovigilance student from Guadalajara was sweet enough to lend me his spare razor so that I could shave my beard off.

Early morning when I stepped out onto my hotel room balcony, the sight in front of me was incredibly amazing. Mesmerizing view of clean turquoise waters of Caribbean sea, tidy white sandy beaches and tall hotel buildings of Cancun standing in a row, was nothing short of some heavenly abode. All my travel miseries vanished in a jiffy and I found myself in an entirely different frame of mind. I found my belief in the saying that fruits of patience are always sweet growing stronger than ever. In fact fruits were much sweeter than sweet this time. All my travel torments had paid back so pleasantly. I had absolutely no regrets for taking all the trouble to reach that lovely place on the face of earth. Courteously my travel ordeal was briefly touched upon without naming me by the Chairman of the Conference, whom I had met at the breakfast, in his inaugural address. My return journey back home was as per schedule without any such hassles since the super storm Sandy had already gone past. What transpired during my four day long stay at Cancun is another story to tell, but of course a very refreshing and enjoyable one. It was the most memorable and cherishable confrence trip of my entire life. And yes my baggage was delivered next day at my hotel with complimentary lamination done.

- Dr Geer Mohammad Ishaq

September 25: World Pharmacist Day and the Continuing Dismal Scenario in J&K

International Pharmaceutical Federation (FIP), a global federation representing three million pharmacists and pharmaceutical scientists worldwide, in its 2009 Council meeting held at Istanbul, Turkey decided to observe ‘World Pharmacists Day’ annually on September 25, the day when FIP was founded in the year 1912. Main objective of the World Pharmacist Day campaign is to raise awareness about the professional activities of a qualified pharmacist and educate the public on the invaluable role and crucial responsibilities of the qualified pharmacists in healthcare system and also to inculcate a sense of pride, solidarity and awareness among the pharmacy professionals on a global level. Given the fact that pharmacists represent the third largest healthcare professional group in the world and India too is home to over ten lakh registered pharmacists, Pharmacy Council of India has also decided to celebrate Pharmacist’s Day from this year onwards.

 

Over the past few decades there has been a trend for pharmacy profession to move away from its original focus on medicine supply towards a more inclusive focus on patient care. The role of the pharmacist has evolved from that of a compounder and supplier of pharmaceutical products towards that of a provider of services and information and ultimately that of a provider of patient care. Number of medication options have also multiplied manifold thus raising the complexity of therapies. Pharmacists have a unique role to play in evaluating these options and utilize their knowledge and skills to prevent, detect, monitor and resolve any medicine related problems. The concept of the seven-star pharmacist, introduced by WHO and taken up by FIP in 2000 in its policy statement on Good Pharmacy Practice, sees the pharmacist as a caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager. However the involvement of qualified pharmacists in J&K state in this regard has remained abysmally low, contrary to trends in other Indian states and developed countries. While seeking medical help, people think of a doctor or a nurse or a medical assistant, but seldom does a pharmacist come to mind probably because even a matriculate is eligible to be registered as a pharmacist in this state and anybody can get a license to sell medicines irrespective of his educational and technical background. Amidst all the mess prevailing in our state, people holding degrees in Pharmaceutical Sciences are jobless and have been left to lurch to fend for themselves. All this needs correction by introducing professional services of Clinical Pharmacy alongwith a novel concept of “Pharmaceutical Care”.

 

Pharmaceutical Care is a patient-centered, outcome-oriented pharmacy practice that requires the qualified pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease and to make sure that drug therapy regimens are safe and effective. Professional Clinical Pharmacy services offered by trained personnel holding graduate and post-graduate degrees in Pharmaceutical Sciences can help a great deal in identifying potential and actual drug-related problems; addressing needs and resolving actual drug related problems; preventing potential drug-related problems and optimizing patient therapy outcomes.  It is a practice in which the pharmacy practitioner assures that all of a patient's drug therapy is used appropriately for each medical condition; the most effective drug therapy available is used; the safest drug therapy possible is used, and the patient is able and willing to take the medication as intended. Patients in our part of the globe have not been able to avail such professional pharmaceutical care services so far as a result of which there is large scale dissatisfaction and disillusionment among them since they largely remain uninformed about various lab investigations conducted upon them and about the necessity for various drug therapies prescribed.

 

Clinical Pharmacy on the whole is in its infancy in the state of Jammu and Kashmir and the concept of Pharmaceutical Care is completely new to most of the physicians, nurses and even pharmacists presently working at the government health facilities. As a result of the patient overload of physicians and some other reasons, they are not in a position to offer detailed counseling, patient education and pharmaceutical care services on individual basis to all their patients. Therefore it is for the trained pharmacy practitioners to step in and fill the void by offering such services with a view to achieve definite therapeutic outcomes that improve a patient’s quality of life. Overall goal of professional Clinical Pharmacy services is to optimize the therapeutic outcome management and decrease the burden of five D’s viz, death, disease, disability, discomfort and dissatisfaction among patients. Clinical, economic and humanistic outcomes will also shift towards the positive side as a result of these integrated and seamless healthcare services rendered by a trained pharmacy practitioner. With these aims and objectives, University of Kashmir started a post-graduate programme in Pharmacy Practice four years back at its Department of Pharmaceutical Sciences. The course includes a mandatory practical internship training for one year in a hospital besides a year-long research work in hospital, clinical or community pharmacy that culminates with compilation and submission of a dissertation.

 

Overall scenario in relation to professional pharmacy services in the entire state of J&K is very dismal where we have mostly unqualified people working as pharmacists in retail pharmacies and dispensing medicines to patients without any technical know-how about the same and without providing any basic information to the patients about the use and possible side-effects of medicines. In government sector too, pharmacies within hospitals, primary health centres and sub-centres are manned by Medical Assistants who have not undergone any formal training as required under norms, specifically in pharmacy. We don’t have any positions available for pharmacy graduates and post-graduates at any level in our government sector. In fact their applications are not accepted for Junior Pharmacist posts advertised by the Directorate of Health and Family Welfare on the pretext of being ‘over-qualified’ for the job. Consequently the services of qualified pharmacists remain completely unutilized in the state, depriving patients of precious information about the use of drugs. Every major hospital in our state needs to have a full-fledged Department of Pharmacy Practice with adequate infrastructure, manpower, equipments and funding. Since that is already well stipulated in the approved drug policy of our state, government needs to start working in that direction in its right earnest.

 

Need of the hour is to design, implement and monitor policies aimed at providing professional Clinical Pharmacy services to the patients at primary, secondary and tertiary care level so that the services of pharmacy graduates and post-graduates can be availed at every level of our healthcare system for the greater benefit of the patients at large. Such services will also pave way for the engagement of trained and qualified pharmacists in providing patient education and counseling services, monitoring drug therapy and suggesting interventions wherever required, reporting any adverse drug reactions and drug interactions, supplying drug information to physicians and nurses, conducting drug-utilization evaluation studies, assist in framing policies, preparing monographs and hospital formularies and in providing poison control services. Trained and qualified pharmacy practitioners should be a part and parcel of the medical team during ward rounds and their assistance must be sought in prescribing best possible drug therapy to the patients. It is time to keep pace with fast changing times and trends and establish clinical pharmacy as a full-fledged profession in the state, ultimate aim of which is to optimize the clinical outcomes of drug therapy and thereby improve patient’s health-related quality of life.

 

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and is incharge of Masters Degree Programme in Pharmacy Practice. He can be reached at ishaqgeer@gmail.com)