How To Read More

Yesterday, I bought Rs. 1000 worth of books, and also spent Rs. 1000 on a family movie night. Somehow, my psychology is weird enough that the money spent on books seemed like an extravagance to me, whereas the dinner was no big deal – something I do regularly. But, when I think about it, I’ll spend weeks reading the books, then my wife will read them, and later I’ll lend those books to other people. In terms of value/entertainment-per-person-per-hour, books are easily 10 to 100x cheaper than any other thing I spend money on.

In other words, I should be spending much more on books.

Buying, Borrowing, and Lending Books

  • Maybe buying: So, I’ve started buying books. And, I often buy even those books where there is only a small chance of me reading it. Because if I buy 10 books, and end up reading only 1 of them, that’s still a good investment. My mother comes from the generation where buying a book is a big decision – she reads reviews in newspapers, asks her friends if any of them have read the book, goes to the store and spends 10 minutes browsing the book, and only then considers buying it. I am slowly converting her to the philosophy that if she even thought “maybe I should check out this book” I will go ahead and buy it on Flipkart/Amazon.
  • Indiscriminate Lending: One of the biggest problems with lending books, is the fear that they’ll not get returned. Trying to keep track of who borrowed which book, and asking for it back is too much work. I stopped worrying about this long ago. I lend books indiscriminately, and don’t worry about whether it will come back. There have been 2 or 3 cases where I ended up buying a second copy of a book because I needed the book, and couldn’t figure out whom I’d lent it to. This is a small price to pay for being able to spread good books.
    • The one thing I do to increase chances of getting books back, is that on the book, I write “KABRA” in really large block letters using a thick marker pen. This ensures that the borrower never forgets whom they borrowed a book from, and eventually they return it.
  • Buying Second Hand Books: There’s a raddi-paper shop on Baner Road that keeps a stack of second hand books, and sells them at really low prices – Rs. 10 or 20 or 30 depending on the size of the book. I go there once every few months, and end up buying 5 to 10 books on each visit. Being able to buy books so cheaply really helps with making it easier to do the maybe buying and the indiscriminate lending described above.

How my reading increased in the last few years

I used to read a lot in my childhood. And this significantly reduced after I started working. Only in the last few years, I’ve managed to again pick up a habit of reading regularly. I think this is because of 3 major things I did: setting up the Kindle app on my smartphone, subscribing to an online library which delivers physical books to my door with just a click of the mouse, and setting up reading queues as described below.

  • Reading Queues: One of the problems I used to have earlier is that when I heard about a book, I was usually too busy to even think about reading, and later when I was less busy, I wouldn’t have appropriate books handy. This might be a problem specific to my and how I function, but I’ve managed to get around it by having reading queues.
    • Reading Queue #1: The online library that I use, BigBooks, allows me to create a queue of books that I want to someday borrow from the library. Whenever I hear about some book that I want to read (usually through social media, or my friends), I check if BigBooks has a copy of that book, and add it to my queue. So, when I am done with the current book, I simply go to the BigBooks website, and ask them to deliver the next book. They randomly pick one book from my queue and send it across.
      Note the important thing here: A book get added to the queue when I hear about it; and I get it in my hand when I have time to read it. This separation has significantly increased my reading.
    • Reading Queue #2: For books that are not available with the library, I usually buy a kindle version and have it delivered to my phone. This book now sits on my phone, ready for me whenever I have some free time – this can be while commuting, while waiting for a meeting to start, while standing in some line somewhere. I read in small chunks of time. It’s amazing how much reading you can get done this way. I finished all of Crime and Punishment by just reading it during the interstitial gaps in my days.
    • Reading Queue #3: Whenever I find an article online that seems interesting, but is too long for me to read right away, I use Amazon’s “Send to Kindle” feature to send that article to my Kindle App on my smartphone. This article now sits on my Kindle app until I read it – either in the next few days, or even weeks later, depending upon how busy I am. In this age of 140-character updates, being able to read long, well thought out articles is a superpower.

Books and Children

  • Reading is one of the most important habits you can inculcate in a child.
  • Many parents have strong feelings that children should read good books, or useful books, for some definition of good/useful. I don’t agree with this thinking. It doesn’t matter what the child reads. Anything is fine. Even if the parents think it is trash. Juvenile stuff like Captain Underpants, shallow romances like Twilight Series or Mills and Boon, is all fine. Any kind of reading helps the child in the long run.
  • It’s not easy to get a child to take up reading. With TV and computer games competing for their attention, books suffer, and parents exhortations don’t really work. In the last few years, I’ve seen that the more I and meetu read in their presence, the more the kids have started reading. And of course, limiting the amount of “screen” based activities they’re allowed in a day.
  • Buy and keep appropriate books around the house. You never know when a child will get interested in which book. I’ve had cases of my kids suddenly pick up and read a book years after I bought it and asked them to read it.

Will antibiotics stop working and will medicine be flung back to the 19th century?

Antibiotics have literally changed the world. Before antibiotics were invented, it was pretty routine for people to die of minor infections, like being scratched by a rose bush, or during childbirth. But antibiotics changed the world of medicine in ways that could only be described as miraculous.

Unfortunately, there is a possibility, that at some time in the near future, antibiotics will stop working as more and more antibiotic resistant strains of bacteria are emerging, and faster.

I first came across this article earlier this year, and was sufficiently alarmed, but on second thoughts, I wasn’t sure whether the author was simply overhyping the whole thing. However, a few weeks ago, WHO has come out with a report on this issue, which pretty much sounds a general worldwide alarm:

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

Where are “antibiotic-resistant” bacteria coming from? This works in pretty much the same way as vaccinations work. Basically, when bacteria are exposed to less than a full dose of antibiotics (i.e. when you discontinue antibiotics before the full course is over), they develop an immunity to that antibiotic. Basically, literally, what doesn’t kill them, makes them stronger. Now this strain of bacteria starts spreading… This process repeats with all the different antibiotics we have. And sooner or later we end up with strains of bacteria that are immune to all antibiotics known to man.

And this problem is getting worse. For example:

Tetracycline was introduced in 1950, and tetracycline-resistant Shigella emerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004.


What is the meaning of all this? A hundred years ago, people used to die of minor infections. We, who’ve been lucky enough to be born in the age of antibiotics don’t know what that feels like. But maybe we’ll get to experience that soon enough:

The chief medical officer of the United Kinigdom, Dame Sally Davies — who calls antibiotic resistance as serious a threat as terrorism — recently published a book in which she imagines what might come next. She sketches a world where infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. It is a dark vision, meant to disturb. But it may actually underplay what the loss of antibiotics would mean.

This is not just a problem for people who get injured. A lot of modern medicine depends upon antibiotics. Most surgery would become potentially lethal if antibiotics don’t work:

Many treatments require suppressing the immune system, to help destroy cancer or to keep a transplanted organ viable. That suppression makes people unusually vulnerable to infection. Antibiotics reduce the threat; without them, chemotherapy or radiation treatment would be as dangerous as the cancers they seek to cure. Dr. Michael Bell, who leads an infection-prevention division at the CDC, told me: “We deal with that risk now by loading people up with broad-spectrum antibiotics, sometimes for weeks at a stretch. But if you can’t do that, the decision to treat somebody takes on a different ethical tone. Similarly with transplantation. And severe burns are hugely susceptible to infection. Burn units would have a very, very difficult task keeping people alive.”

Forget surgery. Something as simple as childbirth will become dangerous once again:

Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure. In a post-antibiotic era, would you mess around with power tools? Let your kid climb a tree? Have another child?

Update: I was reminded by Farhat (see his comment below) of a few things that I left out of this post:

  • This is already happening. In the last one year, I know of at least two cases in my friends’ circle, where an elderly person, who was otherwise healthy, and was admitted to a hospital for a non-life-threatening condition, and was cured, but contracted a “hospital infection” just before getting a discharge, and then died less than 2 weeks later because the “hospital infection” did not respond to any antibiotics.

What should we do about this?

  • First and foremost, STOP ABUSING ANTIBIOTICS. Do not take antibiotics unless it is really necessary. And if you do take antibiotics, do not discontinue midway. Discontinuing antibiotics midway is one of the main sources of antibiotic resistant strains.
  • Stay away from hospitals unless it is life-threatening.

Should we be afraid? Very afraid?


How India defeated Polio

A blog on the New York Times has an interesting article on how India eradicated polio which makes for interesting reading.

The method in which India went about getting 95% coverage for the polio vaccine is impressive, and can serve as a blueprint for other campaigns and other countries.

Multiple agencies – governmental and non-governmental – worked together, with well defined distinct roles to make this happen:

The Global Polio Eradication Initiative began in 1988 as a huge partnership among Unicef, the World Health Organization, the Centers for Disease Control and Prevention and Rotary International. Each organization took on a different job and this continues today as the focus broadens from just polio to all routine immunizations. Unicef handles communications, makes posters and banners, and ensures that the “word” spreads about the campaign, even if it’s through old-school techniques like hauling loudspeakers on a rickshaw through the city center.

The W.H.O. is the data machine, responsible for tracking the virus, collecting stool samples of possible cases and studying the data for any gaps. Rotary International has a Delhi-based team, the National PolioPlus Office, with regional and city-level tentacles to execute polio vaccinations four times a year during National Immunization Days (more days for high-risk areas). Globally, Rotary has been the cheerleader of the campaign, raising funds and keeping the issue in the spotlight.

And it needed a lot of very low level, very localized effort to ensure that nobody got missed:

Health workers, usually women, stand at the booths for eight hours to ensure that every child in the neighborhood is vaccinated. The vaccinated children are marked on the nail of their pinky with black ink. The following day, the health workers search for missed children by going door-to-door, carrying the vaccine in an icebox.

Just having people going around running the vaccination booths is not good enough. The system does not work unless there is measurement that completes the feedback loop, identifies gaps, and fixes them.

The government had elaborate machinery to do this:

Dr. Vishwakarma’s job is tiring, illustrating the depth and breadth of the polio surveillance effort. Based in Agra, he travels daily across Western Uttar Pradesh; he monitors 12 districts of the state, which cover a distance of about 125 miles from Delhi to Agra. His days begin at 5 a.m. and he retires at 10 p.m., after endless cups of tea with local officials, shadowing health workers, combing through stacks of data and overseeing surveillance efforts at regional offices.

“I cannot miss any details,” he says. “That’s where the solution lies. That’s why I’m constantly on the move.”

Overall, missing a single person would result in the whole campaign being set back by years:

The philosophy for the polio campaign was, Dr. Bahl says, “Who have we missed? Why have we missed them? Why did they not take the vaccine? And we constantly looked at the data to help us.”

In a country the size of India, just getting the message across to everybody, without it getting twisted in the process, was a big job with unique challenges. Here is one example:

Communication — Unicef’s job — is the last key pillar of the polio campaign. It goes beyond just fliers, banners and announcements. Previously, when Muslim communities refused the vaccine — on the grounds that the vaccine was designed to make their children sterile — communication became critical. “At the local level, we had to work with the ulema [Muslim clerics], to correct this message,” said Dr. Bahl. By collaborating with local leaders, Unicef found a new venue to preach the message of good health: the mosque. And it was the health workers who took that message further, by carrying letters, written and signed by local Muslim clerics, urging families to have their children inoculated.

Where do we go from here? India is getting ready to use this success and go after the next big challenge – routine child immunizations.

India’s routine immunization rates — for measles, rubella hepatitis B, TB and the like — were last recorded in 2009 at 61 percent nationally. India accounts for a third of the world’s measles deaths. Public health is dismal, and India’s per-capita spending on health care is among the lowest in the world. Yet with polio, India achieved 95 percent coverage.
The success of India’s polio effort has turned it into a blueprint for large-scale health campaigns. Now India is using what it did with polio to boost rates of routine vaccinations.

Read the full article