If I were the Prime Minister of India

A country blessed with enormous species, spices, and reserves, popularly known as Incredible India is the only place holding the largest democracy. The opportunity to be the Prime Minister of such a vast country is nothing less than a blessing. I would have put in every effort to take the nation to the top.

Although it is gifted, no country is without flaws. The position which it holds today is due to all the accomplishments it acquired after conquering the obstacles posed by the foreign invaders.

The biggest problem nationwide is poverty. I would have taken the first step to eradicate it with the help of education. Promising infrastructure and equipment at government schools would have been capitalized for the needy. Without any discrimination, the students of government and private schools would have been taught by world-class teachers in a friendly environment. Therefore, following the saying, “education is the key to success” would have been applied for the bright future of Indians.

The next step would be taken for the graduates to aid them with suitable jobs based upon the skills rather than merits. Officials would be appointed to keep a check upon the data and ensure everyone is getting equal rights. The money earned through jobs would be in turn used in the economy as consumption of resources. And considering that the basic necessities like shelter, food, and clothes would be fulfilled at minimal costs and good quality. Hence, the cycle of economy will be balanced properly.

The nation depends upon assets, and ensuring the safety and health of the working class is essential. High taxes will be levied from the wealthy and accustomed to building techno-savvy devices for hospitals and the defense army. In all, it will lead to proportional distribution of resources.

Governing the region is not a one-time investment but a moving process that should be revised with time. All the hands would be joined, within the five years in which I will be employed.

Hyperthyroidism Awareness

It is important to remember that hyperthyroidism can occur at any age. While most may present with a rather typical constellation of symptoms, many may present with exacerbation of pre-existing conditions which may make the diagnosis initially elusive. Worsening anxiety, insomnia, fatigue, panic attacks, palpitations, hypertension or diarrhea may not initially signal that the thyroid is involved. Clinicians must have a low threshold to check thyroid function early to rule out a component of hyperthyroidism.

Once a suppressed thyrotropin (TSH) has been detected, further investigation with serum triiodothyronine (T3) and free thyroxine (free T4) can help delineate overt from subclinical disease. A thorough history of past thyroid disease, as well as current medications and supplements, can help detect any pre-existing diagnoses or exogenous sources of thyroid hormone or over supplementation with iodine. More commonly, hyperthyroidism is due to either Graves diseasetoxic multinodular goiter or toxic adenoma. Distinction between these can usually be made with the assistance of a thyroid uptake scan, TSH receptor antibody measurement, and thyroid ultrasound. An additional physical exam finding of exophthalmos can further support the diagnosis of Graves’ disease. Understanding the etiology can help guide patient expectations. A small percentage of patients with Graves’ Disease may undergo spontaneous remission after 1 to 2 years, which may prompt patients to wait before considering a definitive treatment option.

With confirmation of the diagnosis of hyperthyroidism, focus is on hormonal control with an antithyroid medication (ATM, most commonly Methimazole in the United States). This may be augmented with beta-blockade, steroids, cholestyramine or SSKI for those who are difficult to control.

Many patients may need further consideration for definitive management with either radioactive iodine ablation (RAI) or thyroidectomy. Your local resources may also influence these options, but it is critical to understand that all three treatments (ATM, RAI and thyroidectomy) are possible options. Certain patient factors and priorities may alter the preferred definitive treatment. Smaller gland size, easy to control hormones, and lack of eye symptoms are factors that may favor continued ATM management. A large goiter with compressive symptoms, difficult to control hormones requiring high dose medications/ multiple modalities, pregnancy, severe eye disease, multiple nodules within the thyroid with or without thyroid cancer, or desire for rapid and reliable hormone control may favor thyroidectomy. RAI is a good option for patients with a smaller gland size, and a desire to pursue definitive management but avoid surgery.

There are also relative contraindications for treatment options. ATMs may have serious side effects, like agranulocytosis or liver failure, which prevent further use, or may cause skin eruptions making long term use intolerable. Additionally, high dose requirements or fluctuating doses may make long term use of ATMs not reliable. Women who are pregnant, wanting to become pregnant in the next 6 months to 1 year, breast feeding or have small children in the home will want to avoid RAI. Patients with severe eye involvement, have a large goiter with compressive symptoms, or are smokers should also avoid RAI. Thyroidectomy will be a poor option for patients with multiple previous neck operations on or around the thyroid due to internal scarring, or who are high risk for general anesthesia. Additionally, if they have a history of previous gastric bypass surgery, they are higher risk for major complications from hypocalcemia/hypoparathyroidism after thyroidectomy.

To help the patient navigate these decisions, it is important to allow them the opportunity to discuss each treatment option with respective physician experts – medical management with endocrinology, RAI with endocrinology and potentially nuclear medicine as well, and thyroidectomy with the thyroid surgeon.

In summary, patients with hyperthyroidism require medical control, as well as a clear understanding of the etiology of their hyperthyroidism. Patients with Graves disease, toxic multinodular goiter and toxic adenoma have more than one treatment option, and it is important for patients to be educated and engaged in treatment decisions.

For Further Reference:
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis| by the American Thyroid Association

Importance of Freedom of Speech in a Democracy

Democracy is a word we hear so frequently that often its meanings and contents are assumed and taken for granted. If we look at the etymology of the word, “democracy” is a combination of the Greek words ‘demos and ‘kratos’ meaning “the people” and “power” respectively. Together they mean “power of the people” or “power to the people”. It is from this that the idea of democracy as “for the people, by the people and of the people” emerges. Democracy is generally considered as the most efficient and viable form of governance in the modern world. The Greeks practiced a form of direct democracy which is the precursor to our current systems of governance. Representative democracy is the norm in most nations practicing democracy now as opposed to direct democracy. This involves the will of the people on the decision of who is most suited to represent them in the parliament. In the direct form of democracy, individuals participate directly in the process but many such as slaves and women were not considered as participants. Citizens in a democracy are guaranteed rights as well as duties. India is a parliamentary republic with the president as head of state and the prime minister as head of government. In the Indian Constitution, the fundamental rights of the citizen are listed in Articles 12-35, and they are the right to equality, right to freedom, right against exploitation, right to freedom of religion, cultural and educational rights, and right to constitutional remedies. Subsumed under right to freedom is the right to freedom of speech and expression in Article 19. The citizen who is to “abide by the Constitution and respect its ideals and institutions” must ensure that those she has elected into power are executing their duties accordingly.

The term “freedom of speech” refers to the articulation of ideas by sound while the term “freedom of expression” also encapsulates expressions through art that might be non-verbal, freedom of the press and acts of communicating informal, regardless of the medium that is employed. Both of these terms are currently used interchangeably. Freedom of expression is recognized as a human right in the Universal Declaration of Human Rights. It promotes creativity, individuality, autonomy, self-realization of the individual, gives him an active role in deciding matters of policy and provides space for criticism of the government. Curbing of free speech and expression is one of the first signs of the disintegration of democracy. One of the reasons there has to be freedom of speech is that of engaging in the governing process. To participate in the way that their nation, their society and themselves are defined, a citizen should be able to articulate their ideas and opinions.

Freedom of speech thus functions as a way of keeping all selfish and tyrannical ambitions of the ruler which is not for the benefit or desire of the public in check. It is called into question when it infringes on other rights such as democratic equality, privacy, or another’s right to expression. It is the inherent ambiguity of free speech boundaries that is exploited and manipulated in many situations by those wielding power and bent on a certain agenda. The privileging of voices, and who gets to decide who speaks and who is heard as well as who is to be silenced are questions that need to be asked.

There has to be constant and critical conversations among the public that are maintained at all costs lest a state of affairs where democracy becomes meaningless as a system comes by. One should be able to speak fearlessly. It is essential that prejudices and opinions not remain unchallenged and unquestioned, and there is an active promotion of a spirit of critical thinking and enquiry thereby reforming the mind as well. The absence of such evaluation can easily lead to a deterioration of the ideals of democracy. It is more important than ever now to ensure that the citizens are aware of their duty beyond voting and that their voices are heard. There is a need to ask the right questions and be aware of the complications that are part of the discussions on free speech. It is not so much about the revolution that speech can make as it is about the very act of speaking fearlessly, exercising our right as well as our discernment, and holding those in power accountable.