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Journalism of Courage
One May night this year, with an eight-hour-old baby, Sunitha, steadily sinking in front of him and with no further tested medication available, Dr P K Rajiv of Amrita Institute of Medical Sciences in Kochi took the plunge.
He gave the baby, who suffered from a fatal lung condition, a small oral dose of Viagra. She survived. Since then two more babies have returned from what the doctor says was ‘‘certain death’’ because of this novel use of what is essentially a cure for male erectile problems.
That the hospital didn’t have the sanction of the drugs controller has sparked controversy, but Dr Rajiv says with a blue baby in front of him, he decided to risk breaking the rules.
‘‘In the next 48 hours, the baby could be very gradually weaned off the high levels of oxygen and could be totally removed from the ventilator after five days of treatment,’’ he recalled.
Dr Rajiv, who has studied in Kozhikode and is a specialist in neonatal care, has also received training in Australia and at the University of Iowa in US.
He says pulmonary hypertension, a potentially life threatening disorder that afflicts newborns, occurs when blood vessels supplying the lungs shrink to such an extent that the baby starts turning blue due to the lack of oxygen.
The most common form of treatment is to put the child on a ventilator, a machine which, he points out, costs about Rs 5-6 lakh. So, not many hospitals can afford it.
In case the baby fails to respond, it’s put on a high-frequency ventilator which is costlier (Rs 8-10 lakh) and hence available at fewer hospitals.
In the west, paediatricians have recently used nitric oxide, a gas known to relieve tension in the arteries, but this needs skilled doctors. Moreover, the procedure costs about Rs 300 per hour and the equipment has to be imported.
Dr Rajiv says that it was on the internet that he found a paper in the May issue of US journal, Circulation, which suggested that the active salt of Viagra, sildenafil citrate, could also act as a pulmonary dilator in children. Viagra is known to act on the nitric oxide physiology of the human body, which is very important for keeping the blood vessels in a dilated condition.
Though the exact mechanism of action in babies when Viagra is given is not fully understood, Dr Rajiv feels it is probably the same principle of dilation that leads to increased supply of blood to the lungs of the newborn.
A week ago the institute finally applied for permission from Drugs Controller General of India to conduct a scientific trial on 50 babies. This, Dr Rajiv, hopes to complete by October, if the approval comes through.
Dr Savitri Shrivastava, retired chief of cardiology at the All India Institute of Medical Sciences and now head of the department of paediatric and congenital heart diseases at Escorts Heart Institute and Research Center in the capital feels ‘‘this new use of Viagra might turn out to be a useful modality since not many drugs are available to treat such cases’’. But she adds that doctors at the Kochi institute should have first done a systematic study before going public.
Dr Anupam Sibal, senior paediatric consultant at Indraprastha Apollo Hospital in New Delhi says ‘‘this new spinoff of Viagra is certainly interesting and offers some hope’’ but adds that ‘‘the jury is still out’’.
