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As her students finished their online exam, Arlet Lara got up to make a cafe con leche. Her 16-year-old son found her on the kitchen floor. First, he called Dad in a panic. Then 911. “I had a stroke, and my life made a 180-degree turn,” Lara said, recalling the medical scare she experienced in May 2020 in the early months of the COVID-19 pandemic. “The stroke affected my left side of the body.” Lara, an avid runner and gym-goer couldn’t even walk. “It was hard,” said the 50-year-old mom from North Miami and former high school math teacher. After years of rehabilitation therapy and a foot surgery, Lara can walk again. But she still struggles with moving. This summer, she became the first patient in South Florida to get an implant of a new and only FDA-approved-nerve stimulation device designed to help ischemic stroke survivors regain movement in their arms and hands. Every year, thousands in the United States have a stroke, with one occurring every 40 seconds, according to the U.S. Centers for Disease Control and Prevention. The majority of strokes are ischemic, often caused by blood clots that obstruct blood flow to the brain. For survivors, most of whom are left with some level of disability, the Vivistim Paired VNS System — the device implanted in Lara’s chest — could be a game changer in recovery, said Dr. Robert Starke, a neurosurgeon and interventional neuroradiologist. He also serves as co-director of endovascular neurosurgery at Jackson Memorial Hospital, where Lara underwent the procedure. The Vivistim Paired VNS System is a small pacemaker-like device implanted in the upper chest and neck area. Patients can go home the same day. The U.S. Food and Drug Administration approved the stroke rehabilitation system in 2021 to be used alongside post-ischemic stroke rehabilitation therapy to treat moderate to severe mobility issues in hands and arms. Lara’s occupational therapist can activate the device during rehabilitation sessions to electrically stimulate the vagus nerve, which runs from the brain down to the abdomen and regulates various parts of the body’s nervous system. The electrical stimulation rewires the brain to improve a stroke survivor’s ability to move their arms and hands. Lara also has a magnet she can use to activate the device when she wants to practice at home. Her therapy consists of repetitive tasks, including coloring, pinching cubes and grabbing and releasing cylindrical shapes. After several weeks of rehabilitation therapy with the device, Lara has seen improvement. “Little by little, I’m noticing that my hand is getting stronger,” Lara said in September. “I am already able to brush my teeth with the left hand.” Since then, Lara has finished the initial six-week Vivistim therapy program and is continuing to use the device in her rehabilitation therapy. She continues to improve and can now eat better with her left hand and can brush her hair with less difficulty, according to her occupational therapist, Neil Batungbakal. Starke sees the device as an opportunity to help bring survivors one step closer to regaining full mobility. Strokes are a leading cause of disability worldwide. While most stroke survivors usually can recover some function through treatment and rehabilitation, they tend to hit a “major plateau” after the first six months of recovery, he said. Vivistim, when paired with rehabilitation therapy, could change that. Jackson Health said results of a clinical trial published in the peer-reviewed medical journal The Lancet in 2021 showed that the device, “when paired with high-repetition, task-specific occupational or physical therapy, helps generate two to three times more hand and arm function for stroke survivors than rehabilitation therapy alone.” The device has even shown to benefit patients 20 years after their original stroke, according to Starke. “So now a lot of these patients that had strokes 10 to 15 years ago that thought that they would never be able to use their arm in any sort of real functional way are now able to have a real meaningful function, which is pretty tremendous,” Starke said. Vivistim’s vagus-nerve stimulation technology was developed by researchers at the University of Texas at Dallas’ Texas Biomedical Device Center and is being sold commercially by Austin-based MicroTransponder, a company started by university graduates. Similar devices are used to treat epilepsy and depression. For Lara, the device is a new tool to help her recovery journey. “Everything becomes a challenge, so we are working with small things every day because I want to get back as many functions as possible,” Lara said. Patients interested in Vivistim should speak with their doctor to check their eligibility. The FDA said patients should make sure to discuss any prior medical history. “Adverse events included but were not limited to dysphonia (difficulty speaking), bruising, falling, general hoarseness, general pain, hoarseness after surgery, low mood, muscle pain, fracture, headache, rash, dizziness, throat irritation, urinary tract infection and fatigue,” the FDA said. MicroTransponder says the device is “covered by Medicare, Medicaid and private insurance with prior authorization on a case-by-case basis.” Get local news delivered to your inbox!(Bloomberg Opinion) -- Disaster. Flop. Average. If you had to bet on a Bollywood movie’s fate in 2024, those would have been your three best options in a year set to end with a 30% to 40% drop in box-office collections. The world’s most prolific film industry is desperately hoping for a better 2025. And so are the city’s cops: When the theaters go empty, the body count starts to rise on the streets of Mumbai. That’s what the 1990s were like — and everyone’s dreading a repeat of lawlessness in India’s financial capital. The fears are far from exaggerated. Baba Siddique, a local politician and real-estate developer who enjoyed close friendships with celebrity actors, was gunned down in October as he was about to get into his car. A member of the gang that claimed responsibility said in a Facebook post that “Bollywood, politics, and property dealings” were behind the murder. Organized crime and the show business of Bombay — as the megalopolis was known until 1995 — have been joined at the hip for a long time. The Golden Age of Indian Cinema that began around the country’s 1947 independence from British rule had a 20-year run. Politics took a cynical turn in the late 1960s, and popular culture began to reflect the loss of idealism. Bollywood scripts shed the social concerns of a young republic and became the escapist fantasy the world knows today. By the early 1970s, India was releasing hundreds of Hindi-language films. Banks wouldn’t finance them. That’s where the likes of Haji Mastan came in. One of Mumbai’s most powerful dons at the time, Mastan was a sucker for glamor. Dressed in all white, the stylish boss became something of a private-equity player for the entertainment business when he began to finance movies for his actress lover. The mob had eked out its initial capital from the docks of Bombay, smuggling gold and electronics. As it reinvented itself for a more open economy in the 1980s and 1990s, bootlegging and extortion gave way to money-laundering, trafficking in drugs and guns ... and more cinema. Dons were no longer satisfied with a profit share, a 2003 report by the Institute of Peace and Conflict Studies noted. They wanted “partnership by becoming producers and getting overseas rights for film and music distribution.” Leading this change was Dawood Ibrahim, a policeman’s son who rose to prominence as the city’s most feared mobster in the post-Mastan era. Dawood began operating from Dubai in the mid-1980s, but his syndicate, known as the D Company, is believed to have carried out the assassination of the founder of T Series, a music-production powerhouse, in 1997. That murder, as well as a subsequent attempt on the life of a producer — whose son Hrithik Roshan was the reigning teen heartthrob — shook the industry. Ibrahim’s suspected involvement in the deadly 1993 terror attack on Mumbai, in which 257 people were killed in a series of bomb blasts across the city, provided urgency to the cleanup. Bollywood has an entire crime noir dedicated to so-called encounter specialists, who would, instead of apprehending underworld operatives and producing them in court, simply execute them. One of my personal favorites is Ab Tak Chhappan, or “56 So Far,” a reference to the kill count. Just when it looked like the city had escaped from that cycle of violence, there are fresh signs of unease. In February 2021, a car packed with explosives was found parked outside the home of Mukesh Ambani, India’s richest tycoon. An elite detective — a former “encounter specialist” — is awaiting trial in that case. While denying the ex-cop’s bail petition last year, a court said his aim was to spread terror in the mind of the Ambani family. Siddique’s murder has deepened the foreboding. Police have invoked a harsh 1999 law designed to crush organized crime. But cops don’t know the underworld’s current level of engagement. “We must have made 20 to 25 films and earned profits, too,” Chhota Shakeel, an Ibrahim aide, had bragged in a 2001 interview, after authorities busted a high-profile case of the mafia’s movie-financing operations. “Instead of extorting money from film personalities, we thought we would do business with them.” Have the proceeds of crime seeped in again, slipping through the veneers of Bollywood’s corporatization? It’s an important law-enforcement question. As the Indian investigative journalist Swati Chaturvedi wrote recently, “Nowhere else in the world does a film industry of this size face such organized threats.” The repercussions go beyond showbiz. Lawrence Bishnoi, the leader of the group suspected of murdering Siddique, has been accused by the Canadian police of colluding with Indian government agents to kill and harass members of the country’s Sikh diaspora. A gangster who’s at the center of a diplomatic spat — and at the same time threatening to eliminate Salman Khan, one of India’s biggest film stars — adds a new dimension to the threat. Arthouse Indian cinema has always felt smothered by kitsch. That has only gotten worse in recent years with right-wing propaganda films competing with the usual song-and-dance and action routines. But now Mumbai is losing control even on its signature over-the-top entertainers. Studios in the southern city of Hyderabad can lay claim to two of the biggest hits in a dull year.(1) That is just like 1984 when the Mumbai industry’s dalliance with crime had begun to get serious. Meanwhile, the acclaimed drama All We Imagine as Light, nominated for two Golden Globes and the winner of this year’s Cannes Grand Prix, is struggling to find exhibitors at home. A second-generation Mumbai producer recently sold half of his studio to Adar Poonawalla, the billionaire vaccine maker who earned handsome profits during Covid-19. The pandemic marked a crucial intermission. It fueled demand for original content people could stream at home on Netflix, Amazon Prime and homegrown apps like Hotstar when cinemas were under lockdown. Now everything is open, and yet audiences are so bored of the insipid fare on screens big and small, they’re neither out for a movie night, nor clicking through big-budget web dramas. When everything starts bombing for Bollywood, things take a sinister turn in Mumbai. More From Bloomberg Opinion: (1) Pushpa: The Rule -- Part 2, made in Telugu and dubbed into five other Indian languages, is an action thriller about a violent sandalwood smuggler. It has beaten Kalki 2898 AD, another Telugu-language movie, as the highest-grossing Indian film of 2024, according to IMDb. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. Andy Mukherjee is a Bloomberg Opinion columnist covering industrial companies and financial services in Asia. Previously, he worked for Reuters, the Straits Times and Bloomberg News. More stories like this are available on bloomberg.com/opinion ©2024 Bloomberg L.P.
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