HEALTHY INDIA 2020

PROF. B. M. HEGDE

Publishers?

INTRODUCTION.

India has been doing well lately in the economic field. The signs of a good future are there in the distant horizon. The growth rate index jumped up last week to almost 8.5%. Technological advances are taking place at a breathtaking speed. India is now a nuclear power and is in a commanding position amidst the comity of nations. Monsoons have been good and the crop position is comfortable. We have been doing well in the trading organizations. Politicians are upbeat about the achievements. Technocrats are also happy and they predict a strong India by 2020. It is projected that we would land on the Mars in a decade from now.

All these and more must make every Indian proud of his country and it’s pre-eminence in the world today. On the darker side is another India of poverty, squalor, hunger and illnesses. No country will be happy until the last man has had his basic needs met. “For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.” wrote Kahlil Gibran in The Prophet. If monetary prosperity and technological advances are the measures of people’s happiness, United States of America should have been the happiest nation in the world. The reality is that America is the one country in the world where neither the rich nor the poor are, in fact, happy.

The rich are afraid of the poor and find life so uncertain that they are not sure of getting back home in the evening. The poor suffer all their lives not knowing where their next meal comes from. This gulf between the rich and the poor is widening by the day in a country which enjoys eighty-five per cent of the world’s wealth with just over fifteen per cent of the world population. The remaining fifteen per cent of the world resources are shared by the rest of the world. Despite this the two most important epidemics that plague the US are suicide and divorce.

It would be naive to equate prosperity and happiness with the betterment of the monetary economy alone where the inverse care law operates always-money is all there with the rich and the wants are there with the poor. The plastic card economy of buy now-pay later works as double edged sword for the middle and the lower middle class. Not having to pay on the spot makes them spend recklessly and buy things that they do not need at that point in time and push them to commit suicide when the debtor comes for the kill. What needs to be concurrently developed is the over all holistic health of the common man. The word health here is not used in the narrow sense of physical health. Health simply means creativity and enthusiasm to positively contribute to society’s progress by individuals where physical, psychological, emotional, spiritual, and societal dimensions of man’s existence on this planet must all be properly balanced. India of the distant past had such an egalitarian society which was advanced even in science, technology, the fine arts and many other forms of human pursuits. It had Universities of excellence attracting students from all over the world while the west was still roaming the forests.

This book looks at that kind of holistic health in India in the next half a century where development is not lop sided but balanced in every direction. We would analyze the malady that is afflicting the present day India and suggest ways and means to change all that for better with every Indian sharing both in its fruits and the struggle to achieve that goal.

“Where the mind is without fear and

the head is held high;

Where knowledge is free;

Where the world is not broken up

into fragments by narrow domestic walls;

Where words come out from the depth of truth;

Where tireless striving stretches

its arms toward perfection.

Where clear stream of reason has not lost its way

into the dreary sand of dead habit;

Where the mind is led forward by thee

into ever widening thought and action-

Into that heaven of freedom,

My father let my country awake.”

Rabindranath Tagore.

That is the kind of India we will have to build in the next half a century-the India that leads the world economically and spiritually as it did before the twelfth century. Monetary economy bereft of moral values will be as good as no progress at all. All this philosophy will fall on deaf ears as long as the majority in our midst do not know where their next meal is coming from and have only the blue sky for their roof and mother earth as their bed to sleep on come rain or shine. All progress starts with the bare minimum needs of the lowest of the low met. If they do not have three meals a day with clean and nutritious food and clean water to drink how will they be able to contribute to the country’s progress? Health is wealth and to that extent a healthy mind and a healthy body are the two basic needs of human progress and prosperity. Even a journey of thousand miles starts with the first step. The first step of a country’s progress is the total healthy development of its citizens.

“The difficulties of life are intended to make us better and not bitter.”

Anon.

HUMAN BODY’S INTELLIGENCE.

Prof. B. M. Hegde,

Vice Chancellor,

MAHE University,

Manipal-576 119.

Human beings have lived on this planet for well over 9,00,000 years in 50,000 generations! Man should have been extinct like the dinosaurs long ago; if what we hear today about drugs, preventive screening of the apparently healthy population and technology keeping people alive on this planet were to be true; as the latter have been operational at best for little over half a century!

Many studies have been looking at the reasons why we are still here despite the absence of modern hi-tech medicine being available to our forest dwelling ancestors over thousands of years of their existence on the planet. Evolution of man does not simply follow the naïve Darwinian laws. Environment, in addition, has a lot to do with our evolution. That is seen in many other species as well. One example would suffice. There is a type of butterflies which, when pregnant, accidentally coming in the close viscinity of a killer reptile, tries to escape from danger. In addition, it tries to so mutate the offspring’s genes that enable the foetus to develop much larger wing span, making it possible to get away from danger more effectively. The mother butterfly simultaneously mutates the genes of its offspring to be able to smell the enemy scent from a longer distance, by enhancing the child’s olfactory mechanism!

Similar evolutionary changes, based on our environment, kept us going for so long without the assistance of any hi-tech stuff. Let us call this “the intelligence of the body”. Time was when man lived in the forests and the causes of death then were primarily senility or predation. To keep man going despite injury in the likely event of an attack by larger animals, genetic mutation helped to develop the sympathetic system. This could keep one going in an emergency, say bleeding, by redistributing the circulation to supply blood to the vital organs in preference to the non-vital parts and also to help the blood to clot and the bleeding vessels to constrict, arresting blood loss. This friend of man could become his own enemy if used on a long-term basis, as happens in clinical heart failure!

The renin-angiotensin-aldosterone system was another boon to the hunter-gatherer man in the forest, who did not eat extra salt in his food. This prevented his blood pressure from falling to shock levels after injury and bleeding. Over the years, the same system has become our curse in the last ten thousand years, with lots of salt added to our diet, resulting in a novel disease, high blood pressure! In Nature extremes are detrimental. Whereas low sugar-high sugar, low blood pressure-high blood pressure, and low cholesterol-high cholesterol are all bad, constant fluctuations of all these parameters are a must. Stationary levels obtain only after death!

The story of man’s immune system being able to cope with adversity is also based on the experience of any hostile environment through genetic mutation. History of man in the New World is a good example. When Europeans landed on the American continents the virgin population of that landmass did not have any immunity against the diseases the Europeans were heir to, like small pox. Large chunks of the Natives died of such scourges that the white man brought with him, rather than his guns!

Medical world is learning the hard way the need to respect this capacity of the body and not to interfere too much too soon, hurting the native wisdom of the body and its in-built protective mechanisms, in our enthusiasm to intervene with modern gadgets and powerful drugs. Some examples would reveal the secret. Our present mindset of “a pill for every ill” and the “quick fixes” has to give place to our understanding that there is a self-regulatory compensatory phase inside the human body for every single alteration or accident!

Studies of sex workers in Nigeria and SanFrancisco have shown that there are many of them in the trade, on a regular basis, housed in the designated areas having “good business” who keep very good health, despite having more than 50% of their clientele with either full blown AIDS or, at least, the presence of the virus in the blood or semen! But the sophisticated classes of sex workers who operate from five-star outfits as and when they need an extra kick or buck do not enjoy this immune protection! The same calamity befalls the hapless victim of accidental exposure to AIDS virus! Oxford University has embarked on studies of the Nigerian prostitutes and the healthy ones from SanFrancisco to see if some sort of vaccine could be produced from the knowledge gained from such sex workers.

Children of migrant workers in Dakshina Kannada district originally from Northern Karnataka, whose parents have lucrative jobs to give them good food, mostly live on makeshift dwellings on the road side literally eating from the dirt, resist most of the communicable diseases much better than their cousins in clean and rich households! Extra clean surrounding might endanger children’s health by exposing them to new risks from ordinarily innocuous germs. Epidemics of viral appendicitis in British primary schools are one such example.

Caucasians exposed to falciparum malaria are likely to die most of the time, if not properly protected by drugs for prevention, as they had not been exposed this germ earlier. This is due to the lack of racial immunity. Similarly, when Europeans first come to the third world countries they would not be able to tolerate the drinking water that we all take without any harm.

Hostile environments make us acquire the capacity to genetically produce immunity against many adverse situations. The same mechanism could work against us under special circumstances. East Africans living there have very little, if any, autoimmune diseases! The same people, who form the bulk of American blacks. There they live in a much cleaner environment without exposure to killer germs like malaria, filaria and others like in Africa. The one hundred-fifty odd genes situated in the long arm of the ninth chromosome exclusively looking after anti-body production against invading germs, at times, feel jobless in their new clean surroundings! They could unwittingly manufacture anti-bodies against body’s own cells, resulting in a very high percentage of killer autoimmune diseases in American blacks of East African origin! Strange are the ways of Nature!

Another glaring example is study of the death rate variations in grievously injured soldiers in the Vietnam War vis-à-vis the Falklands war. Whereas helicopter evacuations and immediate blood transfusions and warming were very common during the Vietnam War, during the wintry war in the Falklands those facilities were absent and the wounded soldiers were sometimes left to fend for themselves for long stretches of time in the cold! Curiously, the per capita death in the two groups showed that a much larger number of them survived the wounds in Falklands compared to Vietnam! One would not easily believe this, but this is the bitter truth.

While the body’s compensatory mechanisms, discussed above, helped wounded bleeding soldiers in South American Island front, effectively, the cold weather helped lower the basal metabolic rate thereby lessening the demand for oxygen to the tissues. In Vietnam the early human intervention with blood transfusion enhanced bleeding by displacing the clot and reducing vasoconstriction, the warmed up body increased the oxygen demand! This kind of mistakes occur many times in some other disease states in the intensive care settings.

Physiological heart failure is another good example. With its onset the sympathetic system remodels the heart and redistributes circulation, but chronic stimulation makes the same system destroy the heart muscle and enhance failure. If we use blocking drugs at the beginning to knock off the sympathetic system patients could die, but later use of the same drugs, when the body’s own protective mechanisms are exhausted, as in clinical heart failure, could save a lot of lives! One could go on and on. Every single intervention by man at the wrong time ends up killing more people than saving them.

It is high time that many of the hi-tech early interventions are properly and meticulously audited in the field before being sold in the market. One would be shocked to know that this does not happen most of the time because of the hype and greed. Newer interventions are touted as the new avatar of life saving God’s in technological form and are let loose on the gullible and demanding patients. It is better to remember the dictum that while it is the bounden duty of the medical profession to do its best for the suffering humanity, even when knowledge in that field is inadequate, it is a crime to intervene in the healthy segment of the population with newer technology or untried drugs, with the fond hope and assurance of averting long term danger when the latter interventions are not properly audited in that setting.

Times change and knowledge is bound to change, but wisdom lingers on. Study of this prayer of a wise physician of yore, Sir Robert Hutchinson, reveals it all. It is as relevant today as it was then.

God give me deliverance from:

* not letting the well alone.

treating suffering humans as cases, and

making my treatment worse than his suffering!

WHAT IS HEALTH?

Health is not the mere absence of physical illness. Health is the overall wellbeing of an individual that takes into account his/her physical, mental, spiritual, societal aspects of life into consideration. With this broad definition of health, most of what happens to society or a nation depends on individuals being healthy. Even the present malady of terrorism is due to loss of a balanced view of life. The whole problem could be solved if one could try and understand the terrorist’s motivation and try to modify that with psychotherapy. It is also connected to the economic health of the individual as most terrorists come from the poor socio-economic background. Even the few that come from the affluent society do so because of abnormal psychological reaction to the goings on in society-oppression, suppression and denial. Individual health is related to social health and vice versa.

Scientific studies have shown that any kind of dependence leads to psychological problems-even religious fanaticism could lead to personal and societal ill health. This is precisely the reason why it is important to have a healthy nation for all rounded development at any time. Mere economic development would be counter-productive, as we have seen in the industrialized countries in the last century. While they have physical comforts and easy access to all the material wealth, they are not healthy nations what with all social ills damaging the moral fabric of the nation. The rich exploiting the poor is a daily affair in their idea of development! Making money has become their religion and money is their God. Affluent nations have been destroying the entire God given resources of this world with their greed and proclivity for comfort. They would, one day, have to realize that money can not be used to buy happiness as also that money can not be used as a substitute for food. Healthy nation is a happy nation; consequently, a happy nation would be healthy.

Every creature in nature is built to last as long as it is supposed to last. Nothing could be immortal in nature. The human system is very robust and can withstand most of the day-to-day insults using the immune system and the autonomic nervous system. This was needed when man was a hunter-gatherer in the forests where the only cause of death used to be predation, in addition to old age. Man has existed on this planet for well over 9, 00, 000 years in fifty thousand generations. Without the above mentioned built-in repair mechanisms mankind should have been extinct millions of years ago like the dinosaurs. This simple truth tells us that man could live happily as long as he lasts.

However, modernity has made man’s environment much more dangerous for man to live compared to the forest life of yore. The present social and environmental degradation is such that the inbuilt repair mechanisms are stretched to their limits every day. To cap it we have created for ourselves the monsters like junk food, fancy beverages, tobacco products in deadly form and the much touted alcohol that is being sold as a health tonic by the market economy. All these put together bring on illnesses despite the fact that the repair mechanism tries its best to keep diseases at bay.

Over crowding, because of high birth rate and acculturation to larger cities for economic reasons, has helped our friendly germs to become deadly and invade us. Industrialization has added to the burden by polluting all our water sources and the air we breathe. Agriculture, by uprooting the soil, has forced the innocent soil germs like the TB germs to get air borne and become violent. Domesticating animals for farm labour as also for milk etc. has brought in its wake the curse of communicable diseases. Most communicable diseases have come to us from animals-common cold from the dog and SARS from the monkey. Overcrowding helps the germ to be more powerful in defeating our immune system. Pollution levels in some of our larger cities have reached such dangerous levels where children below five can not even survive. Thank God, our villages still have very clean atmosphere.

The solution to all these is to make the village economically more attractive to reverse the acculturation process from the cities that are bursting at the seams. One would now realize how important it is to understand holistic village development as the be all and end all of a healthy nation. Overall development of the village would lead to better agriculture and more food helping the starving millions to regain their health and happiness. Innovative cheap technologies would help make life of a villager better than of a town dweller. Electricity from solar power, waterless latrines to avoid hookworms, clean water supply which gets filtered through novel filters using simple local waste products like burnt bricks to filter deadly arsenic in deep well water, cooking gas from manure would avoid millions of cancer and pneumonia deaths due to cooking smoke coming from dry leaves and twigs, would make life enjoyable in the village. Good village roads with efficient rural public transport system should allow villagers to commute to nearby towns for better jobs. Making the village self governing would hit two birds with one stone. While it makes the villagers totally self dependent, it would take away large number of government jobs in larger cities lessening the population burden there.

Adult education in the village would help improve their health status. Educated people are comparatively healthier as they are able to access health tips from others as also to follow them. Good schools in villages would encourage girls to be busy with studies to postpone early marriage bringing down the birth rate. Village schools should also have the primary health centre associated with them in the same campus. The school could be the nucleus of spreading health message, immunization, and hygiene advice as also to get the adults educated about these matters through their wards. Village school teachers must double as health workers. Village schools should have the best brains as teachers. Eighty per cent of the population is still in the villages and village is the place where healthy India should have its foundation. I would even go to the extent of saying that the best boys and girls should be chosen for primary school teaching and the latter included as a central service IES having the same pay and perks of other central services. If the primary education is of the best variety this country would be the leader in the world. It is at the primary level that one prepares the future good citizens.

The primary teachers could be given regular training in health care (not medical care) with health education as a major subject for children between 5-15 years of age with the village as the laboratory where the young teachers and their students could innovate research methods in health care. We could have roughly the following special programme for school children, aarogydarshana.

AAROGYA DHARSHANA

(Heath Awareness Programme for School Children)

This could be an additional subject of instruction to boys and girls in the 8^th through 10^th classes. No examinations and ranks at the end, though. The children could get a certificate, if needed.

It is a comprehensive holistic wisdom of physical, psychological, social, spiritual (secular), emotional, and ecological health awareness programme.

It is audiovisual, assisted by trained teachers. Suitable to be aired through DD on the UGC educational network. Could be broadcast on AIR also.

Based on most recent research data* on mind/body medicine done both in India and abroad.

The main points are:

1) Holistic Definition of Heath, stressing that even social health is as important as physical health-spiritual health of sharing and caring, while keeping society tranquil would improve personal health to a great extent.

2) Simple rules of healthy foods and eating habits.

3) Simple hygienic rules to avoid infections.

4) Vaccination principles.

5) Family Planning ideas: a) For girls the need to keep studying up until the 25^th year of age before marriage, to reduce fertility rate and , for boys the simple truths in this context, coupled with giving incentives to village barbers to put peer pressure on men who come for haircut. Peer pressure is the best way to influence our rustic wise, but illiterate people.

6) Principle of Yogic breathing. If one knows how to breathe properly, healthy body and mind will automatically result from that.

7) How to avoid unnecessary drugs.

8) The twin menace of alcohol and tobacco, the two great enemies of man, not to forget other drugs abuse.

9) Toilet use to eradicate the major killer in India-hookworm. The so-called “Toilet Plus” scheme. Teaching children the dire need to use toilets when provided. Model toilets must be built in every school.

10) How to avoid cooking smoke in village homes.

11) Personal hygiene, bath, nail health, etc.

12) Relation between germs and man-suggestions as to how to keep bugs like AIDS virus at a distance. Incidentally, without going into mundane details, this part gives the child a judicious dose of sex education stressing on the importance of emotional long-term relations in marriage compared to quick-fix free sex.

13) Stressing the need for social harmony to keep one’s health and indirectly conveying the importance of co-existence and co-operation rather than competition.

14) Stress on the major role played by negative feelings like anger, greed, jealousy and hatred as the most important causes of killer diseases like heart attacks and cancer.

15) To stress that a healthy society needs all kinds of people to keep society going. All of them are equally important. A cobbler is as important as a Minister is, for example. Dignity of labour, taught to children, aims to remove the greatest stress for diseases-frustration.

16) Awareness that poverty is the mother of all illnesses-need for sharing is stressed.

17) Clean drinking water and how to get that.

18) Preserve the environment to remain healthy-symbiosis.

19) To learn to live and let live.

We have been doing this in a small way around here with good results. We would be happy to share this with the millions of future leaders of this country, so that we could hope to have a more tranquil and healthy society that might even get rid of narrow mentality and fissiparous tendencies. Children are very intelligent. That every generation is better than the previous one is a genetic truth. They need to be put into the right path in the midst of the multitude of noise that they get daily from their surroundings, especially the electronic media that has invaded their environment in a big way. Earlier we do this the better for them. Teach them to pick the wheat from the chaff.

School is also the place to spot congenital diseases for early correction. One could easily inculcate healthy habits in children at this age-healthy food habits, exercise habits, social health, sexual health, their moral obligation to society and, also their societal dharma. Children at this age are still non-converts and could easily be converted to acquire these healthy habits unlike older adults and adolescents that are already converts. Primary children could also be used to educate their parents in healthy habits. We have done this successfully in some villages in the past.

The school could be associated with the local Panchayat where the child learns the basic rules of civic responsibilities. The local leaders could, in turn, help run the school better. If one has read the PROBE report of the primary schools in the four large states of north India one would understand the need to change the character of the village school to that of the center of activity in the village. The village and the school should be interdependent with the latter being the centre of major happenings in the village.

Villagers should have all the amenities that a city dweller has and this is possible now with the electronic and wireless revolution. This would attract a lot of people to the villages reducing congestion in cities. Best schools including some of the posh residential schools could be encouraged to go to villages where the total environment is more conducive to learning and healthy living. Cottage industries should be encouraged in villages. Local talent could be tapped to look after the health needs of the villagers. We will see later on in this book that the future medical education would be in the community for better patient care. This again brings the village to the centre of medical education. Community educated doctors would love to settle in villages to practice removing the biggest hurdle in this area in the medical field today. Better villages would lead to better health of the nation. We could achieve all this in the next quarter century to usher in a new, healthy, and dynamic India, showing the way to even the developed countries.

HEALTH PROMOTION

Prof. B. M. Hegde,

hegdebm@yahoo.com

“For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.”

Kahlil Gibran

We seem to have a distorted view of health care in India. We have the health ministries that mainly look after ill health. We abuse the term health care when we, in fact, are talking about medical interventions. This brings to mind the old saying of Mark Twain: “The difference between the right word and the almost right word in a given place is the difference between lightning and the lightning bug!”

Neither doctors nor hospitals are needed for health promotion. They are both essential for looking after people who have, unfortunately, lost their health resulting in disease. Diseases are accidents and at any given day there could be a couple of million who are ill, but daily there are more than a thousand million Indians who need health care. If the latter is done correctly we could bring down the illness rates to negligible levels.

In fact, eighty per cent of the gut diseases would vanish and thousands of deaths averted if every Indian gets clean drinking water. If one gets three square balanced meals a day not contaminated by human and/or animal excreta another few thousands would not meet their maker prematurely. Smokeless houses in the villages would save thousands of women from dying of heart attacks and cancer of the lungs. An equal number of children, below the age of five, die of smoke related pneumonias. Seventy per cent of Indian children today have less than fifty per cent haemoglobin in blood mainly because of hookworms that are ubiquitous due to lack of toilet facilities for the poor. This would result in the younger generation not being able to compete in sports as also in intellectual pursuits. Recent data shows how the early development of that part of the brain looking after memory function etc., the hippocampus, needs good iron supply for its proper growth in the mother and the new born. Iron deficiency is the main cause of slow brain development and many other long term health problems.

We get worked up and go mad if there is an epidemic like SARS. Millions suffer and thousands die daily in this world for want of clean water and good food and no one bothers about that. We need some scare to wake up from our slumber and then go to sleep again only to awaken at the next pandemic. Daily deaths do not count at all. SARS did not even kill a single Indian. We seem to have some kind of racial immunity against that virus. But the epidemiologists produced a very big scare and many would have suffered stress related illnesses because of the scare. Instead of scaring the public and lowering their immune levels making them succumb to infections, the epidemiologists should work silently to quell the threat when there is a real one. We could save millions of Indians if we could look after the following in all our villages where nearly eighty per cent of Indians live.

Clean drinking water to every one.

Clean food as three meals a day.

Smoke free house.

Toilet for every house.

Economic empowerment of women.

Educate the village barber to put peer pressure on all men to practise family welfare schemes.

Every village school must be the primary health centre for the village; the present PHCs could be dispensed with and replaced by village health workers that report any illness to the Taluka hospitals from where ambulances could be dispatched to transport patients when needed.

One doctor, the same doctor, should visit every school once a week and look after the health status of the children and do the needful. Children will, in turn, educate their parents.

Health education should be a compulsory subject in the age group of 5-15 years.

Pregnant mothers should get special attention and more nutritious food especially during the first trimester to prevent major killer diseases in the adult population in later life as all the organs are properly made during the 12-16^th weeks of gestation inside the mother’s womb. If the mother’s nutrition is poor the organs are defective. These are the children that get major killer diseases precociously in later life.

Having done all these, vaccination to prevent communicable diseases will work well. Vaccination will not be effective in children with very low blood protein levels.

As has already been pointed out above doctors and hospitals do not promote people’s health; in fact, a recent study showed that a surfeit of hospitals of the hi-tech variety and increase in the number of interventionalists would result in higher than expected deaths in society. An audit of European countries and Japan showed that those countries with the higher number of doctors per unit population compared to countries with less number of doctors had lower health status and higher morbidity. When doctors went on strike in Israel and no intervention on the apparently healthy was carried out death rates plummeted down only to go back to the original levels when doctors resumed full duty.

I have been writing about this for the last four decades but it seems to fall on deaf years and the powers-that-be seem to have selective blindness for this kind of information. “Truth influences but half a score of men in a century while false hood and mystery will drag millions by the nose”. This saying of Aristotle is true even today.

India needs a very strong health promotion set up, may be, headed by a health promotion powerful ministry that has jurisdiction over food supply, water supply as also other infrastructural needs of the people. Large part of the present “so called” health budget could be shifted from hospitals to health care. We need a full department of health promotion. Medical schools should teach health of the public (Public Health) to students for all the five years as a doctor is trained to look after the health of the public in the first place. Unfortunately, today we teach medical students advanced diseases in a five-star technology oriented set up and make them believe that the be all and end all of health care is hi-tech intervention. Students must have their training in the community as also in the villages to learn the real time medicine.

Medical Care:

This needs hospitals, but the future hospitals must incorporate complementary systems, mainly Ayurveda to widen the net to help more patients and also save billions of rupees spent on some of the useless hi-tech stuff offered today. Majority of illnesses (80%) are but simple minor illness syndromes and they could be helped by complementary medicines and some of the chronic illness get better with Ayurveda with much less cost and less discomfort to patients.

Wellness Clinics:

Life style changes, healthy diet advice, yoga and meditation, life style modification advice, alcoholism and smoking advice, could all be done in the new concept of the wellness clinics where healthy people regularly attend, not to get themselves checked up but to get themselves trained in the above methods that would keep diseases at bay for very long time even one were eventually get an illness later on. In the latter event the wellness clinic experience would hasten healing.

These two new concepts must be a part of all Indian hospitals sooner than later for the common good.

HEALTH CARE Vs MEDICAL CARE

"The difference between the right word and the almost right word in a place is like the difference between lightning and the lightning bug."

Mark Twain.

Health care is a word mostly misunderstood and used in place of palliative medical care. The two are poles apart. It is very important, both for the lay man and the administrators, to make a clear distinction between the two, lest there should be mal-administration of health strategies in society.

Health is a state of holistic wellbeing of man, enabling him to be enthusiastic to be creative in society for his own good as well as for the good of others; the latter more important than the former in the social context. On the contrary, palliative medical care is trying to fix the broken pieces of a healthy man into a whole again. There is further confusion here in that it is sometimes called curative medical care, in place of palliative care. Cure, we rarely, if ever!

If one follows the holistic classification of diseases the following classification, suggested by me, would be more practical.

Emergency Medicine (10% of the sick population)

Minor illness syndromes (around 30%)

Doctor-thinks-you-have-a disease (10%)

Patient-thinks-he-has- a disease (10%)

Chronic illness syndromes. (remaining 25-30%)

Drug or Doctor Induced (iatrogenic) diseases (10-15%)

In this scenario only the first ten per cent of the sick population does need modern hi-tech medical and surgical care. Rest of them could make do with conventional traditional systems of medicine coupled with change in the life style. Modern medicine becomes prohibitively expensive when used for all the one hundred percent of the sick population; it could strain the budget of even the richest nation. America is feeling the pinch. Whereas more than sixty percent of the upper middle class Americans can not afford good health insurance cover as the premia are sky high, thanks to the charges of the star-performers!

The National Health Service of the UK is broke and the story repeats everywhere, but if one were to follow the dictum mentioned above one could have equitable medical care for the really needy. While the American hospitals have been reducing their beds, the new idea of HMOs to replace hospital expenses have been declaring chapter eleven one by one.

Action plan for India for the next century:

It is true that the population growth in our country is still not arrested while in many western countries it is either decreasing or is, at least, not increasing. They envisage a large chunk of their population in the next millennium to be in the above sixty category (70% of the population). Naturally, they could expect to see degenerative diseases go up exponentially there. That would be their real problem. Our scenario would be totally different.

More than sixty per cent of our population in the next millennium would be in the second decade. We would have totally different type of problems of adolescence viz.: aids, drug addictions, infective diseases, nutritional disorders, violence, tobacco and alcohol related diseases, and road accident deaths in place of their load of degenerative diseases.

Modern medical wisdom comes in handy here for us to avoid any future threat of degenerative diseases should they show up when our present generation of children grow to the sixth and seventh decades in the third world. Most, if not all, degenerative diseases get born in the mother’s womb in the first trimester of her pregnancy. It is there that the foetus forms its heart, blood vessels and pancreas, to name a few. These structures, if not formed well, could encourage the onset of heart diseases, high blood pressure, diabetes and other vascular accidents in adult life! It is known now that mother’s nutrition in the first trimester of pregnancy is of vital importance to avoid this menace.

The next period in life when these diseases get their encouragement is childhood and adolescence when bad food habits, alcohol and tobacco could further ensure the progress of degenerative diseases in later life.

Action Plan:

1) The comprehensive village development plan should include water supply, toilets, education about common foods available in the village, and also some methods to uplift the economic condition of the villagers. Smokeless choolas should be supplied to all houses.

2) Pregnant mothers should get special attention regarding their diet, more so in the first trimester. Proper nutritional advice should avoid undernourishment during that crucial period in the life of the foetus.

3) Compulsory breast feeding education to be given to all mothers. In case the breast milk is inadequate other human milk, if available, is good enough but not cow’s milk! Instead the baby could be given fruit juices and cereals in an easily digestible form. This could avoid many other diseases in later life, like the autoimmune diseases.

4) Effective education, to keep tobacco and alcohol at bay, aimed at the adolescents using different methods suitable to different set-ups, should be started.

5) Our primary education should change in such a way that it inculcates the essence of Indian education of the yore-humility. Humility begets better life habits. Anger, pride, jealousy, hatred, and ego get suppressed to give place to love, compassion, and camaraderie. The former are now known to be important risk factors for major degenerative diseases.

6) Proper health education of children in school about the dangers of alcohol, tobacco, and also sexually transmitted diseases will go a long way in reducing the future problems of drug addiction and AIDS, which are going to be our big problems in the next millennium.

7) Better roads and stricter licensing procedures should decrease road accident deaths. Coupled with a war on alcohol this should yield better results. The only truly avoidable deaths are accidental deaths. Punishment for careless driving should be more stringent to persuade rich kids from rash driving in larger cities.

8) Family planning should be pursued on war footing. In the villages, where the bulk of India lives, men are at fault. The best way to educate the men in the village is to catch the village barber. The latter is an incessant talker and also has a lot of influence on all the men in the village. If we could properly educate the barbers and then give them an incentive, that could work wonders in addition to the conventional methods followed.

9) Screening whole populations for high blood pressure, heart disease and diabetes to get them under the net of doctors, drug companies, and instrument manufacturers to fix the defect would look good on paper. It can work in the laboratory, but it does not work in the population, and it is definitely not cost effective.

10) In addition, screening apparently healthy populations could even be counter-productive. “It could seriously damage the health of the population”. Past experience has shown that screening increases sick absenteeism in society making more people sick! It also increases false positives.

11) Screening a population of one billion is not feasible. Screening only the urban elite is also not going to help. This would certainly net more people into the system for treatment and also get more hapless victims for intervention in the present top heavy hi-tech medical field, but would not change the scenario as far as the imaginary threat of the degenerative disease epidemics, as predicted. Predicting the future is impossible. “We have been predicting the unpredictable”.

12) Reliable studies even in the West have shown that the so-called epidemic rise of certain degenerative diseases and their subsequent fall has been spurious and flawed heavily.

13) Life style modifications have been palpably more effective in containing these diseases even in the West. While the effect of life style modifications has been 59.4% effective in reducing the incidence of coronary artery disease, interventional methods have only been effective to the tune of 3.4%. The story is not different in the field of drug therapy, either. The famous MRC study of mild to moderate hypertension treatment, which has 85,000 patient years of experience, clearly showed that to save one life from stroke we have treat 850 apparently healthy people in society with anti-hypertensive drugs unnecessarily.

14) These speak volumes about the very effective role of life style modifications in altering the future incidence of degenerative diseases.

15) Coupled with the prohibitive cost of population screenings and their attendant dangers to human health it makes lot of sense for third world countries to concentrate all their efforts in modifying the life style of their populace to contain these dreaded diseases even if they were expected in the next millennium.

16) Here the role of tobacco and alcohol has to be stressed. We have to fight the powers-that-be that try and push these two evils on society with all our might.

17) Another area is the field of diet for our adolescents. Indian vegetarian diet has a lot to recommend it to them in place of the modern junk non-vegetarian food, which seems to be invading the world of the young in a big way. Nutrition based education should start in the elementary school itself.

18) Need to have physical exercise is the next area to be stressed. This could be done in many ways aimed at the younger generation.

19) The need to keep the human mind filled with universal love to avoid hostility and depression-the two most important risk factors for heart and vessel diseases in addition to cancer –has to be stressed right from day one in school.

20) Economic empowerment of our masses is of vital importance to avoid future epidemics of vascular degenerative diseases.

The need of the hour is the courage to implement these right away and keep the pressures on population screening and mass drugging only to the symptomatic in society, thus bringing down the cost of curative medicine to affordable limits.

Would someone listen please?

I’m sick of gruel, and the dietetics,

I’m sick of pills, and sicker emetics,

I’m sick of pulses, tardiness or quickness,

I’m sick of blood, its thinness and thickness,-

In short, within a word, I’m sick of sickness!

Thomas Hood, `Fragment’, c. 1844.

VILLAGE SCHOOL AS THE PROMOTIVE HEALTH UNIT

(PHUs)

Prof. B. M. Hegde,

hegdebm@yahoo.com

Healthy India would certainly be a wealthy India with its all round progress. Rounded development of an individual, and consequently of the whole society, depends on his/her total health. The latter could be defined as the enthusiasm to be creative in life to live and let others live with physical, mental, social, emotional, societal, and spiritual wellbeing. The foundation of this kind of growth should be laid in childhood. The parents and the home environment are as important, if not more, than all the education that the child gets in life outside the home. Village schools are the ones that train the bulk of future India. There are well over six lakh villages in India where more than eighty per cent of Indians live. Unless the village school, where the future India is being brought up, is given due respect and importance the country has no future, despite all the fanfare of the Sensex rising and India shining.

Lop sided technological development and economic growth are not as important as the emotional and ethical growth of the populace. While aping the west we should be careful not only to imitate the worst in their culture, we would do well to concentrate on the best that they have. Monetary economic growth alone would eventually take man into the valley of moral nihilism and extremism, as has happened in the west today. Monetary development must be combined with healthy human development, as defined above. We, in India, have had a hoary past of a great culture. Indian culture depended on what every Indian did when no one was observing him/her. Indian culture demanded that we walk our talk. Indian culture, combined with the good points in the western economic growth, would make India the world leader once again. It all depends on India’s greatest asset-its man and woman power.

Even the journey of a thousand miles starts with the first step. The first step for the growth of a strong India in the next few decades is to change the face of the village primary school. This should be the nucleus for village development, nay the country’s development. The prevailing scenario is anything but conducive to this kind of human growth. The recent PROBE report made very sad reading about the appalling conditions of village schools in the four large northern states of UP, MP, Bihar and Rajasthan. The earlier we do something to change this, the better for the nation. Good life depends on good health to begin with. Health depends on man and his surroundings. Health does not depend on doctors and hospitals. The latter are needed only by those who are not healthy. If we try to preserve and promote positive health, the need for doctors and hospitals would automatically go down.

Education for healthy living:

Educated people, especially those that receive correct guidance to live and let live, have been shown to live longer and better than those that do not have education. Education and health promotion are inseparable parts of human growth. It makes good sense to make the primary school in every village also the village health promotive unit. The present concept of a primary health centre in villages is not only a waste of resources, it is counter productive. The PHCs, as they are conceived now, are fashioned more like mini hospitals without the capacity to do even minor surgery, not to speak of the doctors presence in the first place. Doctors in India today are trained within the four walls of a hi-tech modern hospital where they get to see a microscopic minority of serious terminal illnesses. Such training, which stresses the use of gadgets and scanners for every diagnosis, would be an anathema in a village set up to assess and diagnose illnesses as they present in society. The young doctor, not exposed to this kind of medicine in his medical school, feels like a fish out of water in a village and feels guilty. This is the reason why our doctors do not want to go to villages.

Village school teacher as a health promoter:

In the new concept the village school teacher is trained for a year with a teaching diploma in school health promotion (TDHP) to replace the village doctor. Every medical school could be made to train certain number of selected bright village teachers, free of charge, with a special curriculum to equip them with enough know how to look after the holistic health of the children and their parents in the village. They should be provided with communication facilities to inform the Taluk hospital about any sick child or adult in the village to be shifted there for treatment. They should be trained to spot trouble and inform the doctor and the hospital to do the needful. The money being spent for the PHCs could be diverted to develop this new concept along with the village school. The teacher/health promoter would look after sanitary needs in the village like toilets for every household, clean drinking water, smokeless houses, and clean meals for all, and assist the villagers to live like a large family in the village. In due course people would look up to them for all kinds of guidance. The idea is to develop a cadre of village teacher who becomes the friend, philosopher, and guide of the villagers.

In the school these teachers have added responsibility to see that children get proper nutritious meals, they develop healthy habits, clean dress and are made to wash hands before eating. Children should be trained to use the toilet and teach their parents in turn at home. Children should be taught to respect all life on this planet as we are all inter-dependent. These teachers are responsible to see that children get proper immunization at the right time. They could help children to develop a healthy social outlook with universal compassion, sharing and caring. Healthy living should be one of the important subjects in the curriculum but without the conventional end year examination. However, those who excel should be given a special certificate as also some incentive by way of a prize or so. Children could be encouraged to think for themselves to develop curious healthy citizens for science training in later life. Catch them young should be the motto. My friend, Dr. Solomon Victor, a famous cardiac surgeon of Chennai, has a model for teaching school health. That could be supplemented to make a special curriculum for the subject of health promotion in school, as also expanded to make the curriculum for the teaching diploma mentioned earlier.

Village School as the cultural centre of the village:

Rounded education needs an overall development of human personality. Arts, humanities, behavioural methods, community living etc. could all be promoted through regular festivals in schools periodically where the villagers use local talent to entertain others with the help of the teachers and students of the school. This could be a good medium for spreading health messages like AIDS awareness, family welfare etc, through dance, drama and songs. Folk arts could be promoted here. Creative writing, story telling, poetry reading etc. could be arranged in addition. Neighboring village talents could also be tapped in the bargain. The stress in all these should be communal harmony and community living and letting others live. The school should be the place where all special occasions of all religions should be celebrated to show the oneness of all human beings-the fatherhood of God and brotherhood of man. Village school teachers could wear the cap of village counselors in their spare time. For all these one will have to make the village teacher happy with comfortable living standards where he/she does not have to depend on a side business for living. It would be better to tap the best brains with right qualifications for the village teachers job. Bright young men and women should shape the future of India. They would do well in this area rather than in central services or in IITs, where they may do well for themselves. As a village teacher one builds a new India that will be the world leader, not only in monetary terms but in human terms.

Family Welfare and the Village Barber:

Another area where our planning has gone astray is the family welfare. If we are able to control our population we will be able to build better village schools. The village barber is the friend of every male in the village. Males are the usual culprits in the failure of family planning. The barber meets every man at least once a month for about half an hour. Barbers are incessant talkers. Peer pressure is the best influence. If we could train the barber and motivate him to convey the message of family planning in his own rustic terms to every male in the village, I am sure our family planning would be a lot better in future. The village teacher/health promoter could be used to train and give continuing education to the village barber to replenish his knowledge. The credit for this idea should go to a friend of mine, Late Dr. H.K. Ranganath, a noted writer who told me to try this method while I was trying to help develop a few villages with the help of money from a generous patient of mine, Shri Durgadas Mandelia.

School Children to help develop the village atmosphere:

We have been able to get the children in village schools to help grow more trees and also help keep their surroundings clean. They could be the best influence on their parents in following good healthy habits. Children should be given prizes for growing tress and gardens in their own homes instead of giving prizes for mugging g up textbooks! In short, the village school could be the nucleus for the great future for this country. May the future India develop a healthy tradition which could be the model for the whole world? The present school scenario in the west is so bad that our children should not even know what is happening there. There have been eleven thousand serious crimes against teachers in schools in the US in one year and eleven teachers were shot dead by their own students. School children use their parents’ guns to settle daily quarrels with their peers and/or teachers! When one ponders over these facts, one realizes the significance of what is written above.

Other Chapters:

Industries and Human Health

Are we barking up the wrong tree building five-star hospitals?

Food Industry and Human Health

Pharmaceutical Company’s role in Human Health

Hi-Tech Medicine-a boon or a bane?

Complementary systems in Medicine

Trade Organisations and Health

Landing in the neighbour’s house with a smile or Landing on the Mars.

Health Promoting Indian Agriculture

High, Medium, and Low Tech.

Ancient Indian Wisdom in Healthy living.

Vedic Wisdom and Health

Bhagavadgita as a psychotherapeutic tool Vs Freudian school for India.

Healthy Indian Infrastructure development.

Eastern Science of holism Vs Western reductionism in medical care.

Indianness in medical education for keeping the health of the public.

Meditation and Health- Indian style.

Secularism of the right type and good health of the society.

Afterword.

A PIECE OF MIND

Prof. B. M. Hegde,

hegdebm@yahoo.com

“Know thou this-that men

Are as the time is………..”

Shakespeare.

I shall give you a piece of my mind to help you get some peace of mind. All writings on esoteric matters like meditation, God and philosophy are shrouded in mystery and couched in unintelligible sesquipedalia verba. Nowadays they come packaged for sale, not to speak of their high cost in tune with the present trend in the market. They remind me of the popular junk food. I hope these methods are not as dangerous to health as are the junk food packets! Not a day passes without a new age guru appearing on the scene with his/her method of modified meditation, yoga and what have you.

The need for peace of mind started with the onset of the monetary economy, culminating in the new epidemic of suicides and divorces in the west. The plastic card economy would only enhance this need. Once a student reminded me that my efforts to make man tranquil would have to, per force, fail, since this universe is a combination of the opposites- good with the bad, yin with yang, positive with the negative, happiness with sorrow, elation and depression, etc. Even at the micro level, he said, the atom remains intact because of the protons, neutrons, and other quantum particles with opposite charges.

While I agreed with him, my submission was that the balance between the good and the bad- the bad arising out of oppression, suppression, and denial- has reached a flash point. If that were to happen to the atom the latter would have exploded by now. Before the macro world explodes we have to hasten to act. Otherwise, the saying of the poet “when the last tree is cut, when the last river is poisoned, and the last fish eaten, mankind would realize, for the first time, that money can not be the substitute for food and water,” would come true. Mankind then would have to follow the path shown by the mighty dinosaurs.

I have tried every one of the methods of meditation to get tranquility. While each one of them results in lower breathing and heart rates, I am not sure if there would be long term tranquility. I could draw a parallel from modern medicine. While blood pressure, sugar, and cholesterol lowering drugs get us better laboratory reports, almost all of them fail to translate into better health in the long run. The reason is not far to seek. Lowering the physical parameters alone will not translate into holistic health and longevity.

Be that as it may, let us look at common day to day human activities that bring permanent pleasure and lasting tranquility. Our scriptures have shown the path and the great science of Ayurveda has reiterated the same time and again for centuries. “Aaapthopasevi bhavet aarogyam”-treating everyone around you like your near and dear ones would give you positive health for certain, is the basis of Ayurvedic art of healthy living. I have been trying this experiment on myself for decades now with very good results. If I had a day when I did not get an opportunity to show some kindness to someone, do a good turn to others, give a smile to the needy, or wipe a tear from another’s eye, I get tired easily. On the other hand even when I was dead tired, if I got an opportunity to be of some use to another, my tiredness would vanish. Similarly, if I had inadvertently harmed someone, my body signals that all is not well by way of backache, pain in the neck, heartburn, sleeplessness, tension headaches, migraine etc.

Over the years I have learnt to analyze my body responses to my thoughts. Even when I think ill of others my breathing and heart rates hasten. When I help another I feel very tranquil and have peace within. Anger, hatred, jealousy, hostility, frustration, and other similar negative thoughts bring on discomfort immediately. This needs one to fine tune oneself to receive body signals. My post-meditation feeling is not comparable with the immense happiness that I get from sharing and caring that make me tranquil round the clock. I have come to realize that spirituality and meditation are nothing but sharing and caring. The joy of sharing is enormous when one cares for those that hate you. This is not easy, though. It requires lots of practice and understanding. If one could fill “the unforgiving minute with sixty seconds of distance run,” one could be really, really happy.

That said, I must hasten to add that the above simple message can not be packaged into a ready made recipe for all. No two individuals are alike, not even the uni-ovular twins. Each one will have to tailor this to his/her convenience. Perseverance pays dividends in the long run. Total health requires a holistic approach. I am not infallible. I, however, feel that I have described meditation in a more tangible fashion for the common man to understand. There are no easy short cuts in life. One has to work hard to get good results, but the results are better if one does not get too possessive about the outcome.

“Joy, temperance, and repose,

Slam the door on the doctor’s nose.”

H.W.Longfellow.

FOOD-GENE MISMATCH.

Prof. B. M. Hegde,

hegdebm@yahoo.com

We have been hunter-gatherers for millions of years before we settled down as groups (society today) on the fertile banks of rivers. Using the water way as the mode of transport to collect more food for members in the last ten thousand odd years, we have grown into larger societies and nations today. During our very long sojourn as forest dwellers we were depending on the hunted animals and the roots and fruits that we get for food. Naturally the food supply was not only erratic but uncertain. Mankind used to live long and the causes of death were predominantly predation and old age. Occasional deaths due to starvation must have been there.

This kind of life made the human body’s intelligence to mutate our genes over a period of millions of years into those that could live and survive on very little food during the lean seasons. We have, therefore, inherited those genes that give us the ability to live on very little food indeed, the thrifty genes. Even now we hear of saints and Jain monks who live on very, very little food, indeed. I am told, I have yet to confirm scientifically though, that many of them live on just one handful of food given by the devotees for the whole day and, that too, if there is any defect in the food or its contamination with human hair or so, they would reject that and eat nothing for the next twenty-four hours!

Be that as it may, now we have planted ourselves, in a relatively short span of ten thousand odd years, in a new environment of plenty of food available at all times and places, and most of it completely transformed into cooked and preserved food, far removed from the original natural state. Still there are the poor amongst us that have to subsist on very little food and that too of the poor quality. Minority of the rich and the powerful have access to plenty of food and most of them “enjoy” eating rich food, almost completely spoiled by cooking and processing. Consequently, while the majority suffers from malnutrition and sub-nutrition, the rich suffer from over eating and eating the wrong type of food. Instead of looking at this problem of food-plenty in its entirety, modern medical nutrition of the western type wastes its time in studying the micro-nutrients. Their findings now and then make headlines in the media making life miserable for everyone who is literate.

Western medicine has also created a new myth by inventing some chemicals in the food that we have to eat naturally naming them as vital amines to make money by selling them. The world accepted them as the panacea for all ills and in the west, as also in the westernized India, every home has these multi-vitamins on the dining table. Modern man gets deluded to think that if he ate these vitamins regularly he need not bother to eat fresh natural food to get those good things in them. The following two examples will show the futility of this exercise. If one ate 500 mg of vitamin C daily for well over five years he/she has a good chance of increasing the kidney cancer risk three fold. On the contrary, if one ate a fresh tomato daily lifelong, (may be slightly steamed) his/ her chance of getting any cancer is reduced significantly. While tomato also contains the same 500 mg. of vitamin C, it contains many other chemical anti-oxidants that we do not know, that assist the vitamin C to do good and prevent it from doing any harm. This is the difference between the reductionist science that western medicine follows and the holistic science that the human body understands.

A similar study of fifty thousand post-menopausal women in Canada showed that the one matched half of those women who were given three extra helpings of fresh fruit and vegetables compared to the other half given Vitamin combinations of A, C, and E remarkable difference in the incidence of cancer and heart attacks in the groups. Whereas the fruit eating group had three times less cancer and four times less heart attacks the vitamin eating group had both diseases in abundance. Many more studies and examples could be given but the above two are good enough to drive home the point that micronutrients are only chemicals partially effective but still have the capacity to harm in the long run. This does not mean that vitamins are bad for short term replacements when one is ill or has vitamin deficiency because of poor diet or poor absorption from the gut. Eating vitamins when you are healthy and have good balanced diet could be dangerous in the long run.

There is another side to this problem. Most of us who have come from the lower income groups have had mothers who were not fed well during pregnancy. Even some of the rich mothers could not eat well due to a disease in early pregnancy, hyper-emesis gravidarum, a long Latin tongue twister used by us to make the patient get awe-struck! It simply means extra vomiting in early pregnancy. In either case the organs of the foetus in the womb of such mothers, which are all formed between the 12-14 weeks of pregnancy, suffer for want of good nutrition. Consequently, they are made much smaller than normal and the whole foetus itself is too small to survive in the womb. Nature still struggles to keep the foetus viable by making the mother’s placenta too big so that it could supply extra blood. Many of these children are born small, if they survive in the first place. This vital combination of a small baby with a large placenta is the cause of many of our troubles in later life.

To give you one telling example let us take the usual adult onset diabetes. Those adults that were small babies at birth, if they get themselves transplanted into a food –plenty environment ( man going to Dubai to earn Dinars) and end up eating lots of calories in the rich junk food there, the small made pancreas will find it very difficult to cope with the sugar levels in blood. The pancreas quickly gets exhausted and the result is the precocious development of Type II diabetes. We could change this by changing our life style in future. This applies to many other chronic illnesses like high blood pressure, heart attacks and strokes etc.

This diabetes incidence at an early age is misused to frighten the public through various means by drug companies for their benefit. Doctors also fall into this drug company trap! The whole problem is that of gene-food mismatch and not that Indians in the west and in Gulf have any new disease. Yes, when someone is ill we have to drug him/her, but the long term solution is in telling people the truth, the whole truth and nothing but the truth for them to change their mode of living. If all such people who are born small have a frugal diet and work very hard to burn calories they will not be diabetics at an early age at all. Health promotion through diet is our future hope.

At the end of it all the poor suffer all diseases because of their poverty in the first place. The poor pay for their poverty with their lives. Their main problem is not knowing where their next meal comes from. Even when they get a meal there is no guarantee that it is not contaminated by human and/or animal excreta. When the last man gets his three clean meals a day this world would be a happy place for all of us to live on. Let us contribute our bit to see that this becomes a better place to livr.

FUTURE MEDICARE SYSTEM

Prof. B. M. Hegde

Vice Chancellor

MAHE, Manipal

“Men are disturbed not by things which happen, but by the opinions about the things.”

Epictetus; First Century Greek Philosopher.

Modern medicine has become prohibitively expensive. It is going to be still more so with newer technology invading medical diagnosis and management more and more. Most of these technologies have not been audited and some of those that were inadvertently audited did not come up to the expectations of their promoters and, in some instances, have even caused more harm than good. It is estimated that around 80% of the world population have not been availing the modern medical facilities! Around half of the rest who have even free access to modern medicine would prefer to have an alternative system, if available, even in the industrialized west. The reasons for the disillusionment are protean², but the lack of medical humanism is one of the foremost.

Oregon state in the USA realized, to their dismay, that one bone marrow transplant in a terminally ill cancer child would cost as much to the taxpayer as looking after the health needs of one thousand pregnant women through pregnancy and delivery, as also the health needs of the baby for the first year of life. Recently, they enacted the Oregon Law that bans bone marrow transplants for terminally ill cancer children at the taxpayer’s cost. This did create trouble in the beginning but, eventually, many other states have followed suit. This could give one an idea of the magnitude of the financial load of covering every citizen with all the hi-tech stuff even in the rich nations. Most of these techniques only make life appear longer making the patient a slightly better cripple.

Let us not bother to look at the scenario in the poorer countries for the purposes of this paper. Suffice it to quote the recent WHO document (WHO 2002) that shows that if the people of the poorer nations were to get clean drinking water, it would bring down two million deaths per year and prevent half a billion serious illnesses. Obviously our priorities are skewed very badly. The western pharmaceutical industry, however, is trying to push the costly, many times unproven, drugs and technology into the third world, where even today the common man does not have access to clean drinking water, three meals a day with food uncontaminated by human and/or animal excreta, and a toilet to avoid the deadly hookworm infestation of children!

Need for a new paradigm in medical care:

Robust circumstantial evidence goes to show that the 80% of the world population that does not have access to modern medicine lives using their intuition in times of need and get benefit from many other time-tested alternative systems of medicine, many of whom being much more ancient compared to the modern medical wisdom. One of them, the Indian system of Ayurveda, is much more ancient, having survived the discouragement in the recent past even in India. We now have unequivocal data to show that Ayurveda is the mother of most other systems, notably the modern medical system. Present day modern medicine originated in the Nile Valley five thousand years ago as sorcery, witchcraft, magic and mumbo-jumbo. Present day “much of the news and advertisements of health education with which we are bombarded are designed to heighten our worries, not soothe them; many drug companies play upon our tendencies toward hypochondriasis.” Wrote Herbert Benson in his celebrated book Timeless Healing.

In its onward journey through Arabia and then Greece, modern medicine came under the spell of Ayurveda taken to Greece by the army of Alexander, the Great. There are two authentic works to support this hypothesis. India in Greece is an excellent treatise written by a great Greek scholar, E. Pococke, who lived in India for years. He wrote this book in 1832 AD. Another authoritative book is the one on Ancient Indian Medicine written in 1936 by Late Prof. P. Kutumbiah, MD, FRCP., who served as the Professor of Medicine both, in Vellore and, later, at the Madras Medical College.

This apart, the popular belief about the eradication of the only scourge of mankind, smallpox, needs a major change to get at the truth. Dr. T.Z.Holwell, FRS, was a Fellow of the London Royal College of Physicians. He spent twenty years in “The Bengall Province” of the Raj to study the Indian system of vaccination and its effect in preventing small pox. After twenty years of prospective controlled studies, he concluded, in his report to the Royal College, submitted in the year 1767 AD, that the Indian system of vaccination, which existed for “time out of mind,” with a type of attenuated small pox virus, was ninety per cent effective in preventing small pox deaths and had very little side effects. This report, in its original shape, is still available in the archives of the College library. It can not be Photostatted but is in the Internet as a Revised Version. Surprisingly, it survived the great fire in the library some years later. Holwell favored permitting the anecdotal experience of Edward Jenner to be used freely in view of the Indian experience of antiquity! He pleaded with the President and Fellows of the Royal College to recommend to the King the free use of Jenner’s unproven method in view of his solid proof from Indian vaccination system. Rest is history known to all.

Suggested New Classification of Diseases:

To understand the new paradigm one needs to classify human diseases based on the treatment needs thus.

Emergency Medicine………………………….. 10% of the sick population.

Minor illness syndromes………………………35% ibid

Doctor-Thinks-You-Have-a-Disease……….15% ibid

Patient-Thinks-He-has-a-Disease………….10% ibid

Neoplasias………………………………………..10% ibid

Chronic Degenerative Diseases…………….10% ibid

Iatrogenic Diseases…………………………..10% ibid

Classified like this most of the diseases, where modern hi-tech medicine, with all the glittering array of diagnostic tools, the expensive interventions and drugs are of utmost need, fall into the first category of emergency diseases. The new specialty of emergency medicine in the west is the most welcome timely step in the right direction. Rather, it heralds the need for the paradigm shift, referred to earlier. It is here that the advances of modern medicine could make a dent in improving the lot of the suffering humanity and, possibly, also in preventing avoidable deaths. In the emergency set up even the unproven technology could be justifiably used in extreme situations.

Time has come for a proper audit of the present use of hi-tech medicine under all the illness situations classified above. I strongly feel that in the non-emergency situations we need not (possibly, should not) resort to hi-tech modern medical help. We could easily put together an inexpensive method of managing most of those 90% illnesses using a judicious mix of the best in many useful alternative systems of medical care. Rarely in some of those situations, like the neoplasias, modern medicine could be used in conjunction with scientifically tested alternatives, to reduce the cost and the intolerable side effects of chemotherapy and radiation. The two mentioned above have not shown themselves in very good light so far.

Many of the newer, yet to be tested but, much hyped, chemo-therapeutics are prohibitively expensive for the poor. These methods of cancer management have not made a significant dent in total cancer deaths. Cancer deaths have still to level off before showing a tendency to come down. This could be contested using statistical methods known to modern researchers, though.

There are excellent remedies for the control and/or prevention of the major class of minor illness syndromes, that cause the largest sick absenteeism in productive fields everyday, in Ayurveda as well as other alternative systems. Some of them have been tested by the modern medical methods already. The powerful anti-viral properties of Indian spices, mainly garlic, ginger, and pepper have been studied in the leading western laboratories. More than all that is the thrust in Ayurveda of methods to keep the healthy well. These health-promotive strategies are the backbone of Ayurveda.

“Swasthasya swastha rakshitham.”

[Keep the well healthy]

This is the most important slogan in that system and there are many methods of health promotion based on life style changes, food habits, exercise, yoga, meditation (making the mind tranquil), and also certain herbal remedies to slow the ageing process. Time does not permit me to detail the useful methods in many other systems of health care delivery that people have been using down the ages.

Unfortunately, quacks and unqualified people have brought disrepute to most of those systems. It is because those methods have not been scientifically evaluated before being let loose on the gullible public. This must stop forthwith! The reader could be surprised to know that the ancient school of medicine of Shushruta needed a much longer period of training to be a doctor compared to most modern medical schools today. The students studied human anatomy in much greater detail for much longer time to achieve perfection! All these need to be looked into before we jump at the new bandwagon of other systems. What I am advocating is not too many systems to be used concurrently. The best brains in the various systems will have to put their heads together to evolve a new system, the complementary system of medical care, that has a scientific judicious mix of the best in all those systems, along with the emergency hi-tech care of modern medicine for a wholistic medical care delivery system that could economically do most good to most people most of the time.

There was an audit of the effect of modern medicine in the USA about two decades ago. Whereas 59% of the improvement in human health and fall in disease incidence there could be attributed to improvement in sanitation, improved nutrition, better education, decent housing, economic empowerment of the masses, and healthier life style avoiding tobacco and alcohol, only 3.4% of the change could be attributed to modern medical claptrap! One needs to repeat this in many other countries to get a better picture that might motivate even the skeptics to agree to the paradigm shift.

Surprisingly, even in the emergency set up; although I feel that the latter definitely needs hi-tech, a comparative study of the per capita deaths of the wounded soldiers in the Vietnam and Falklands wars did show that it was marginally better in Falklands compared to Vietnam. While the American soldiers in Vietnam had the best base hospital in nearby Saigon, the British did not have such a luxury in the South American war theatre. Many a time the wounded soldiers in Falklands were left to be tended by the forces of Nature, before being attended to and, that too, not in a sophisticated hi-tech modern base hospital. One of the explanations for this disparity could be that we have been interfering with Nature’s methods of dealing with human injury with the help of the sympathetic system. This system evolved to protect the hunter-gatherer forefather of man, from the most important danger those days of predation!

Complementary Medical Care Delivery System:

The idea of mooting this strategy is to stimulate people to think about this possibility to make medical care available to all the people of the world, rich and poor, that is not only equally effective but cost effective as well. We must take care to see that the new system is put in place after due care to see that untested, unproven, and potentially dangerous methods do not get included. The scientific methods and agencies overseeing this stupendous task must not only be highly competent, but should be equally authentic. We hear of the fraud in medical research in modern medicine almost daily, to be brushed aside lightly. With that background in view, the people at the helm of affairs must have proven track record.

“I know that most men, including those at ease with the most problems of greatest complexity, can seldom accept the most simple and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted………..….in weaving thread by thread into the fabric of their lives.”

Leo Tolstoy

There would be great opposition from the all-powerful drug and technology lobbies that literally run medical education in the west these days. They start brainwashing the future doctors from day one at the medical school, only to stop at their graves! It is heartening to know, though, that there are very good people even in those areas, but they are like an occasional oasis in the vast desert sand and are an endangered species, indeed. We should be able to get their help in this humanitarian venture.

With the present worldwide communication facilities the task of bringing the best people together need not be difficult. Well meaning people in the modern medical field should take the lead to bring respectability to this effort. We need to do a lot of education of the common man and the media to accept this line of thinking in the midst of the powerful and rich medical claptrap. The latter has a vested interest in keeping the system as it is. The present hi-tech medical care delivery system is a big business. This is the very reason why medicine has lost its heart today. The time-honoured doctor patient relationship is replaced by the doctor being viewed as the seller and the patient the buyer of medical technology, bringing in its wake the consumer movement into medicine. The crux of the medical scenario is the trust that the patient has in his/her doctor that provokes the immune system to heal the sick. Healing is a much larger concept than the concept of “curing” used commonly by doctors. Doctor only dresses the wound; the immune system heals it. Let us bring back the patient confidence in his/her doctor back into the medical arena for the common good, before it is lost for ever.

“No man, no author, not even the greatest, ever provide the last word on anything. Men are vain authorities who can resolve nothing.” (II, 13)

Michel de Montaigne.

HATRED BEGETS HATRED.

Prof. B. M. Hegde,

Vice Chancellor,

MAHE Deemed University,

Manipal-576 119.

"Love Begets Love"

The war is on. America is exhibiting all its might. The Taliban is showing all its resilience. There seems to be no end in sight! This will go on and on. Even if America eventually succeeds in wiping out every single man alive in Afghanistan, there will still be no peace on earth, and the Americans would never be able to go to bed in peace forever. Wars are born in the minds of men. It is always dangerous to leave the war to the generals alone just as it is not safe to leave governance to politicians alone, as elegantly shown by George Orwell in his celebrated book Animal Farm. The present reductionist science that is taught to our students makes people get a narrow, one-sided view of things. It is only the holistic view of anything that gives man the correct perspective. It is time that the Americans had a holistic view of what happened on September 11^th and the subsequent events, despite the horrors of that fateful day. Wendell Berry, an octogenarian American Eco-philosopher, had expressed similar thoughts recently.

American public, and to a lesser degree people in the "so-called" developed first world, were continually fed with the idea that their "new world order" and their "new economy" would keep on growing bringing prosperity for ever. Their leaders, politicians, corporate heads and the common investors never realized that this prosperity (or its illusion) is only limited to a microscopic minority of people in this world, and to an ever smaller number of people even inside the US! This had created a widening gulf between the haves and the have-nots in this world. This gulf is at the root of all human ills, including terrorism. The rich should now live in the ever-present threat of the poor resorting to illogical methods to get even with them. The poor, on the other hand, have to live a hand-to-mouth existence, and on many nights have to go to bed with empty stomachs.

The greatest stress in life is not to know where your next meal comes from. This is the segment of the population, which is amenable to brain washing by the vested interests in the name of religion, caste, creed, region and what have you. Converts to any new thinking are more fanatical than their masters as they try and prove that they are purer than the king is! Every country has this kind of threat from the misguided and disgruntled youth, who believe that there are only two opposites in this world, black and white. They are never aware of the Grey areas in between; in fact, the latter is the rule rather than exception. When once man realizes that there are other points of view on every problem, violence recedes. The Zen philosophers had what they called the "wu", or the "mu" concept, which is in between the two extremes. The "wu" concept would generate tranquility at the end. Our future generation must realize the importance of sharing while caring for others. It is in giving that we get. Rarely does one get true happiness in getting, but in giving one always gets that sense of satisfaction.

The misguided and the frustrated poor and illiterate make up the majority of terrorists. Of course, there are the misguided youth from the richer families also in the ranks of the latter but they are only the leaders. The vast majority of their followers come from the poor strata in society. Even the crime graph of any state or city would prove this point. Thus the free market economy has resulted in both the rich and the poor living in constant fear of one another. The wider the gulf between the rich and the poor, the worse would be the scenario. Majority of the poor in the third world countries, who do not have even remote contact with this kind of anti-social groups, pay for their poverty with their own lives, anyway.

The developed countries' economies flourished at the cost of the poor nations in the first place. Political colonization of the past gave place to the economic colonization of the present day. While the British took our people to work in their sugar cane fields in the past, the west today takes our youth to work in other areas. This make-believe world where people are fed with all kinds of distorted information about consumables through expensive advertisement gimmicks, makes the younger generation fall a prey to their tricks. Every single activity of the advanced nations has a hidden agenda. Never did they realize that one day this technological monster would try and gobble them up. Technology went unhampered and the resulting stockpiling of weapons, even the all-powerful nuclear weapons, today are their biggest headaches. The potential threat of biological warfare and, worse still, the chemical warfare, stares the very nations that invented them in their face. The whole American nation is at the throes of the anthrax threat. The wheel has come one full circle.

The advanced nations never could foresee that the weaponry and the science of war that they taught to the world would become available not only to recognized national governments but also to rogue nations, dissidents, and fanatical groups in the end. Never did they realize that technology is not only good but could be used to annihilate mankind. They also felt that their technology was so sophisticated that the less powerful would never be able to copy it and beat them at it! Now that is shown to be invulnerable to terrorism, sabotage, or even proxy war by the unscrupulous groups.

Time has come for introspection and soul searching. "National self-righteousness is as bad as personal self-righteousness". It is time that the advanced nations took a serious stock of the prevailing conditions dispassionately and tried to heal the wounds with love and compassion. Jesus rightly had asked us to forgive even our enemy. Forgiveness is the only permanent solution to this "catch 22" situation from where we find it almost impossible to get out. Hard thinking has to go into this but the rhetoric we hear from our leaders and the media does not seem to point in that direction at all. It is, therefore, time that every thinking citizen in every corner of the world has to raise his voice against this madness of "eye for an eye" philosophy. If one were to analyze the gravity of the situation, one would very quickly see that it is the poorest of the poor that suffer in the end. Afghanistan has been in the middle of this big power struggle for the last couple of decades. The tranquil people of that serene landscape have been reduced to abject poverty, illiteracy and disease. Now the only one's left behind there, other than the fighting soldiers, are the disabled children, poor war-widows and the infirm, left behind to die there. They neither have the money and means to migrate nor do they have anywhere else go either. In a way, death is more humane than living a miserable hungry existence for most of them!

War mongering, hatred, and terrorism are all social diseases needing radical surgery than the quick-fix methods of hi-tech war machinery. Health is defined as that state of mind where the person has enthusiasm to be of use to himself and society for the common good of all. This could be impaired by physical, mental, social, and spiritual infirmities. Human mind, with all the negative thoughts of hatred, greed, jealousy, ego, and pride, is at the root of all diseases, both in individuals and in society. Spiritual health is an absolute prerequisite for common wellbeing. Spirituality is simply caring and sharing and is the same for every religion. Man must transcend the narrow religious beliefs to comprehend this universal truth.

"War and peace are not mutually exclusive in the true sense, although peace is not the goal of any war; it is victory that is the aim of war". In times like this the common man should not be made to shape his opinion of the enemy given by the politicians, officials and the media. We should see the other side of the coin as well to be able to be more balanced in our attitude towards the worst of our enemies. Then, and then only, would we be able to forgive our enemy. Real dispassionate neutral media is the need of the hour to educate the common man.

To make the future generation more tolerant we need to change the present educational system. A child, born with only two instincts of self-preservation and procreation, is being converted into an epitome of all the negative thoughts to generate wars in the future by the competitive ethos of the present day information based replicative educational system with its examinations. This should be replaced by a more meaningful subjective, intuition-based, inner realization of the all-pervasive loving human soul. Humility should be the greatest virtue in education. Whereas competing with others, as is done now in our educational system, is only mediocrity that leads to hatred and jealousy, competing with oneself, true education, would bring out not only excellence but also humility in the future generations. Education should aim to teach the child the fine art of living-living and letting others live.

We can not spend and consume endlessly. This is only possible for a few in this world as has been done so far. Now is the time to live by sharing with those who are less fortunate. Every human action must be looked at from the point of view of the other man-never trying to hate the action, weep at the action or laugh at it. Understanding others gives us the power to forgive and forget. People could be self-centred, illogical and unreasonable but it takes a truly educated man to love them all the same. This message must reach the younger generation in no uncertain terms. The present idea that Americans can consume endlessly even when children are dying in Somalia without food should be forgotten forever. Sharing and caring is the essence of human existence here.

The present trouble brings us to the reality, like never before, that our educational system has to change and change very fast from that of competitive ethos to that of co-operative ethos. Education should never be an "industry" in that sense of the word. Unlike what is thought now that education's main role is to prepare youngsters for the industry, by job-training them and making them do industry based research, "education's main role should be to enable citizens to live their lives that are economically, politically, socially and culturally responsible to society." In short, education is transformation of the human being from the innocent and loving child to that of a man or a woman who knows his/her social responsibilities. Education must build character to make a student a cultured citizen. Culture is that which remains with one after all that is studied in school and college is forgotten.

Education also should teach the young to preserve our natural resources like air, water, and soil. "We should not allow public emotions and public media to caricature our imaginary enemies" wrote Wendell Berry. We should try to understand our enemy's point of view and try and see how we could help him to understand our culture and our point of view. Education should stress on local self-sufficiency. The rich should stop exploiting the poor by making them work as cheap labor and spoil their environment for the benefit of the former. Any human endeavour, including scientific research, should aim at universal benefit to mankind. In this context it may not be out of place to quote Nobel Laureate Max Bohm, when he felt really sad. His three illustrious students, all Nobel Laureates themselves, Oppenheimer (American), Enrico Fermi (Italian) and Neils Bohr (Scandinavian) were trying to split an atom. He is reported to have told a reporter at that time: "I am very proud of my pupils' cleverness; how I wish they had used a little bit of their wisdom instead. This atom that they are trying to split will teach mankind a bitter lesson one day."

What a prophetic statement! That is exactly the biggest headache right now for President Bush, who looks ten years older in the last one-month or so. If that all-powerful atom falls into the hands of the illogical terrorists it would be the beginning of the end of mankind on this planet. Let our educational system change the concept of science from that of one-upmanship to that of altruism, the economy from that of endless consumption and waste to that of saving and thrift. The former economy is, per force, "violent and eventually leads to war", but the latter is peaceable bringing peace and contentment everywhere. There is enough in this world for man's need; but not enough for man's greed. Let our educational system be based on truth and high ethics, the two casualties of the present system.

"Satyam, ….brihad ritam ugram…

…vishwan dharaayanthi…………."

Rg Veda.

(Truth and high ethics, applied sternly in life, shall make this world go on for ever)

This agenda is more important and urgent than the war of hatred that we are waging in Afghanistan at the moment which seems to lead to no where! The third world war would be the end of mankind, as it is not going to be a conventional war anyway, what with all the stockpiled deadly nuclear, germ, and chemical warfare stuff that the "so-called" superpowers have in their command. God only knows who else has some or all of them in addition! One reaps what one sows is an eternal truth. The deadly weapons that the super powers built over the years are the ones that are threatening their very existence. This is the irony of the whole affair. Indian wisdom had this kind of warning to man. It preached that hatred begets hatred but love begets love. American thinkers also had similar ideas.

"If love is what you give away,

Love is what comes back each day."

American poetess, Amy Cassidy.

Time will soon come when the world would forget the horrors of the September 11^th. It will be suicidal not to learn our much-needed lessons from this experience. Future generations would not forgive us if we did not correct ourselves and make man love man, forgetting our petty differences in the name of region, nation, religion, caste, colour, creed etc. Let us develop the God in each of us, with the help of the right kind of education.

MAN AND HIS PROBLEMS.

Prof. B. M. Hegde,

Vice Chancellor,

MAHE University,

Manipal-576 119.

Man has been evolving and living on this planet for well over 9,00,000 years in about 50,000 generations. How did we survive this long on this planet? The basic secret of our long survival is the inherent "WISDOM OF THE HUMAN BODY." This is aided and abetted by our environment, which has an important say in this business. " Contrary to popular thought natural selection usually restrains evolution, which would otherwise happen at the mutation rate, by weeding out those mutated variants which would cope less well." Even if the environments differed slightly then the present successful living organisms could have been totally different; dinosaurs would have survived and man would have been extinct instead!

Today man, mesmerized by the reductionist scientific developments, including the advances in modern medicine, is led to believe that he could control all these with his technology, modern drugs and surgical feats. In addition, recently tall claims of successes in genetic engineering and also cloning have raised human hopes to the skies. Serious audit, of course, did not give credence to this belief. Illnesses and death without any drastic change still plague man in the last several centuries. Even the claims of "epidemic rise and subsequent fall of degenerative diseases has been shown to be fallacious." The graph of cancer death has not shown a tendency to come down although we have seen some improvements in certain childhood cancers.

Modern medicine has been there with all its gadgets for the last 4-5 decades, but man survived here long before that without any of those gimmicks. "Modern medicine, for all its breathtaking advances, seems to be slightly off balance like the Tower of Pisa," was the opinion of Prince Charles, the heir to the British throne.

The one system of holistic health management that existed since the dawn of man's history is the Indian system of Ayurveda (the science of life). There are now enough evidences to say that this was the mother of all systems of medicine. A great Greek writer, E. Pococke, in his celebrated book The Temple of Greek History has given evidence that Greek civilization was originally taken from India by Indians who migrated to Greece!

The advantage of this system is that it aids and abets Nature to keep man healthy and happy, if followed properly. It caters to the body, mind, and also the soul. The latest WHO's definition of health takes into account all the three.

The shortsighted modern reductionist scientific medicine looks at diseases from a narrow point of view. The latter would be beneficial in an emergency set up; but might even harm the system in the long run. Antibiotic resistance is one such example. In the field of other advances, like genetic engineering, the omens are not that good, going by what we observe in the genetically modified plant kingdom!

Modern medicine is analogous to the fire fighting system. When the house is already on fire, with some parts of the house destroyed, the fire fighters try to quench the fire with water hoses. But in biology this kind of fire fighting results in the hose being short of the fire in many instances.

Having realized the importance of holistic healing, many have now become interested in our ancient wisdom of Ayurveda, that supplements the wisdom of the human body for survival. We in the land of its birth have been lukewarm in our approach.

May I hope the present conference gives Phillip to developments in Ayurveda, especially the research part of it to spread its goodness to the world. Research shall be refutative and not repetitive.

Good Luck and Godspeed.

MOTHERS, BABIES, AND KILLER DISEASES.

Prof. B. M. Hegde,

hegdebm@yahoo.com

“A mother is a mother still,

The holiest thing alive…..”

Coleridge

Thanks to a dedicated community nurse midwife in Hertfordshire County in England, Ethel Margaret Burnside, who despite all the drawbacks tried her best to reduce the infant mortality in the early part of the last century, before the First World War. She was known as the bicycle nurse as she did not have a car to go about. The meticulous records of every birth there, recorded in indelible ink in her best handwriting, gave new insight into the possible triggering factors of major killers like heart attacks, vessel blocks, high blood pressure, and diabetes etc. Of course, you would wonder as to what is the connection between the two! Another equally tenacious researcher, Professor David Barker of the Southampton University, who was born in that County, chanced upon those records when he went in search of his sister’s birth details. The records are the property of the archives now. They are not to be disclosed for another fifty years. Because of his sister’s birth, David could access the records.

He tried to get all the medical records of those babies, now in their 80s and 90s if alive, and also the death details of those who had already gone to meet their maker. Luckily, all this was possible in that country. Having obtained the details David then went on comparing their medical details with their birth details not knowing that he would stumble upon one of the rare discoveries. Those babies that were born underweight were the ones that had premature heart attacks, diabetes and vascular diseases as also other medical problems in later life.

David went into greater details of these smaller than normal babies only to discover that they were born with very large placentae. He was able to fish out the details of the mother’s pregnancy of these babies as well, thanks to the efforts of Ethel mentioned above. Almost all the mothers of the babies that were born small with very large placentae came from either a very poor background where they did not have proper nutrition during the first trimester of pregnancy when all the foetal organs get formed inside the womb or had a rare disease called hyper emesis gravidarum-pregnancy vomiting-resulting in the mothers not taking sufficient nutritious food. May be nature, in its wisdom, tried to keep these babies alive inside the womb of a poorly fed mother by increasing the size of the placent two to three fold to see that the baby gets much more blood to somehow keep it going.

David Barker put the pieces of the jigsaw puzzle together and came up with his hypothesis that underweight babies whose mothers were undernourished during pregnancy, especially the first trimester, did not have properly built organs like the heart, blood vessels and the pancreas which, in later life, especially if the hapless offsprings put themselves in the food-plenty environment, could result in premature vascular damage, heart diseases, as also diabetes.

Although the hypothesis was attractive, vested interests would not accept it without proof. David was lucky twice. He found out that a veterinary researcher in New Zealand was studying the same problem in ewes prospectively and had come up with the data that if the mother is deliberately kept undernourished during the time of the formation of foetal organs, the foetus would either die in utero or the surviving foetus is kept alive by nature through extra supply of blood to the growing foetus through a larger than normal placenta. This was the much needed support that David obtained for his serendipitous discovery of the Hertfordshire county retrospective data. David has helped similar study in India at the Holdsworth Memorial Hospital, Mysore, where similar records are available. This hospital was founded in the name of a Hertfordshire county nurse whose husband kept the memory of his late wife alive in a city where his wife worked as a missionary nurse.

This has a great lesson for the developing countries like India where majority of women, especially from the socially deprived classes, would have poor nutrition during pregnancy. Rich ones also might not eat well due to pregnancy vomiting or due to the new fad of thin figure as a beauty symbol. This could be one of the important contributing factors for premature diabetes, heart attacks and high blood pressure in young Indians these days. The truth is more obvious in those individuals who migrate to the western countries or to the Gulf for earning their bread. They inadvertently put themselves into a food-plenty atmosphere there. This kind of food-gene mismatch results in their becoming diabetics early in life. Deformed small blood vessels also lead to premature clogging and raise the pressure early on in life. The additional stress of present day living adds to the burden to result in premature death and disability due to heart attacks. The conventional much touted risk factors have very little to do with this newer disease profile as is very clearly shown by many studies in the west of Asian Immigrants there.

The moral of the story is that pregnant mothers need very good nutritious food all through pregnancy, but more so in the first three months of pregnancy. Our knowledge of pregnancy and child birth has advanced so much more to the point that we now know that the pre-natal consciousness is influenced by the environment in which the pregnant woman lives. A tranquil home, good relations and good work environment could bring forth a bright child. The child starts to learn right from day one inside the mother’s womb. That would be for another article at a later date. Suffice it to say that our lives depend very much on our pre-natal life in our mother’s womb. Future mothers must have this knowledge lest they should take their pregnancy nutrition very lightly. We could look forward to a world of good humans if our pregnant mothers are well cared for.

“One of the essential qualities of the clinician is interest in humanity,

for the secret of the care of the patient is in caring for the patient.”

Francis Weld Peabody 1881-1927.

POWER OF PRAYER

Prof. B. M. Hegde,

Vice Chancellor,

Manipal.

Hegdebm@yahoo.com

I was thrilled to witness a rare phenomenon happening in the holy city of Varanasi on the Mahashivaratri night. Burkha clad Muslim women were singing bhajans with their brothers and sisters owing allegiance to Lord Shiva. I had tears of joy welling up in my eyes. I still could recall my childhood in our village where people of all religions, Christians and Muslims included, joined us in celebrating, not only the religious festivals but, also, the village rituals like the buffalo race, Bhoota kola, etc. - common to this part of coastal Karnataka. We, on our part, used to share in their joy and also partake in their wonderful food on Easter, Christmas, Bakrid and Moharam days. I grew up not knowing that we have any difference whatsoever. The environment now makes me feel nauseated to say the least, but those Mahashivaratri night TV clippings were a great relief. How I wish all of us could take it forward from there.

Coincidentally, the occasion was the right one. Though the rituals were meant to pray to the all-powerful Shiva that night, the connotation was to try and open one’s third eye, representing the third eye of Lord Shiva. The third eye is the symbolic representation of one’s ability to see the reality. The two eyes, which most of us have, with or without artificial corrections using lenses, could only show us the world of delusion. Very rarely a few of us have evolved to have our third eye function to have an insight into another’s sorrow to be able to empathize with him/her. One is supposed to fast that night, sit-up and pray to Lord Shiva to grant us the power of the symbolic third eye (the insight) to be able to see the reality in this world. “Purusha Shreshta Ishwaraha.” One could elevate oneself to that level by spiritual efforts.

The reality is that mankind is but one large family and God is only the all pervading universal compassion that gives succor to every living thing on this planet. We might create our own individual Gods and there is no harm in that. We always create God in our own image. But none of our Gods would want us to be at each other's throats using HIS name. God and conventional religions should strive to bring man and man together and never try to divide man from man. All right thinking people would support this contention that religion is meant to be social shock absorber.

Religion, initially created to bring tranquility and contentment to the human mind has, unfortunately, over the years, become a powerful tool to have control over the gullible people. When one tries to understand one’s religion thoroughly, he/ she would automatically love another human being outside his own narrow religious beliefs. With this in view, one should strive to use ritualistic religion to bring people together. Every Indian, nay every one in this world, has an obligation to see that this world becomes a better place to live in - more tranquil, more passionate, more productive and less destructive in the end. Intolerance of any kind is the beginning of terrorism and crime. Tolerance needs more giving than getting.

At a more mundane level this philosophy boils down to using all our religious festivals to bring about inter-religious harmony. Whereas there were bhajans in the temples on the Mahashivaratri day joined by the Muslim women, there could be prayers in Churches during Christmas and large gathering of people in the Mosques on Muslim festival days. On each of those occasions there must be more people from the other religions in these group prayers. Scientific studies have shown that intercessory prayers have a very powerful positive effect on the life and health of human beings. If each one of us in the community prays for the welfare of the people of other religious beliefs, we would certainly have a society, which would be more creative and caring but less destructive.

Mankind has been happy in the sustenance economies of the distant past where there was no dependence of any kind coupled with egalitarian sharing and caring for others. Fear of God, greed for money, and running after the mirage of power has slowly turned man into a cruel animal. Love of God would undo this cycle for certain. Today man does not even bat an eyelid to destroy another of his species in the name of religion, caste, creed and what have you.

We must try to garner the strengths of good people in society to do most good to most people most of the time. In every village, town and city we could organise groups of motivated citizens from all religions to implement the idea that they should live together and let live. One of the cementing factors could be this type of interfaith prayer meetings mentioned earlier in the article. On the days of the important festivals in temples, people from other religions could be invited to sing bhajans and take part in the ceremonies. Similarly during Christmas, Easter time other religions segments should be there in the churches for prayers and the mass. Islamic festivities should be co-sponsored by other religious adherents and all should visit Mosques with our Muslim brothers in their neighbourhood.

Recently, when I was in Mumbai, I enjoyed the bhajans of a group of people who came from very far off coastal Karnataka. They sang and danced so well that it was a moving spectacle to watch. How I wish they had invited people of all faiths to share in their joys that day. Majority of people in this world is good but is silent. It is a vocal minority, which creates problems for others. By and large, people are so nice to one another if left to themselves. When politicians and others manipulate them with ulterior motives society gets disturbed. It is always better to debate on contentious issues like this rather than to accept or reject an idea without any debate. Let these thoughts provoke an active debate all over the country. I am sure the powers-that-be- would sit up and take note of the happenings. They could try to replicate the same in other parts of the country.

Intellectual intolerance is the worst kind of terrorism. Poverty and illiteracy will breed terrorists, in addition. Well meaning citizens should take up the cause of the less fortunate in society to try and assist them to come out of the bottomless pit of poverty. It cannot be done in bits and pieces. This must be a large movement on a large nationwide scale. Misguided youth, with lots of energy and wrong directions from the vested interests, initially try to be destructive for the heck of it. Eventually, it becomes a part of their life style. At that stage punishment need not (usually does not) have long term good effects on society. Prevention is always better.

Poverty has one other flip side to it. The poor pay for their poverty with their lives. Poverty is also the mother of all human illnesses. How do we expect these people to come to the main stream of society, unless those of us who are above the poverty line come out with a helping hand? In this process we are not doing any favour to the poor people. We are only doing our duty to society. We are helping Gods of all religions to help those in distress.

I hope this will initiate a debate wherein right thinking people join in larger numbers to try and implement the suggestions given here, if need be, with modifications and innovations in the housekeeping details. The present set up can not be allowed to go on like this and eventually lead to anarchy. Please think about it with all seriousness. Man has existed here for nearly nine hundred thousand years in fifty thousand generations. The present cruel world might have been there for a maximum of one hundred years. If not corrected soon enough, greedy man, with his proclivity for personal comfort and his greed, would rob the world and the less fortunate people of the entire God given resources. Let us wake up to stop this rot before it takes deeper roots.

EDUCATIONAL SCENARIO IN INDIA TODAY.

Professor James Tooley of the Newcastle University has been studying the educational pattern in India for some time. He has an advice for his countrymen that India could teach a thing or two to Britons about educating their people in England. He also feels that the Indian experience could be very useful for many other developing countries. This might sound preposterous when most Indians would want to believe that Indian educational system needs to borrow ideas from the West. I was sorry to read a write up by an Indian writer in The Statesman the other day, wherein the person was pontificating on the virtues of govt. schools and colleges and was very critical of private initiative in education in this country.

I did reply to the editor explaining the other side of the coin. How I wish our writers really worked hard to get to the bottom of the problem before writing about any field that is new to them. I suppose the learned journalist did not see the brighter side of higher education in the private sector. Having been in this field of higher education for four decades, I feel that empirical experience (anubhooti) teaches many housekeeping details that one can not get from any amount of reading.

Let me start with the government sponsored “Public Report on Basic Education in India” (PROBE) to understand the whole gamut of education in general. The report could be replicated about higher education without any change!

Only in 53% of schools in the villages of Madhya Pradesh, Bihar, UP and Rajasthan was there some kind of teaching going on.

Teachers were absent in one third of the schools surveyed.

Many teachers had closed their schools and were running their shops in the buildings.

In some schools teachers were dead drunk; they even expected the pupils to get them their daily share of the heavenly liquid.(Daaru)

Some teachers were asleep in the school most of the time as they were busy otherwise at other times of the day and night.

Some teachers engaged the pupils in their house hold chores.

Baby sitting in the teachers’ houses was the commonest job the students had to do in many schools.

More and more parents, therefore, were turning towards private schools even in villages and wayside slums. The PROBE team discovered that private schools, even in remote villages, were very active in teaching and getting good results for their pupils. In the private schools the teachers did not have job security and consequently, their continuation depended on their performance, watched both by the owners who wanted a fair name for their schools and the parents, who could shop around for a school with a good name anyway. That motivates the teachers to work hard and put their heart and soul into teaching. Those village schools charged very reasonable sum of 35-50 rupees per month; in the city slums the going rate was 60-100 rupees per month.

These private schools were more popular because they all taught English, in addition. In the slums around Charminar in Hyderabad alone there were as many as 500 such schools belonging to a single Federation, serving predominantly the poorer sections of society like the Rickshaw pullers, daily wage earners, vegetable sellers, fisher women, and the like. They charged very modest fee of around a thousand rupees an year. None of them depended on government subsidy! These schools also had an altruistic motive in reserving a quarter of their seats for the poorest of the poor in the locality giving them away free. Similar experiments were going on in many other developing countries like Thailand, Columbia, Tanzania, and Chile. This method could be easily replicated elsewhere. In fact, Prof. Tooley recommends many of these methods to the inner city area schools that starve for want of funds and good teachers.

This self-help idea was the one that prompted the first ever private medical college in India in Manipal by a thinking man, Late Dr. T. M. A. Pai, who wanted that the motivated students should be provided with an opportunity to pursue their interest, assisted by their parents chipping in their lot to sustain the institutions. The Manipal Academy of Higher Education, a Deemed to be University, is the result of his initial effort. Independent surveys have given us very high rating not only in India but abroad. We have students from thirty English speaking countries. We have been assessed as one of top four colleges in medical education.

Institutions do not depend for their growth on either the government or other owners. Educational institutions get their name and fame because of the men and women who struggle to keep up the highest academic standards as also the ethical values. Our founder's motto was to nurture the best of teachers. Having been in these institutions for forty years I could vouch for that truth. Universities should be proud of their faculty and not their brick and mortar or equipment as much. Our powers-that-be do not seem to realize this naked truth.

It is only in our country that private effort in education is being looked down upon and treated badly. People outside governmental control have founded some of the great institutions all over. A banker, like Dr. TMA Pai, founded the University of Edinburgh, way back in the eighteenth century. That was the time of the Scottish enlightenment when Edinburgh was considered to be the Athens of the north. Except the University of Georgia Medical School, most of the American medical institutions of repute are in the private sector. Harvard, Yale, Stanford, Johns Hopkins, Mayo Clinic, Cleveland Clinic and most of the others belong to that class. The Guy brothers, business tycoons of those days, founded the famous Guy's Hospital Medical School in London. They are not untouchables in their countries, but are venerated very much as centres of excellence and repute.

This pioneering Manipal experiment, the first of its kind in India, unfortunately has been badly replicated by many others to make it into a big "business" in higher education. These kind of unscrupulous methods are being abetted and nurtured by politicians and their goons for their own benefit. That is no reason why the original idea of Dr. T.M.A.Pai should be found fault with by our thinkers. Many of the later institutions do not have even the bare minimum necessities, not to speak of the all-important faculty. It would be shocking to know that a sizable percentage of them thrive only on visiting faculty, who rarely visit. People in authority would overlook all these so long as their machinery is well oiled and greased! Thanks to the munificence of our greedy powers-that-be, such institutions thrive better in India. It is only the honest and the meritorious that suffer in this environment.

What is the need of the hour? Many of our journalists with the holier-than-though attitude towards private efforts at higher education and many of our armchair intellectuals who live in ivory towers, having no touch with reality and without any personal experience in the field, think that education, outside the government setting, is getting commercialized in India. They feel that this is the greatest sin and should be curbed at any cost. We would be happy to host them here to have first hand knowledge of the trials and tribulations of running excellent educational institutions.

Similar arguments were put forward for "socialism” of the Russian variety in the ‘50s, despite the fact the Mahatma Gandhi had strongly advocated the cottage industry and village development as the need of the hour. Now even the champions of the mega things in development are convinced that "small is beautiful". The country is suffering from the fall out of that sin at an enormous cost to the people. Governments got involved in every aspect of the common man's life, starting from transport, electricity, water supply, food distribution, industry, health care, hotels, and what have you. None of them function properly even after half a century! It has now dawned on the politicians that they should get out of these as soon as possible. Education is another field where the government has miserably failed. Sooner they realize this the better for our future generations.

We must nurture and develop private schools and even professional colleges that keep up excellent standards of education. There should be no compromise on standards. Let us learn the lessons of the PROBE study. Let private institutions depend on their excellence for their very existence! Allow them a level playground without throttling them. Let there be an independent accreditation body of independent people of integrity that periodically publicizes the standards for students and parents to know.

Let there be survival of the fittest without any outside agency bringing in unreasonable restrictions. Let the buyer, the well-informed student, take the pick. The bad institutions would die a natural death in the process. That is the exact way how American medical education was cleaned of the unscrupulous medical schools of which there were more than two hundred in the fifties. Flexner Committee, an independent body, rated all of them. Their findings were made public by the government repeatedly in national dailies over a period of a month or so. Only seventy-two colleges survived, as the rest died a natural death for want of student aspirants to fill their seats. No amount of regulations and rules would work that effectively, since the crooked owners could twist many of the latter.

This reminds me of a lecture given by Mrs. Margaret Thatcher, the then Prime Minister of Britain, in one of the conferences on "quality control". She got up to speak and started by narrating her own experience, as the grocer's daughter, at her father's shop, when she was young. "Whenever the vegetables we sold were good the customers came back; when the vegetables were bad the vegetables came back and the customers went away to other shops! That is quality control." How true! The institutions should survive on their merit alone and not on rules and controls in the open market. That would be healthy for higher educational institutions as well. The really bad institutions will die a natural death under those conditions, as no student would want to go there.

The private institutions should be allowed to grow without the usual constraints of the “licence-raj” let loose on them both by the politicians in the government and their henchmen. The above categories do not want to loosen their grip on the private institutions. The corrupt people's bread and butter are these institutions. That is precisely why they want to have their complicated regulations and rules to have an absolute control over private effort at education. Our biggest curse is this "license-raj" system. The root of all corruption starts there. The more rules that the government puts forward, the better for the greedy in power. Every single rule is an opportunity for corruption.

This country, or for that matter, even the developed countries, would not be able to subsidize primary education, leave alone higher education, in the new millennium. The recipient should pay for higher education. If he is poor or hails from an economically backward community, the government could help him raise a loan from the Educational Development Bank to be repaid only after he gets a job and the interest thereon could be waived or reduced depending on his economic status.

Most governments would not be able to service the interest on their foreign borrowings in the next decade even with all their revenue collection. Many of them would not have the money to pay their staff! In that situation education could only be in the private sector. Our netas should not be under the delusion, that by selling the idea to the gullible public that commercialization in education is bad for the country, they feel that they could continue to use this "milch cow" to fill their coffers for elections and also to hoard money for their progeny. They seem to forget that they can not take the hoarded money with them when they go to meet their maker.

Even the famous “Unnikrishnan” judgement of the Supreme Court subscribes to this view that private education is bad in principle. I am sure with the present scenario one could go back to the Supreme Court for a revision of that judgement in the background of the wisdom from the PROBE investigations. With more evidence accumulated against the view, our adversarial system of justice might agree with the new wisdom.

As of now the private institutions face great hostility from the government. They are viewed with suspicion as thieves. While there are thieves in every field of human endeavour, there are also excellent institutions run on ethical principles. Of course, there is no free lunch anywhere. The private institutions should be allowed to get back a reasonable return on their investments and also be able to break even to sustain themselves. A logical financial assessment of the needs vis-à-vis their expenditure could be made by an independent body whose members’ credentials could be bared for public scrutiny before being appointed, but the committee should not have any kind of restrictions, either from the governments or the watchdog bodies. I am sure there are many in this country that are honest and ethical. In fact, they are in the majority, but they are a silent majority not noticed by our media and also the merit award giving bodies of the country! Let them be given at least this thankless job of overseeing private initiative in educating our masses in higher studies.

Many of our leaders in the government behave as if they belong to a higher race. I am reminded of what French President Giscard d'Estaing wrote in his memoirs in 1981. "In my country" he said, "there is the idea that those who govern belong to another race."

Earlier we change the set up and clean up the stables the better for the future generation. With more than five hundred million young men and women looking for higher education in the country in the next fifty years, we would create chaos in the near future unless we set our house in order. There is no desirable pattern of non-governmental educational efforts in higher education prescribed so far. Consequently, the unscrupulous would want to commercialize education. Unfortunately, they are the ones that get all the perks from the powers-that-be as they supply the needs of the latter. Those who want to be honest and authentic get all sorts of hurdles put on their way.

Every rule is made to be used to either make money for the rulers and their ilk or for having some control over the hapless organizations in the field of higher education. A survey of the present facilities for higher education in the existing set up would throw up worse things than what was brought out by PROBE team in primary education.

While the government set-ups have very little infrastructure, the private ones are made to achieve the impossible. I get a feeling that there must be a deep-rooted conspiracy to keep up the governmental hegemony in education for the politician and the bureaucrats to make money perpetually. This reminds me of the nice study published from the Cato Institue in Washington edited by Doug Bandow and Ian Vasquez entitled Perpetuating Poverty, wherein the authors have systematically shown how the World Bank and the International Monetary Fund have promoted poverty in the developing world for the ultimate good of the big powers, so that they could keep the former under their thumb perpetually. Writing a commentary on the book, Melvyn B. Krauss, professor of economics at the NewYork University, has this to say: "This book destroys the myth that the multilateral aid agencies are forces for good and shows they are instead a major fraud perpetuating poverty in the developing countries…………..The editors are to be congratulated for editing this precise, cold-eyed, and extremely important collection of essays that merits a wide audience."

I think our governments are in a similar setting, professing to look after the good of society at large but really working hard to keep the people poor and ignorant so that the powers-that-be could make hay when the sun shines. The election process, the selection of officers and staff in the government set up as also the educational process along with all things that matter in the common man's day-to-day existence are being kept under their control, so that they could dictate terms to the common man for all times to come.

Earlier we get the all-important higher education out of their clutches the better for mankind. Let there be a national debate on this to see how best we could achieve this goal. There will be teething troubles but they will get over sooner than we think. Change will bring difficulties in its wake, but change is the essence of life itself. Let the process of education try to get the best out of every child for the common good of man on earth.

DEVELOPMENTAL HUMANISM.

“Under democracy one party always devotes its energies to trying to prove that the other party is unfit to rule-and both commonly succeed and are right.”

H. L. Mencken (1880-1956)

In Minority Report.

Any activity on this planet must consider man as the centre point. This concept is called humanism. Humanism is a neologism. If the world has to change first man has to change basically to fit into the world. The greatest problem today seems to be the lack of humanism in every sphere, be it political, bureaucratic, judicial or, even, the media. Truth and ethics are the first casualties. All these areas can not be cleansed from above; we need to change the educational system to bring forth a new ethical generation charged with the spirit of humanism. Humanistic culture demands that man does not do anything that he does not want the world to know. Culture is that which man does when no one is observing him.

Humanism is a word that is so ambiguous that one might lose its significance if the word is not immediately properly defined. The word was coined by a German historian, Pierre de Nolhac, the author of Petrarch and Humanism, in the nineteenth century, to be precise in 1808. Petrarch also introduced the word to the French University in 1886, during the course of his lectures, Ecole des Hautes Etudes.

In the present context the word could be applied to an ethic based on human nobility. It should recognize and exalt the greatness of the human genius and the power of its creations. “What is essential remains the individual’s effort to develop in himself or herself, through strict and methodical discipline, all human faculties, so as to lose nothing of what enlarges and enhances the human being,” wrote Fernand Braudel in his celebrated book A History of Civilizations. “Reach towards the highest form of existence” said Goethe at the beginning of Part II of The Faust, “by dint of uninterrupted effort.” Man should neglect nothing that could make him/her great.

Humanism, in general, lays the foundations of “individual and collective morality; establishes law and creates an economy; it produces a political system; it nourishes art and literature.” Thus defined humanism is totally against a purely materialistic world, although materialistic growth today is inevitable for man’s existence on this planet. We can not now reverse the clock and go back to the age of sustenance economy where man must have been very happy indeed. The word developmental humanism, my own creation, gets more significance in this background. Development is inevitable with the growing population and many more mouths to feed. Until and unless the poorest of the poor get three square meals a day this world will not be tranquil. No human development is possible without the basic needs of every citizen met in any country.

With this in view we have developed an organization, Jaya Sri Krishna Environmental Friend Inc., an NGO which oversees all developmental efforts in and around our part of the world as a watch dog to see that the technological and other advances do have a human face. It is also the responsibility of this organization to keep a careful watch on the hazards of industrialization that aims purely to improve the economic conditions of the owners without due regard to the dangers the industry might bring in its wake for the health and welfare of hapless people around. When the word humanism was developed first it was noted that if only the surroundings are conducive man could develop all his faculties to the fullest. Thus, through this organization we would strive to build an entrepreneurial atmosphere that would attract industrial capital to this coastal Kanara district without harming the unique bio-diversity and ecology of this region which has one of the greatest laboratories of biodiversity in the Western Ghats.

Situated as it is between the Western Ghats on the east and the vast Arabian Sea in the west, our district could also be developed as a tourist paradise in addition to attracting environment friendly industries. It has lots of very beautiful spots that need infrastructural facilities to attract tourists. Known for its culinary specialties this district could be a heaven on earth for the western tourist who is looking for authentic tourist destinations with basic amenities at affordable costs. All these and more could be provided by us. This district has one hundred per cent literacy, lowest infant mortality from global standards, and life expectancy equal to Washington DC!

Thanks to the efforts of a few well meaning but misinformed groups agitating against industries in this area, our district has been noted as an investor unfriendly district in the world industries guide book. That has to change and the potential investors must be assured of friendly welcome provided they bring with them the most modern pollution control techniques of international standards to be implemented honestly. It shall be the responsibility of this organization to see that while the industrial capital comes in the health and future welfare of the citizens of this tranquil coastal district are preserved zealously.

Developmental humanism would facilitate industrialization of the area with special emphasis on the following important parameters.

Not more than ten per cent of the land area only should be used for industries.

Only the land that is not being used for any other purpose now would have to be selected for industry.

Industries should not be situated within ten kilometers of human dwellings.

Around every industrial zone there should be a buffer zone of greenery. The latter must be created and maintained by the industry. For every tree that the industry cuts ten trees will have to be planted and looked after by them.

Industries must be scattered in such a way that at a future date they should not be cause of unnecessary traffic congestion making life miserable for people on the roads.

We have the best communication facilities here-an air port that could be expanded to let international charter flights to land directly bringing in tourists, a large harbour for import and export industrial use, rail connection to all parts of the country and good roads for road transport.

This district is the mother of five large nationalized banks in India and many other financial and insurance industries even as early as the beginning of last century.

It has some of the finest educational institutions led by the MAHE deemed University known all over the world for its excellent standards.

People are friendly, authentic and intelligent. They need to be convinced of the need for proper growth of the area.

Agriculture had been our main breadwinner, but has been almost forgotten lately. Reasons are protean but, the future economy should be based on scientific and environment friendly industrialization.

Fishing has been our cottage industry and the land between the National Highway 17 and the sea should be exclusively reserved for fishing related activities and no other industry should come there.

We probably have the best medical care facilities in this district of world class. This could be developed to be another industry attracting patients from the richer countries offering them the same class of services at a very low cost compared to their own countries.

With infrastructural facilities developed we could be one of the important airports for transit stop for the future long range aircrafts flying from the west coast of USA to the east coast of Australia or to New Zealand.

We have to take our people along with us in all our endeavours. Regular information dissemination is another area of the activities of this organization. Information is disseminated through talks by experts and through writings in the media both print and electronic. To this end we have already formed a highly specialized group of six men-a bio-diversity expert, a scientific environmentalist, a civil engineer who has specialized in industrial problems, an expert in water and sanitation management, a pathologist that understands diseases well, and an economist to help with the monetary aspects. Every new industry will have to be rigorously screened by this group. The group will only have moral authority but no legal authority. We strongly believe that anything that is ethical and moral has got to be legally correct but the converse might not be always true. Anything that is legally correct need not be ethically sound. This organization, therefore, derives its powers from the people of this district who could easily separate the wheat from the chaff, based on its authenticity.

This organization was originally conceived and built by a devoted son-of-the-soil, Tonse Jayakrishna Shetty, who has made it big in Bombay but, it has now become a popular mass movement. This district as of now depends solely on its money order economy: money orders coming from Bombay and the Gulf. This might dry up any time soon. Before it is too late we have to wake up to the reality and do something without waiting for any outside agency to help us, be it the government or otherwise. The functioning of this organization is an open book for anyone to audit. We also believe in the Gandhian principle that this organization should not have any capital fund. Gandhiji felt that, and rightly so, that any sincere organization doing good to society will have to be maintained by the society itself. We hope and pray that this is true in our case also. Our vision is to make this the pilot project for the whole nation, while our mission is to do most good to most people most of the time.

EXAMINATIONS IN SCHOOL AND HUMAN HEALTH.

I was thrilled to read the recent report that examinations and ranks are, to be abolished up to the age of fifteen years of a child's life, beginning from 2002. I have written and have struggled to impress upon the powers-that-be of the grave threat to human health and, even human behaviour resulting from examinations of the type that we have inherited from the British.

One would certainly wonder about the connection between examinations in schools and human health. Many are the believers that examinations should be good for health. Nothing could be farther from truth. First and foremost examinations fill one with fear, anxiety, uncertainty, dejection after failure, depression, and pride after getting a good rank. These negative feelings are the ones that are now recorded even in the modern western system of medicine as the pal bearers of deaths due to the great killers like cancer, heart attacks and what have you. Unfortunately, there is no place for the essence of education, humility, a health tonic, in this whole process.

Education should aim at transforming a human child, born with only two innate instincts of self-preservation and procreation, into a social animal with altruism and enthusiasm. It should encourage the child to explore all the avenues of human endeavour to bring out its best. Education should be the manifestation of the best already embedded in man. Unfortunately, the present examination system does just the reverse. The system tries to make him memorize a lot of information which, many a time, does not have much relevance to real life situations and, in the bargain, curbs the child's curiosity and creativity. Examinations have become the be all and end all of the whole system.

Textbooks are written with the sole motto of giving spoon feeding to students to pass their examinations; one wonders how popular such books are among the students. There are now publishers vying with one another to publish only such books. I wonder what would happen to mankind after a few years with no creativity left in any of the end products of the present system of education. We seem to have forgotten wisdom in the midst of knowledge and even the knowledge is only accumulation of information. In short, education has become synonymous with collection of information!

Be that as it may, our concern in this article is about human health and the system of examinations. I shall try and explain the sequence of events in lay man's language so that the reader could grasp the seriousness even if one is not medically trained. One could easily understand that every examination, right from the kindergarten days, is a very stressful situation, not only for the hapless child but also for the grown up parents. The latter are most anxious that the child should do well to get a rank to climb up the "educational" ladder. Parents, probably, spend sleepless nights when the child is small and later both the student and the parents spend sleepless nights burning their midnight oil.

What happens when one gets too much anxiety on a chronic basis? Man has been endowed by nature with a very friendly system, the autonomic nervous system, that comes to his help in any emergency to keep him out of danger as long as possible. This evolved mainly during man's existence as a forest dweller where the main cause of death, other than old age, was predation. If one is injured by a wild animal this system, predominantly the sympathetic part of the autonomic system, tries to keep him alive temporarily till such time that either he gets outside help or could recover on his own. For reasons that are not very clear nature intended this system to work only on a short-term basis. On long term stimulation this very friendly system itself could be man's enemy numero uno and eventually could even kill him! In short, the sympathetic system could blow hot and cold from the same mouth.

In the normal course the sympathetic system looks after man in any emergency viz.: fight, flight or freight. To give an example when one sees any danger coming on the sympathetic system gets stimulated and gets a chemical messenger secreted by the adrenal gland (adrenaline) which raises the blood pressure, races the heart enhancing its force of contraction, in addition, to increase blood output. If one has to run for life in that situation the chemical thus secreted would be digested in the skeletal muscles used for running and gets burnt out. On the contrary, when one gets frightened of an examination, the same chemical comes pouring out into our blood but can not be burnt out in the working muscles. The resulting accumulation of this chemical in the long run tries to destroy almost every system of the body.

Children and their parents develop cold hands and feet even when they think of an examination. They get palpitations in the chest and sweaty palms and soles. Their mouth dries just before an oral examination and the hair, at times, stands erect. All these signal the stimulation of the sympathetic system. If one observes them breathing one could see the fast, laboured breathing. While these external signs are alarming in themselves what happens inside is still more worrying.

The adrenaline and its other cousins stimulate the heart and also redistribute the circulation to overcome physical danger. (there is no physical danger here) The damage, therefore, on all the above mentioned sites, when repeated over long periods of time could be permanent. In addition, the blood vessel constriction raises the blood pressure, which, of course, comes down temporarily, but we still do not know the link between this transitory rise and raised blood pressure in later life. Similarly to give man extra energy to run in the face of danger, adrenaline is made to release stored sugar from the liver glycogen stores, raising the blood sugar transiently. Again the relation between this and later onset of diabetes is another moot point. Lastly as the elevated sugar gets burnt in the muscles, it lowers the blood potassium level which could be potentially dangerous.

Similar changes occur in the steroid hormone secretions and many other parts of the body. In short every attack of anxiety is an invitation for certain body parts to suffer irreparable damage. Repeated attacks of anxiety could lead to illnesses of all kinds. In addition the anger, frustration, depression, and hatred that the examination system produces in many students and their parents are now thought to be at the root of all killer diseases.

With all these risks what does the examination system measure in a student? It does not measure his aptitude, his creativity, his level of maturity, his comprehending capacity, his skill in managing real life problems, his humility that is the essence of a cultured man's life in society, his insight into another's problem, and his suitability for any vocation. Examinations simply check the students' memory power and his capacity to replicate textbook information onto the answer books. The earlier the system changes the better not only for students and teachers but also for the parents.

In this narration we did not go into the area of corruption in the system. We never teach our students the motto that it is "better to fail than to cheat". Since success is measured by passing the examinations we are condemned to live with all sorts of corrupt practices in every examination from the school to the highest level. This results many times in chronic guilt feeling in the culprit adding to his misery. Thank God many of us do not have a conscience to feel the guilt anyway. That is why many of us are externally happy about our achievements. I am reminded of what Winston Churchill once said, " it is better to deserve than to get." The other fall out of this system of corruption is that the "poor" students who can not pay in those situations get punished. Corruption, like in any other field, is a double-edged weapon.

I am sure even the lay reader who does not understand the intricacies of the working of this wonderful machine, the human body, could gauge the gravity of the situation. There are many other minor ways in which human health could be damaged by the examination system in schools. Competition is one such. Competition breeds mediocrity as it compares one with the other, while competing with oneself brings out the best in the person, excellence. The latter could only be achieved by every one of us who understands that the only way we could bring out the best in us to be in competition with us daily. In the latter competition there is no hatred involved, but the comparative merit that the examination tries to bring out begets hatred, another enemy of man.

This kind of competition taught early in life remains with man wherever he goes. This hatred becomes a part of man's life and he hates everyone in this world. The latter is the reason for all ills of society. Crime, suicides, divorces, underworld activity, mal-practices, unethical business practices, and all the societal vices could be traced to this early bad blood in school. If only we could teach our young impressionable minds the need for co-operation we would have had a heaven on earth.

Earlier this devil of an examination, in the present form, is terminated, at least up to the age of fifteen, the better for mankind. Assessment in education should be continuous and should also be teacher evaluation coupled with peer evaluation. Creativity, humility and insight into other's problems should be the key words in assessment. Education then would realize its goal as enunciated by Adam Smith in 1644, as that activity which prepares a man "to act justly, skillfully, and magnanimously under all circumstances of peace and war." It would also bring out the best in man that is already in him.

HEALTH CARE Vs MEDICAL CARE.

"The difference between the right word and the almost right word in a place is like the difference between lightning and the lightning bug."

Mark Twain.

Health care is a word mostly misunderstood and used in place of palliative medical care. The two are poles apart. It is very important, both for the lay man and the administrators, to make a clear distinction between the two, lest there should be mal-administration of health strategies in society.

Health is a state of holistic wellbeing of man, enabling him to be enthusiastic to be creative in society for his own good as well as for the good of others; the latter more important than the former in the social context. On the contrary, palliative medical care is trying to fix the broken pieces of a healthy man into a whole again. There is further confusion here in that it is sometimes called curative medical care, in place of palliative care. Cure, we rarely, if ever!

If one follows the holistic classification of diseases the following classification, suggested by me, would be more practical.

Emergency Medicine (10% of the sick population)

Minor illness syndromes (around 30%)

Doctor-thinks-you-have-a disease (10%)

Patient-thinks-he-has- a disease (10%)

Chronic illness syndromes. (remaining 25-30%)

Drug or Doctor Induced (iatrogenic) diseases (10-15%)

In this scenario only the first ten per cent of the sick population does need modern hi-tech medical and surgical care. Rest of them could make do with conventional traditional systems of medicine coupled with change in the life style. Modern medicine becomes prohibitively expensive when used for all the one hundred percent of the sick population; it could strain the budget of even the richest nation. America is feeling the pinch. Whereas more than sixty percent of the upper middle class Americans can not afford good health insurance cover as the premia are sky high, thanks to the charges of the star-performers!

The National Health Service of the UK is broke and the story repeats everywhere, but if one were to follow the dictum mentioned above one could have equitable medical care for the really needy. While the American hospitals have been reducing their beds, the new idea of HMOs to replace hospital expenses have been declaring chapter eleven one by one.

Action plan for India for the next century:

It is true that the population growth in our country is still not arrested while in many western countries it is either decreasing or is, at least, not increasing. They envisage a large chunk of their population in the next millennium to be in the above sixty category (70% of the population). Naturally, they could expect to see degenerative diseases go up exponentially there. That would be their real problem. Our scenario would be totally different.

More than sixty per cent of our population in the next millennium would be in the second decade. We would have totally different type of problems of adolescence viz.: AIDS, drug addictions, infective diseases, nutritional disorders, violence, tobacco and alcohol related diseases, and road accident deaths in place of their load of degenerative diseases.

Modern medical wisdom comes in handy here for us to avoid any future threat of degenerative diseases should they show up when our present generation of children grow to the sixth and seventh decades in the third world. Most, if not all, degenerative diseases get born in the mother’s womb in the first trimester of her pregnancy. It is there that the foetus forms its heart, blood vessels and pancreas, to name a few. These structures, if not formed well, could encourage the onset of heart diseases, high blood pressure, diabetes and other vascular accidents in adult life! It is known now that mother’s nutrition in the first trimester of pregnancy is of vital importance to avoid this menace.

The next period in life when these diseases get their encouragement is childhood and adolescence when bad food habits, alcohol and tobacco could further ensure the progress of degenerative diseases in later life.

Action Plan:

21) The comprehensive village development plan should include water supply, toilets, education about common foods available in the village, and also some methods to uplift the economic condition of the villagers. Smokeless choolas should be supplied to all houses.

22) Pregnant mothers should get special attention regarding their diet, more so in the first trimester. Proper nutritional advice should avoid undernourishment during that crucial period in the life of the foetus.

23) Compulsory breast feeding education to be given to all mothers. In case the breast milk is inadequate other human milk, if available, is good enough but not cow’s milk! Instead the baby could be given fruit juices and cereals in an easily digestible form. This could avoid many other diseases in later life, like the autoimmune diseases.

24) Effective education, to keep tobacco and alcohol at bay, aimed at the adolescents using different methods suitable to different set-ups, should be started.

25) Our primary education should change in such a way that it inculcates the essence of Indian education of the yore-humility. Humility begets better life habits. Anger, pride, jealousy, hatred, and ego get suppressed to give place to love, compassion, and camaraderie. The former are now known to be important risk factors for major degenerative diseases.

26) Proper health education of children in school about the dangers of alcohol, tobacco, and also sexually transmitted diseases will go a long way in reducing the future problems of drug addiction and AIDS, which are going to be our big problems in the next millennium.

27) Better roads and stricter licensing procedures should decrease road accident deaths. Coupled with a war on alcohol this should yield better results. The only truly avoidable deaths are accidental deaths. Punishment for careless driving should be more stringent to persuade rich kids from rash driving in larger cities.

28) Family planning should be pursued on war footing. In the villages, where the bulk of India lives, men are at fault. The best way to educate the men in the village is to catch the village barber. The latter is an incessant talker and also has a lot of influence on all the men in the village. If we could properly educate the barbers and then give them an incentive, that could work wonders in addition to the conventional methods followed.

29) Screening whole populations for high blood pressure, heart disease and diabetes to get them under the net of doctors, drug companies, and instrument manufacturers to fix the defect would look good on paper. It can work in the laboratory, but it does not work in the population, and it is definitely not cost effective.

30) In addition, screening apparently healthy populations could even be counter-productive. “It could seriously damage the health of the population”. Past experience has shown that screening increases sick absenteeism in society making more people sick! It also increases false positives.

31) Screening a population of one billion is not feasible. Screening only the urban elite is also not going to help. This would certainly net more people into the system for treatment and also get more hapless victims for intervention in the present top heavy hi-tech medical field, but would not change the scenario as far as the imaginary threat of the degenerative disease epidemics, as predicted. Predicting the future is impossible. “We have been predicting the unpredictable”.

32) Reliable studies even in the West have shown that the so-called epidemic rise of certain degenerative diseases and their subsequent fall has been spurious and flawed heavily.

33) Life style modifications have been palpably more effective in containing these diseases even in the West. While the effect of life style modifications has been 59.4% effective in reducing the incidence of coronary artery disease, interventional methods have only been effective to the tune of 3.4%. The story is not different in the field of drug therapy, either. The famous MRC study of mild to moderate hypertension treatment, which has 85,000 patient years of experience, clearly showed that to save one life from stroke we have treat 850 apparently healthy people in society with anti-hypertensive drugs unnecessarily.

34) These speak volumes about the very effective role of life style modifications in altering the future incidence of degenerative diseases.

35) Coupled with the prohibitive cost of population screenings and their attendant dangers to human health it makes lot of sense for third world countries to concentrate all their efforts in modifying the life style of their populace to contain these dreaded diseases even if they were expected in the next millennium.

36) Here the role of tobacco and alcohol has to be stressed. We have to fight the powers-that-be that try and push these two evils on society with all our might.

37) Another area is the field of diet for our adolescents. Indian vegetarian diet has a lot to recommend it to them in place of the modern junk non-vegetarian food, which seems to be invading the world of the young in a big way. Nutrition based education should start in the elementary school itself.

38) Need to have physical exercise is the next area to be stressed. This could be done in many ways aimed at the younger generation.

39) The need to keep the human mind filled with universal love to avoid hostility and depression-the two most important risk factors for heart and vessel diseases in addition to cancer –has to be stressed right from day one in school.

40) Economic empowerment of our masses is of vital importance to avoid future epidemics of vascular degenerative diseases.

The need of the hour is the courage to implement these right away and keep the pressures on population screening and mass drugging only to the symptomatic in society, thus bringing down the cost of curative medicine to affordable limits.

Would someone listen please?

I’m sick of gruel, and the dietetics,

I’m sick of pills, and sicker emetics,

I’m sick of pulses, tardiness or quickness,

I’m sick of blood, its thinness and thickness,-

In short, within a word, I’m sick of sickness!

Thomas Hood, `Fragment’, c. 1844.

HEALTH CARE IN INDIA.

MANJU HEGDE

India is more than a country. It is a vast continent with diverse ethnic, religious, and social classes of people living in harmony. They could show to the world the principle of unity in diversity. The bane of Indian people is the poverty level in the rural masses that still dogs the country. While there are the large number of people who are filthy rich in India, some of them making it even to the Forbes Fortune list, the majority does not know where the next meal comes from. Poverty is the womb of all diseases. Diseases originate in the human mind. The greatest stress for man is not knowing where his next meal comes from; the next most important cause is intense fear. The gulf between the haves and the have-nots is widening by the day in every part of this universe. In America this is the main cause for the newer epidemics of heart attacks, cancer and suicide. Whereas the poor, even in the rich countries, do not know where their next meal comes from and suffer from killer diseases, the rich, on the contrary, live in intense fear of the poor. It is the poor who form the bulk of terrorists, muggers, car-jackers, murderers, robbers and what have you. No one could go out of the house, in large cities like NewYork, with the certainty that he/she would return home safely at the end of the day! The rich, therefore, suffer from degenerative diseases basically because of the intense fear and frustration. Recent studies in the US have shown how important the mind is in the genesis of heart attacks and cancer.¹ (Social support, hostility and other psychosocial conditions in coronary heart disease, editorial, Cardiovascular Review and Research June 2001 issue pages 332-334)

Independent India:

When the British left India in 1947 without any blood shed, they left behind abject poverty in the country, having looted it for well over two hundred years. Resurgent India inherited this very low-income group of the masses of people whose life expectancy at that time was just about 27 years. It is heartening to note that it is nearing 70 years today. The country has progressed very well. The foreign exchange reserve has crossed the all time high and today stands at $ 80 billion. India is the first country to have prepaid a large part of the loan and has now declared that it does not want loans from any nation. India has already come forward to give loans to small countries. But the gulf between the rich and the poor has widened, leaving behind large parts of the country still in poverty. The overall picture looks good in that the sanitation and the food position have improved dramatically. This is the main reason for the life expectancy to go up. Common belief is that doctors, hi-tech hospitals and, the modern drugs are the cause of health improvement. This reminds one of Oscar Wilde who said, “lies are the truth of other people.” This myth that modern hi-tech medicine is the cause of health improvement of the common man is the biggest lie that the drug and the technology lobbies want the public to believe, as this myth keeps their till moving. One would be shocked to know that American medical education, which most parts of the world emulate, is run mainly by the money from the drug companies!² ( Drug Company Influence on medical education in the USA. editorial The Lancet, London 2000; 356: 781)

Be that as it may, health does improve only with basic amenities being given to people, but India still needs to go a long way, very long way indeed, to make its masses healthy. Even today 70% of the children have less than 50% hemoglobin because of rampant hookworm infestations in the rural areas. Malnutrition and diarrhoeal diseases take a very heavy toll of human lives, basically because of lack of clean water supply to villages. A recent UNIDO report noted that the developing world would have to concentrate on four fundamental aspects to improve the health levels of their masses:

Clean drinking water for all.

Three square meals a day uncontaminated by human and/or animal excreta.

Avoiding cooking smoke from coming into the house. This kills children below the age of five of pneumonias and women of lung cancers and heart attacks.

Economic empowerment of women in the village to be able to feed the hungry kids when the husband comes home drunk having spent all the money for alcohol. For any mother the greatest health risk is seeing her own kids go to bed on empty stomachs.

Poverty does kill people even in developed countries. A recent report in Ireland showed that in one year nearly 6000 people died basically because of poverty in that country.³ (Vivien Kilfeather, Institute of Public Health Report 2002) Poverty in the middle of plenty!

Present Scenario in India:

The present state of affairs, vis-a vis medical care delivery in India, could be compared to any developed country in the world. However, that does not mean that the health of the Indian masses has kept pace with the developments in the curative modern medical field. The hi-tech medical facilities in India are as good, if not better than, many of the advanced western countries. Increasing the number of doctors per population and increasing the number of hospitals has nothing to do with either life expectancy or mortality. Across the industrial world the numbers prove my point. United Kingdom has only 160 doctors for 100,000 population. Italy, on the contrary, has thrice that number (thrice as expensive also) but the life expectancy is almost the same, slightly better in the UK. This is no fluke. Ireland and Japan have around 200 doctors per 100,000 population compared to Belgium and Switzerland where there are 400 and 320 respectively. Life expectancies are the same all the same in all those four countries.⁴ (Andrew Oswald. Times, London April 25^th, 2002)

Hi-Tech Five Star Hospitals:

We have more hospitals of the hi-tech variety in India than many other developed countries in the world. Every metropolitan city in India has more hospitals than hotels. Most of them over do things so much that most of them could easily be closed without detriment to human health in general! This is the situation in many countries. Recently, a large hospital’s cardiovascular surgical facility was forced to close down as the two doctors there were doing more than 50% coronary bypass surgeries on normal people to make money. One of the shareholders of this hospital made a profit of $ 67 million last year! This is the Tenet Hospital in Redding, Northern California. If that were so in the US one shudders to think of the problems in a country like India.

The modern medical facilities in India are of such good quality that the National Health Service of the UK is negotiating with many corporate hospitals in India to get their patients on the long waiting lists to be flown to India for elective surgeries. Many private hospitals are already in this business. Modern medicine has become a business these days and doctors are easily brainwashed by the drug and technology lobbies to do what they want them to do.⁵ (Is academic medicine for sale? Kaiserer A. New England Journal of Medicine 2000; 342: 1516-1518) When doctors went on strike in Israel recently death rate came down significantly.⁶( Siegel-Itzkovich J. Doctors’ strike in Israel may be good for health. British Medical Journal 2000; 320: 1561 page) Similar experience was there in Israel in 1983, Los Ageles County about ten years ago and, Saskatchewan in Canada fifteen years ago. Lately drug companies have been creating new diseases to sell their drugs. Female impotence is one such disease produced with the help of specialists by the Drug Company to sell viagra tablets!⁷ ( Moynihan R et.al. Selling Diseases. BMJ 2002; 324: 886-91)

Now it would become clear to anyone that modern hi-tech medicine is not a panacea for human ills. However, modern medicine is definitely a boon to the suffering humanity as it could “cure rarely, comfort mostly, but console always,” in the words of the father of medicine, Hippocrates. The problem with the present modern medicine is that it claims to do good to healthy people by changing their body parameters, even when they are healthy. This is labeled as doctor-thinks-you-have a disease syndrome. This is the bane of modern medicine. Time evolution in the human body does not follow linear rules. Changing the initial state partially with drugs or surgery, in healthy people, might not hold good as time evolves.

In the long run all interventions in healthy people results in higher deaths and disability. This is the reason for the fall in death rate when doctors do not interfere with healthy peoples’ lives. The medical profession, along with the drug lobby, has turned even an advanced nation like the USA into a nation of hypochondriacs! This is just to make big money.⁶ (Kelvin A Benarde - You’ve Been Had! Book, Published by Rutgers University Press 2003.) The screening industry is another big fraud on the public. Doctors have been predicting the unpredictable all these years making everyone anxious.

The problems lie in medicine’s difficulty in defining the normality, the devil of false positives and their poor understanding of time evolution and natural history of diseases. “Simple minded enthusiasm for screening-combined with industrial opportunity to make fat profits-may mean that soon none of us will be normal. We will be screened for every kind of cancer…..It is always hard to put a case for not knowing, but economists-cold hearted beasts that they are-have a wonderful notion of rational ignorance” writes Dr. Richard Smith, the editor of the British Medical Journal in his editorial in the journal of April 26^th 2003. (BMJ 2003; 326: 893) Ignorance can be bliss.

India, thus, does not lag behind the world community in this rat race for the latest in technology, but all that is for the rich and the powerful. This brings to mind the Mathew Law in the Bible, of course with the wrong connotation. “He who hath shall be given.” The poor in India are that way happy in that the ravages of this kind of modern medicine do not touch them. More than 80% of Indians (80% of world population also) lives without any influence from modern medicine. So far so good. There is another side of the coin that must be made known in this context. In India we have a mix of the good, bad and the ugly even in the field of human health. Whereas the life expectancy of a new born child in the southern state of Kerala and, in my own district of South Kanara, is as good as that of a child in Europe today, the picture in north Indian states like Bihar and eastern Uttar Pradesh, the life expectancy is at the level of Sub Saharan Africa. This shows the distribution of literacy levels as also the poverty standards.

Despite all these the health expectancy of an average Indian is very high compared to the advanced west. Health expectancy is the number of years a newborn baby could expect to live well without the help of doctors and medicines. Many of our able bodied villagers would not have seen doctors all their lives and some of them, the ratio might be the same elsewhere, are centenarians! Medical facilities also are distributed without consideration for the need in society. The highest incidence of diseases are seen in the poor population of the villages while the large number of specialists and sub specialists are seen in large cities. This kind of disparity exists even in the west. A thinking senior doctor of Wales, Tudor Edward Hart, calls this the inverse care law.

While there were only sixty odd medical colleges and as many large teaching hospitals in India around 1947, we have hundreds of medical colleges and as many private corporate hi-tech hospitals in larger cities. Unless and until the economic prosperity reaches the poor in the villages and they are literate the health disparity would continue. India could still show case itself as the most advanced medical center in the world. Even Pakistani children come to India for heart surgery. The media blows up these simple events into large events. The truth again is otherwise. While the third world countries still have a large burden of valve heart disease in children due to lack of sanitation and warm dry homes for children, we make a fuss about a rare congenital heart child being treated for a small hole in the heart. No one bothers to treat valve disease, as the victims are very poor children. A study in the USA in the last decade did show how even in that country the improvement in health standards and deaths were predominantly due to the change in life style and affluence (59.4%) while the role of modern hi-tech medicine was miniscule (3.4). The latter, however, gets the limelight and media claptrap. Story is the same in India.

HEALTH PROMOTION

Prof. B. M. Hegde,

hegdebm@yahoo.com

“For the master spirit of the earth shall not sleep peacefully upon the wind till the needs of the least of you are satisfied.”

Kahlil Gibran

We seem to have a distorted view of health care in India. We have the health ministries that mainly look after ill health. We abuse the term health care when we, in fact, are talking about medical interventions. This brings to mind the old saying of Mark Twain: “The difference between the right word and the almost right word in a given place is the difference between lightning and the lightning bug!”

Neither doctors nor hospitals are needed for health promotion. They are both essential for looking after people who have, unfortunately, lost their health resulting in disease. Diseases are accidents and at any given day there could be a couple of million who are ill, but daily there are more than a thousand million Indians who need health care. If the latter is done correctly we could bring down the illness rates to negligible levels.

In fact, eighty per cent of the gut diseases would vanish and thousands of deaths averted if every Indian gets clean drinking water. If one gets three square balanced meals a day not contaminated by human and/or animal excreta another few thousands would not meet their maker prematurely. Smokeless houses in the villages would save thousands of women from dying of heart attacks and cancer of the lungs. An equal number of children, below the age of five, die of smoke related pneumonias. Seventy per cent of Indian children today have less than fifty per cent haemoglobin in blood mainly because of hookworms that are ubiquitous due to lack of toilet facilities for the poor. This would result in the younger generation not being able to compete in sports as also in intellectual pursuits. Recent data shows how the early development of that part of the brain looking after memory function etc., the hippocampus, needs good iron supply for its proper growth in the mother and the new born. Iron deficiency is the main cause of slow brain development and many other long term health problems.

We get worked up and go mad if there is an epidemic like SARS. Millions suffer and thousands die daily in this world for want of clean water and good food and no one bothers about that. We need some scare to wake up from our slumber and then go to sleep again only to awaken at the next pandemic. Daily deaths do not count at all. SARS did not even kill a single Indian. We seem to have some kind of racial immunity against that virus. But the epidemiologists produced a very big scare and many would have suffered stress related illnesses because of the scare. Instead of scaring the public and lowering their immune levels making them succumb to infections, the epidemiologists should work silently to quell the threat when there is a real one. We could save millions of Indians if we could look after the following in all our villages where nearly eighty per cent of Indians live.

Clean drinking water to every one.

Clean food as three meals a day.

Smoke free house.

Toilet for every house.

Economic empowerment of women.

Educate the village barber to put peer pressure on all men to practise family welfare schemes.

Every village school must be the primary health centre for the village; the present PHCs could be dispensed with and replaced by village health workers that report any illness to the Taluka hospitals from where ambulances could be dispatched to transport patients when needed.

One doctor, the same doctor, should visit every school once a week and look after the health status of the children and do the needful. Children will, in turn, educate their parents.

Health education should be a compulsory subject in the age group of 5-15 years.

Pregnant mothers should get special attention and more nutritious food especially during the first trimester to prevent major killer diseases in the adult population in later life as all the organs are properly made during the 12-16^th weeks of gestation inside the mother’s womb. If the mother’s nutrition is poor the organs are defective. These are the children that get major killer diseases precociously in later life.

Having done all these, vaccination to prevent communicable diseases will work well. Vaccination will not be effective in children with very low blood protein levels.

As has already been pointed out above doctors and hospitals do not promote people’s health; in fact, a recent study showed that a surfeit of hospitals of the hi-tech variety and increase in the number of interventionalists would result in higher than expected deaths in society. An audit of European countries and Japan showed that those countries with the higher number of doctors per unit population compared to countries with less number of doctors had lower health status and higher morbidity. When doctors went on strike in Israel and no intervention on the apparently healthy was carried out death rates plummeted down only to go back to the original levels when doctors resumed full duty.

I have been writing about this for the last four decades but it seems to fall on deaf years and the powers-that-be seem to have selective blindness for this kind of information. “Truth influences but half a score of men in a century while false hood and mystery will drag millions by the nose”. This saying of Aristotle is true even today.

India needs a very strong health promotion set up, may be, headed by a health promotion powerful ministry that has jurisdiction over food supply, water supply as also other infrastructural needs of the people. Large part of the present “so called” health budget could be shifted from hospitals to health care. We need a full department of health promotion. Medical schools should teach health of the public (Public Health) to students for all the five years as a doctor is trained to look after the health of the public in the first place. Unfortunately, today we teach medical students advanced diseases in a five-star technology oriented set up and make them believe that the be all and end all of health care is hi-tech intervention. Students must have their training in the community as also in the villages to learn the real time medicine.

Medical Care:

This needs hospitals, but the future hospitals must incorporate complementary systems, mainly Ayurveda to widen the net to help more patients and also save billions of rupees spent on some of the useless hi-tech stuff offered today. Majority of illnesses (80%) are but simple minor illness syndromes and they could be helped by complementary medicines and some of the chronic illness get better with Ayurveda with much less cost and less discomfort to patients.

Wellness Clinics:

Life style changes, healthy diet advice, yoga and meditation, life style modification advice, alcoholism and smoking advice, could all be done in the new concept of the wellness clinics where healthy people regularly attend, not to get themselves checked up but to get themselves trained in the above methods that would keep diseases at bay for very long time even one were eventually get an illness later on. In the latter event the wellness clinic experience would hasten healing.

These two new concepts must be a part of all Indian hospitals sooner than later for the common good.

INTEGRATED THERAPY APPROACH

e advent of modern hi-tech medicine, the rich in the world are made to believe that one can not exist without the help of hi-tech modern medicine. The truth is otherwise. Man has been here on this planet, for well over 9,00,000 years in 50,000 generations. Hi-tech modern medicine has been there for less than half a century. If human existence on this planet were to depend solely on modern medicine, mankind would have been extinct, like the dinosaurs, long, long ago! Modern medicine has become top heavy and prohibitively expensive. More than 80% of the world's population does not have any touch with modern medicine at all. Prince Charles, the heir to the British throne, once said: " modern medicine, for all its breathtaking advances, is slightly off balance, like the Tower of Pisa." How true!

Classification of Diseases:

From the utilitarian point of view diseases that man is heir to could be classified under the following heads:

Acute emergency problems

Minor illnesses syndromes

Chronic, incurable, degenerative diseases

“Doctor-thinks-you-have” diseases

"Patient-thinks-he-has" diseases, and

Doctors and/or drug induced diseases (Iatrogenic)

The above classification would give a very comprehensive scenario of medical care delivery in the world today. While it is true that modern hi-tech quick-fix methods are palpably effective in almost all emergency situations to mend the damaged human organs and or their functions, rest of the five classes of diseases need not (usually don’t) rely on modern hi-tech for relief. In fact, many a time, modern medical methods applied to these diseases might even make matters worse, not to speak of the prohibitively expensive cost of the treatment and investigative methods. It is worthy to note that only about 10% of the times when man and medicine come together, do these quick-fix methods work. In other words, 90% of the doctor-patient contacts happen in the non-emergency set up.

Many a time the apparently healthy people in society are being labeled as having elevated blood sugar, abnormal fat profile, and/or having borderline high blood pressure etc. Many short-term interventional studies with drugs for these “doctor-thinks-you-have” diseases have shown benefit. However, long term studies in all the above three categories of apparently healthy individuals, have unequivocally shown no significant difference in their long-term outcome. There are instances where interventions have even harmed patients.

This is understandable. With the present knowledge of time evolution in a dynamic system, like the human body, it is almost impossible to predict the future evolution of an apparently healthy human being, based on one or two physical characters like altered sugar, cholesterol etc. Time evolution depends only on the total initial knowledge of the human being. Changing any of the parameters at the initial stage might not (usually does not) hold good as time evolves. To correctly predict the future of a human being, doctors should be able to know the total picture of his body, a peep into his mind, as also the total picture of his genes. This is impossible at this point in time, and consequently, routine check-up of healthy population and labeling them based on a few characteristics has led to more misery in the long run.

This has provoked the British Medical Journal to write an editorial: “Routine screening might seriously endanger your life” Similarly, blood vessel blockages, as seen in coronary arteries, brain arteries, and peripheral arteries are now used as the excuse for interventions by means of either bypass surgery or angioplasties. Both these procedures are useful only in relieving symptoms. This is easily explainable as blockage of the vessels starts at a very young age in people having the right genes. Blockages make the human system attempt to make necessary alterations in the vascular systems, lest the patient should come to grief. Only in rare cases the body’s wisdom to correct the fault might fail. In the latter situations, the unfortunate victim suffers from pain and /or reduced functioning of the organs concerned. Doctor interventions come in handy only when symptoms start.

Unfortunately, we in modern medicine, use the "banana logic". Banana has yellow skin; therefore anything having yellow skin must be banana. Toilet steel pipe gets blocked; it needs to be unblocked or bypassed. Therefore, when the coronary blood vessel gets blocked, it has to be unblocked by angioplasty or bypass. It is sad, though, that audits have consistently shown that 80% of the asymptomatic people who go for these procedures, do not get any benefit. Moreover, significant numbers of those hapless recipients suffer other damages like stroke, in addition.

Sixty percent of improvement in the health scenario in the USA has been attributed to change in life style in the last half a century. Avoiding preserved junk food, eating more fruits and vegetables, avoiding smoking and alcohol with better education about healthy life styles, nutrition and regular exercise with the modern economic prosperity (which removes the greatest stress for disease – poverty), have all been responsible for the healthier western society. Only 3.4% of the improvement was due to the hi-tech, very expensive, modern medical interventions. The latter mostly were emergency quick fixes.

Most recent studies have shown that it is the negative thoughts of man - anger, greed, hatred, depression, hostility and pride that bring on major killer diseases like cancer, heart attack, brain attack, raised blood pressure, raised sugar etc. In fact, on-going studies in young American students aged 15-20 have shown that the hostility of mind went parallel to the blockage of heart vessels even in that young age. The good news, however, is that properly randomized controlled, prospective and long term studies have shown that tranquility of mind, praying for others (intercessory prayers), and faith in a higher reality bring about excellent results in reversing the trend of killer diseases coming on in those with negative thoughts in the mind. In short, ancient Indian yoga system would go a long way in helping humanity.

Integrating the various systems of medical care – With modern medicine going beyond the reach of even the upper middle class white men in the advanced West and having no contact with 80% of world’s population inhabiting the poorer countries of the world, there is a pressing and urgent need to evolve a new system of medical care which incorporates the best in modern medicine for emergency care and the scientifically proven good and useful interventional methods of various complementary systems of medicine being practiced at different parts of the world from time immemorial. One must hasten to add here, though, that only those methods, which have stood the scrutiny of the real scientific touch stone tests, from among these various complementory systems, should be adopted in the new integrated system. There have been attempts to separate the wheat from the chaff in the various alternative systems. There was a recent conference on the same topic in the Royal College of Physicians, London. In the forefront of the complementory systems are Ayurveda, Chinese medicine, various other systems of medicine practised in India, as also homeopathy. Right thinking people who have the scientific background to pick the best from among these systems must put their heads together to filter and see that an inexpensive, patient friendly, integrated system of medicine evolves to do most good to most people most of the time.

Health care Delivery Vs medical care Delivery:

The common man has a misconception that the health of the public needs doctors and hospitals. Nothing can be farther there from the truth. Doctors and the hospitals are not needed to keep society healthy. In fact, doctors and hospitals might even make society unhealthy. There was significant fall in total morbidity and mortality in Israel recently when doctors there went on strike for two months.

Health of the public needs the following very important ingredients

Clean drinking water for all citizens (not available for the 80% of the world population)

Three square meals a day uncontaminated by human/ and or animal excreta.

Toilets for every house in the village to avoid hookworm infection

Healthy, locally available, nutritious food for the poor people.

Cooking methods in our villages, where dry leaves, dry twigs and cow-dung cake are used for cooking, emit more carbon monoxide than tobacco smoke, resulting in physical damage to inmates. The most important cause of death in children below the age of 5 is pneumonia and in women due to lung cancer and other lung diseases, both of which are aided and abetted by cooking smoke coming into the house. We must provide the poor with simple smoke free cooking methods.

Education of the poor people about healthy lifestyles and the danger of smoking and drinking and irresponsible sex life.

Economic empowerment of the masses to avoid the greatest stress for all illnesses viz- not knowing from where your next meal comes from.

The poor and the rich should also know what to eat and what not to eat although it is not what you eat that kills you but it is what eats you that kills you. The science of nutrition in modern medicine has no sound basis at all. But the great science of Ayurveda has the most scientific basis of diet advice.

Eat in moderation at frequent intervals.

Eat only if you are hungry.

Vegetarian food is much better.

Food must be fresh and not spoiled too much to please the taste buds.

Preserved food, with added salt to increase the shelf life, is poisonous.

One should be happy while eating.

Have a clean conscience.

Work very hard.

Don’t cheat, lie, steal or back bite.

Forgive people who harm you.

Treat everyone as your near and dear ones.

The earlier we evolve an alternative method of medical care delivery, the better for mankind.

INDIA THE GREAT.

“New opinions are always suspected, and usually opposed, without any reason, but because they are not already common.”

John Locke.

Culture is difficult to define. There would be some that would disagree with any watertight definition, in any case. However, a working definition would suffice for the purposes of this study. The oft quoted definition is “that culture is something one does when one has forgotten all that one has studied in school or college”. I would prefer a personal definition. Culture is all that one does when no one is looking! India has had a hoary culture even when most of the west was still roaming the forests. Voltaire himself had admitted this in the following statement.

“I am convinced that everything has come down to us from the banks of the Ganges, astronomy, astrology, metempsychosis, etc. It does not behoove us, who were only savages and barbarians when these Indians and Chinese peoples were civilized and learned, to dispute their antiquity.”

-Voltaire

Culture of any land is depicted in the epics of the land. Let us analyze two of our epics the Ramayana and the Mahabharatha with one of theirs Homer’s Iliad. While there are many similarities, there are two distinct cultural differences worth noting. While all the three epics were spun around a major war - Lankan, Kurukshetra and the Trojan War – all the wars were basically fought because of women – Sita, Droupadi and Helen.

Whereas both Sita and Droupadi went back to their husbands after the war for a happy reunion, Helen decamped with the enemy. Watch out for the leading western epidemics of suicide and divorce, in contrast to their absence (almost) in our culture although, we are trying to catch up with the West lately even in those two areas. Likewise, in the area of authenticity and ethical standards, our culture was totally different. Karna, the great hero of Mahabharata, was the dearest friend of Duryodhana, the evil king. Even after realizing his real identity and biological kinship with the Pandavas, Karna stood steadfast like a rock with Duryodhana until death did them apart. Compare that with Agamemnon, who was the closest allay of the hero of the Trojan War, Achilles. At one stage in the war Agamemnon attempted to desert his friend for the sake of a beautiful damsel, Baysies and, even, planned to annihilate Achilles! Authenticity is the root of Indian culture. The word “aarya” is derived from the etymological root meaning, “cultured”; ”arya” being agriculture. “Anaarya” is someone who is uncultured.

Sri Krishna tells Arjuna in the Bhagavadgita, when the latter keeps his weapon “Gaandiva” down and refuses to fight and kill his own kith and kin: “Oh, Partha, you would be an ”anaarya”, (uncultured man), akeerthipara (infamous) and aswargeeya (not going to heaven after death) by this act. You are only an excuse for them to die, anyway. (Nimitha maathram). Fight you must, as it is your duty. The result is not in your hands. What a great culture we have inherited?

“Karmanye Vaadhikaarasthe,

Ma Phaleshu khadaachana”

[Do your duty unmindful of the results]

Let me now define science – a thoroughly misunderstood word. The original Greek root sciere = knowledge, does not define science completely. “Science is measurement and measurement is science” of Mary Curie, no longer holds water, as elegantly shown by Werner Heisenberg in his Uncertainty Principle” in 1925 (pq ≠ qp). All experiments are done using only the five senses of the scientist, thereby reducing all measurements subject to the “eye of the beholder,” as demonstrated by Erwin Schrodinger in his “Cat Hypothesis” in 1932. The Sanskrit etymologic root of the word science is “Ski” which means to ‘cut into”. I think this definition conveys it all. Western Science of quantum particle physics comes very close to the Indian science of holism (Poornam). Aakaasha or space is the container of all things in this universe. Prajnanam, the ultimate reality – Brahman, universal consciousness, is the content. This concept of the container with its content is the present effort (Unified Field Theory) by western scientists to try and marry their conventional physics of Newton and Einstein to that of quantum cooks, like Paul Dirac, Neils Bohr, Heisenberg, Schrodinger, Max Bohm and their gang.

While all these changes are going on almost from the early part of the last century in physics (1925 AD), medical science, which got the label of science in the European universities only in the twelfth century, remains still mired in the conventional physics of deterministic predictability and the Cartesian reductionist model. While the whole world of quantum physics has undergone one full circle to go back to pre-Descartes era of Blaise Pascal’s “doctrine of probabilities”, medicine still hangs on to the skirt strings of reductionism. Indian medicine is securely grounded in the law of probabilities, as always.

In fact, five thousand years ago the origin of modern medicine was based mostly on the Indian textbooks taken to Greece by Alexander’s army (India in Greece by E.Pococke, 1832). Hippocrates, the father of modern medicine, literally echoed the sentiments of Charaka. (Ancient Indian Wisdom by Kutumbiah, 1936 – Orient Longman, Madras). The dictum used to be “cure rarely, comfort mostly, but console always”. In the last fifty odd years medical science, riding piggyback on modern technology, has gone deep into reductionist science of predictability.

The reasons are not far to seek. The concept that “there is a pill for every ill” – even an imagined ill, is a very profitable business for the drug and technology industries. Established illnesses treatment is good but, creating newer illnesses (Selling Sickness: the pharmaceutical industry and disease mongering: British Medical Journal 2003; 324: 886-891 April 13^th 2003.), in otherwise healthy individuals, is very attractive! The whole new industry of “routine screening” of the healthy in society would have the enormous catch of nearly six billion people. It would also net billions of dollars in cash and publicity for the players. Use of technology, (interventional medicine) to reset imaginary alterations inside the human system (healthy people) with the claim that the altered state thus produced would hold good as time evolves, following the linear deterministic predictability models, to postpone death and prevent illness, is a big success story for the drug and technology lobbies! This is the real medical claptrap for the gullible. This concept (doctor-thinks-you-have-a-disease syndrome), many a time, produces epidemics of “patient-thinks-he-has-a-disease” syndromes in hypochondriacs.

The lay man will not understand the scientific fallacy in this medical claptrap. Time evolution in man (dynamic system) is not linear. One can not predict the future of any man, well or ill, by studying a few known parameters or changing those parameters by interventions. The future is unpredictable. Most such efforts by the medical world have come to grief. Lowering borderline “raised” blood pressures, lowering “elevated” sugar levels in apparently healthy people, using expensive drugs and surgery in the fond hope of preventing future onset of heart failure and/or stroke in those without any symptoms, as also going against nature to replace female sex hormones after menopause (HRT), have all been shown to be dangerous in the long run although, on short term basis, those dangers might not come to light through the conventional randomized controlled studies, touted to be the last word in medical science!

“The first law of ecology is that everything is related to everything else.”

Barry Commoner.

Time and again modern medical science has demonstrated that man’s attempt to defeat Nature does not succeed. But when man tries to assist Nature’s efforts to keep human beings healthy as long as they live and in treating symptomatic illnesses, has been met with success in alleviating pain (comfort mostly) and even in preventing premature death. Such efforts have also made death bearable and dignified (console always). Go with Nature to succeed in human affairs. This is the essence of the Indian culture where we treat Nature as our mother. The present western medical science tries to control nature by force and abuse nature to win over illnesses. I am reminded of what Chakravarthi Rajgopalachari wrote to the then Prime Minister, Jawaharlal Nehru, on the latter’s plans to build the Bakra Nangal dam, following the example of Abdul Gamel Nasser’s Aswan Dam. Nehru and his followers had quickly forgotten Mahatma Gandhi’s advice for micro-economy through village development. They preferred the western model, led by Scheumacher, of macro-economies of major projects. The west had its vested interests in these areas, anyway. Rajgopalachari wrote, “My dear Jawahar, if you treat nature as your mother she will feed you and nurture you, while, on the contrary, if you abuse nature as your mistress, she would kick you in the teeth!” This prophecy has come true! It is sad that the father of macroeconomics, Scheumacher himself, has now realized his folly and has penned a beautiful book “Small is Beautiful.” He lives in a small home in his own world on the outskirts of London.

Indian medical wisdom, Ayurveda, the mother of most medical wisdoms including modern medicine, follows the dictum of “go with Nature to keep the well healthy” as long as possible to try and postpone illness and pain.

Swasthasya Swastha Rakshitham

(keep the healthy well)

The thrust in Ayurvedic holism is to boost the inbuilt immune system to keep man healthy as long as possible and not to use drugs in healthy people to postpone diseases, as is done in modern medical reductionism. The key to do this is to keep ‘praana’, the breath, in good shape – ‘praanaayaama’. Modern quantum physics now agrees with this concept. The concept of ‘mode-locking’ is exactly the same as the breath – the most dominant rhythm – capable of ‘mode – locking’ and controlling all the major rhythms of the normal human body (circadian – once in 24 hours and ultradian – many times in 24 hours) under its belt. There is one rhythm, however, which occurs once in a month – the menstrual cycle – the infradien rhythm that does not come under the control of praana, the breath. This was known to Ayurveda thousands of years ago but was unknown to modern medical science up until 2002 AD.

“Kujendu Hetu Prathimaasaarthavan,”

(Moon’s effect causes the woman to blood once in 28 days)

avers Ayurveda. The recent findings in non-linear physiology of fractals and chaos, have shown that the endocrine orchestra that maintains the infradien rhythm, gets its original stimulus to the cortical brain cells through the gravitational pull of the moon! Once again modern physiology is unraveling the time – honoured secrets of Ayurveda. Immune boosters are methods elaborated in Ayurveda to help us fight diseases. They are becoming popular these days. The leading methods are meditation, satvik diet (vegetarian natural foods), yoga, praanayama, regular exercise and panchakarma. Even radiation damage to the body could be undone by these methods. One powerful immune booster that the Indian Council of Scientific Research has patented recently comes from the original Ayurvedic ‘panchagavya’.

“What we really mean by originality is the modification of ideas.”

Carlos Fuentes.

Modern medicine, on the contrary, believes in killing germs and attacking illnesses with powerful germ-killers called anti-biotics. Most of the latter, however, have led to the birth of deadly resistant germs that are threatening mankind now. The concept of immunity did not blossom well up until 1981 when AIDS virus killed lots of white homosexuals. Until then the fallacious Koch’s postulates kept the drug industry till moving. Now we are thinking of using immune modulators in disease control.

“The first wealth is health.”

Ralph Waldo Emerson

In short, modern medical culture of conquering Nature has failed. It is slowly looking to Eastern wisdom of keeping the healthy well. The game of inventing new diseases has reached its zenith in an American company trying to invent “Female Impotence” with the help of six US Urologists (thought leaders) has been now exposed. The company wanted to increase their profit 100 per cent by selling Viagra to all women for the imaginary female impotence. Similarly the hoax of healthy screening and intervention based on linear science was shown to be faulty after a recent audit in Israel. Doctors there went on strike for three months, but looked after acute emergencies. They did not intervene in any one otherwise. Doctors came back to work as usual on the 4^th month. Audits now show that the death and disability rates plummeted remarkably during those three months of doctors’ strike. Similarly, long term audits of drug treatment of apparently healthy people with raised blood pressure and sugar also did more harm than good. These drugs would help people who are suffering-the symptomatic illnesses. Go with nature is the essence Indian culture, which seems to be healthier for the ailing western medical science as well.

“Nature never did betray the heart that loved her.”

William Wordsworth.

LIFE EXPECTANCY VERSUS HEALTH EXPECTANCY.

Modern hi-tech medicine claims that it has increased human life expectancy. In fact, the life expectancy started increasing with better food supply, control of communicable diseases, and better education of the masses making them live a healthier life style. In developing poor countries life expectancy could have a quantum jump if only infant mortality comes down. Life expectancy is a statistical term, which does not mean that human life span has increased in this century due to all the hi-tech stuff that we are trying to sell to the gullible public! On the contrary, life span has, if anything, come down from the usual 120-140 years that some of the aboriginal races in certain pockets of the world still enjoy. It is now estimated that the average American life expectancy can not go beyond 89 years even in the next millennium.

What is life expectancy?

If a mother gives birth to ten children and if eight of them die around birth, as used to happen in many parts of the poor nations, even if the other two children live up to 100 years, the life expectancy of another child being born to any mother in similar settings would be only twenty years. (100 multiplied by 2 and divided by 10) This could change dramatically if instead of eight children dying around birth,only four die and the rest live for 100 years, the life expectancy in that setting would jump to 60 years! Now one could understand the meaning of the word life expectancy. The change in life expectancy, therefore, has very little to do with the so-called hi-tech curative medicine.

What is life span?

The maximum number of years any species (Homo sapiens) could live is called life span. This is fixed, as early as the day one is made in the mother's womb, in the genetic material. This can not and would not change with even the highest tech. efforts. The Hayflick's rule gives each cell its maximum capacity to reproduce and apoptosis tells the cells when to die (in certain cells like the heart muscle cell there is no apoptosis under normal circumstances). Recent efforts to increase the life span by genetic engineering also have come to naught, as senescence could not be halted in those modified cells. It is no use having a 150-year-old very senile vegetable in society! The latter would be a burden on society, any way. Life span has remained the same since the dawn of the human race.

What is health expectancy?

It is the time interval between birth and the end of healthy life-before the onset of any major incapacitating illness. Man is healthy only when he is creative in society. Absence of physical illness is not the complete definition of health. In fact, many people with physical diseases are more creative, and consequently healthier, than their counterparts in society without any physical disease, but having no enthusiasm.Thus defined, health becomes a very useful commodity in society. In fact, healthy people in society could even make society more tranquil. Crime of every kind from petty theft to murder and terrorism are all signs of disease (dis-ease)-not of the body but of the mind. Mental illnesses are not only depression and schizophrenia. Aberrant behaviour patterns should also fall into that category.

Now let us critically examine if the present day scientific hi-tech methods have increased health expectancy in society. The most advanced country in the world, United States of America, probably is the most unhealthy country in the world with the lowest health expectancy. Health screening surveys there have shown, in larger cities like NewYork, that every other man had either high blood pressure, heart disease or diabetes. There is hardly anyone who has not seen a doctor for a major illness or has had some surgical procedure done on him or is taking some kind of a medicine or the other at a given time. Crime is on the increase, novel methods are being discovered now and then. Even high school students resort to shooting their own classmates in school!

Time has come for us to ponder over this tragedy very seriously. Professor Eiesenburg, an American professor of medicine, recently wrote to say that a truly well man is not available in America. If all the available screening tests are used on every American all of them will have some sort of an abnormality or the other requiring intervention. In an interesting article The Last Well Man the author, an American doctor, laments on the present state of the art in this field.

Our aim should be see that majority of people in society have at least half their lifetime free of disease. Next millennium should aim at having the populations health expectancy come up to, at least, fifty years.

What are the prerequisites for attaining decent health expectancy?

Clean water, adequate food supply, care of the pregnant women, adequate pacing of pregnancy, universal literacy so that every one has access to information, avoiding tobacco and alcohol, avoiding dependence on others for any reason including religion, avoiding unhealthy competition in life which begets hostility, hard physical work or regular exercise for all, proper immunization methods in childhood, trying to live in a clean atmosphere without excess pollution, controlling the world population by reassuring the poor man that his children need not die prematurely in the new set up rather than selling contraceptive methods to him, empowering the poor man economically by narrowing the gulf between the haves and the have-nots in society and bringing up children, especially our adolescents, correctly should go a long way in achieving the health expectancy for the population of, at least, 50 years.

To cap it, we have to make man more tranquil by the ancient Indian methods of meditation and breathing techniques; the latter go a long way in postponing the onset of illness thereby increasing health expectancy. Prevention is better than cure may not be true always, but changing the mode of living of people is definitely cheaper than both the former. Hope we channalise our efforts in this direction rather than continuing the rat race of more and more technology for fire fighting (curative methods). The fire fighting hose seems to be perpetually short of its target!

Trying to change the mode of living of society is much cheaper in the long run and more effective than screening large populations for diseases and then trying to set them right. There is no guarantee that the change in the initial state of the organism (man) due to drug treatment or surgical intervention of the apparently healthy population is going to do good in the long run. Human body does not follow the linear mathematical rules! To give a concrete example: if one brings down the mildly elevated blood pressure in an apparently healthy man might not do any good; on the contrary it may do more harm due to the side effects of long term drugging. Whereas trying to change his mode of living might bring the pressure down by the natural means for the long term good of the victim. Similar is the story with diabetes or even cancer.

Screening large populations is prohibitively expensive and only increases anxiety in society resulting in large-scale sick absenteeism. In a well-researched editorial in The Lancet the authors make out a good case against screening. The heading is very interesting to read: Do Epidemiologists cause Epidemics? I think they do! At the same wavelength is an editorial in the British Medical Journal entitled Screening Could Seriously Damage Your Health. I must congratulate the authors for their courage! They could not be more correct.

Why do we, then, advocate routine screening of health people?

I strongly feel, I may be wrong though, that is how the medi-business thrives. If the medical establishment were to tell the public the truth, the whole truth and nothing but the truth, then we should be content with treating the sick population only. There may be only a few million clients for the curative business at any given time. If on the other hand, we target the whole population there is a huge stock of six billion to draw from. The latter makes lot of business sense. Logically the latter is better business. The multibillion-dollar drug industry, equipment manufacturing industry and also the corporate hospital industry should thrive on this business and it makes sense that they target a larger clientele.

Well meaning NGOs and the governments of the poorer countries should read the writing on the wall that hi-tech top heavy modern medical interventions are not a panacea for man's ills but are a good quick fix for mending damaged organs. The long-term outcomes are anybody's guess. Doctors have been predicting the unpredictable! Let us put our heads together to see how best we could change the mode of living of man in the present world of cutthroat

LIMITS OF SCIENCE.

“Science becomes dangerous only when it imagines that it has reached its goal.”

George Bernard Shaw (1856-1950) in Doctor’s Dilemma.

Science and scientific outlook have taken mankind forwards in the last one hundred odd years is the tall claim that scientists make. What provoked me to write this piece is that little wonderful book Limits of Science by a great scientist and a Nobel laureate, Sir Peter Medawar. Anyone who questions the above rhetoric is dubbed as superstitious or downright illogical, in addition to being unscientific. Rational thinking is said to be the key to good living and wisdom. How I wish this were that simple! Rationality, per force, has to have its limitations. Rational thinking is based on the inputs from five senses and possibly some degree of “knowledge” derived from one’s past experience. All these do not come in lump sums but in bits and pieces. Pascal was the first to proclaim that there are two important aspects of man’s life that are vital to his actions. First is to exclude reason in his dealings; and the second is to believe that there is nothing beyond reason. Going back hundreds of years, this thinker could have foreseen the truth of his statement despite the fact that the present scientific advances that we swear by have not existed then. He is not far off the mark even today.

Rational thinking and scientific outlook have enormous limitations. When you look beyond reason you get an insight into Nature’s functioning better. Nature has its reasons always, but reason can not explore them many a time. How else can one feel love, hatred, jealousy etc. in life? None of them can be measured in scientific terms. One could experience love but not be able to see love and measure its dimensions. To deny the effects of intense feeling of love for one’s beloved on oneself is to deny the truth. If “science is measurement and measurement is science” as defined by Marie Curie, love as an emotion does not exist at all. No one has seen the wind, but when the trees dance and bend the wind is passing by, wrote the poet.

Similarly there are a lot of things that one can only feel but not be able to see and measure. The problem with mankind today is intolerance for other’s views. Rousseau was despised by many of his peers for his strong and unconventional views. His life was in danger. Voltaire came to his rescue and asked Rousseau to stay with him to avoid any harm. Eventually when Rousseau did come, Voltaire told him “I do not agree with a single word of what you say, but I shall defend to my last breath your right to say what you want to say.”

That is the kind of tolerance that would take mankind forward. Science, if anything, has taken mankind backwards, if one critically looks at it philosophically, pushing him to brink of self destruction. Is not the threat of nuclear war from the terrorists based on scientific data? Is not the anthrax fever in the USA born out of complicated scientific research to get resistant germs to fight wars? Is not the ever-present threat of chemical warfare based on science?

Recently, when doctors went on strike in Israel the death rate and morbidity fell significantly there; only to bounce back to the original levels when there was peace between the striking doctors and the government. It is to be noted that morticians, whose business all but disappeared when the strike was on, brokered peace between the striking doctors and the government! The so-called evidence-based medicine, when looked at carefully, is only evidence burdened and makes life that much difficult for both the doctor and the patient. This is because scientific evidence gathered need not have a linear relationship to what happens inside the human body. The latter is run by the human mind which is scientifically unfathomable. There are so many imponderables in Nature that one can not answer all the questions in Nature with the help of science alone. There are many things outside the realm of science which are beyond the explanatory capacity of science.

Any intolerance is the beginning of terrorism and “scientific intolerance” is one such. Scientific terrorism could be more lethal than the present day political terrorism. If allowed to go beyond control it could destroy mankind forever. Let us look at some happenings that science will never be able to gauge.

Years ago Leonard Leibovici showed that “remote, retroactive, intercessory prayer could do wonders for patient recovery in hospitals.” A positivist that he was, he went a step further to urge doctors to include prayer in their armamentarium. He also gave evidence to show how scurvy could be controlled hundreds of years before the discovery of vitamin C, as shown by James Lind.

The prayer theme was taken to great scientific heights by a recent study in an American University hospital in a well controlled, randomised, triple-blind (the patient, his treating doctor and the relatives are kept in the dark) prospective study of heart attack patients. The prayed for group had very significant fall in all parameters of the illness in a coronary care set up. Even death rate was significantly lower in the prayed for group. This was replicated in patients who had severe infective fevers in another milestone study.

Konotey-Ahulu documented some unexplainable deaths in his hospital in Africa (very thoroughly studied even after post-mortem) where medical science could not give any clue to the happenings. Recitation of the Rosary, which derives its origin from the Tibetan monks, brought to the West via Arabs and other crusaders, and the yoga mantras that are well known in India, have been elegantly shown to reduce the rate of breathing which had significant improvement in the patients’ illness. Yogic breathing is shown to lower elevated blood pressure, and many other cardiac parameters like aortic pressure, pulmonary artery pressure, the ventricular ejection fraction etc. in those with severe heart failure. Tranquility of mind that it bestows is immeasurable and is the added bonus.

Studies in America have shown that the Chinese and Japanese Americans had significantly higher death rates on the 4^th of every month. This was not seen in the White races. The Chinese and the Japanese believe the 4^th to be very inauspicious day of the month. Another mile stone study in London showed that Friday the 13^th was definitely dangerous for at least fifty per cent of the Britons who dared to go out and work that day. The other fifty per cent stayed home on those days, the real superstitious. The conclusion of the study was that Friday the 13^th is definitely bad for at lleast one half of the British population.

If one is a conscientious medical scientist and observes patients very closely one would discover many such inexplicable feats happening almost every day in a busy clinical setting. I call them as “butterfly effects”, the phrase having been borrowed from Edward Lorenz of weather predictions fame. It was only after Lorenz got all the bouquets for his discovery of the method of predicting the weather that he discovered, to his surprise, that accurate prediction of the weather is impossible. He then propounded the butterfly effect. If one wants to know the limitations of science one should study human beings in distress, where butterfly effect is the rule rather than an exception. Of course, doctors have been predicting the unpredictable all along.

One unforgettable incident comes to mind. One of my patients whom I had known in my professional capacity for a very long time, was the priest of a very famous temple in Malanad area of Karnataka. He was an authentic scholar of ancient Indian wisdom and was venerated by his people. He managed his temple affairs with total dedication. His temple was an example for others. When this incident occurred he was well past ninety years of age but was very alert mentally as well as physically. His wife, who was in her 80s, was admitted under my care for a heart attack (inferior infarct, a milder variety with good outcome). When she was progressively improving on the third day he made a strange request to me. He wanted her to be discharged that very day, as he was sure that she would meet her maker the following day at 12 noon or so. I was non-plussed but, knowing him as I did to be very authentic, I was in a “scientific” dilemma. Ultimately he took her against medical advice. His argument was that she should not die in a hospital.

I was shocked to learn from their son that the patient was in good shape at 11.55 am. She drank some water and died without any distress at 12noon. I could not bring myself to believe this whole episode until after a year the old man wanted to see me to thank me. He told me that he was going to die on a particular day at a given time and wanted all his children and grandchildren around him at that time. This prediction made me curious. He did keep his word and the end came as he had predicted. He had all his people around and slept on a banana leaf on the floor minutes before breathing his last! I have no scientific explanation even now. He was a great astrologer himself and had done very deep study of all the great works in that area. He had a reputation of being an authentic astrologer, in addition to his philanthropy-all for free!

This single episode is only one example of the many paranormal phenomena that one observes in day to day medical practice. Konotey Ahulu’s episodes are stranger than mine are, though. May be they are culturally different. He was practising in Africa. I know what Erik the Genius would say. Since he is an intellectual and a know-all scientist, he would label all our experiences as anecdotal. Of course, they are anecdotal, but it is anecdotes that make us wiser and not arrogant. Any knotty problem, when looked at more carefully, becomes more complicated. Great minds of yore knew this very well. Albert Einstein, during his last days, wrote: “I do not believe that this world is a wonder; I think it is a wonderful wonder.” Stephen Hawkins wrote: “I do not believe that there is God; if there is one I do not want him to interfere with my work.”

Wisdom is not just the sum total of the inputs from our five senses. There is more to it than what meets the eye. The effects of prayer on illness, the placebo-doctor effect on the human immune system, the “will to live” feeling that keeps people going despite intolerable pain and disability, and many other such scientifically proven methods of giving relief to the suffering make one believe in the possibilities beyond hypothesis refutation and measurements.

Science, like any other human activity, should have its limitations. It would be foolhardy to believe that science is the be all and end all of human wisdom. Very far from it. What we know is probably a very small fraction of what is there to know. This is the best education scientifically given in school. Live and let live. While one could have one’s views he should be tolerant of others views as well and be ready to examine them without any prejudices. That would be progress and that alone can rid this world of all kinds of terrorism. One who understands science very well alone realizes the depth of his ignorance. The genuine rationalist is one who has understood the limitations of reason. Positive sciences, at best, could answer questions like “how” or “how much.” Positive sciences will never be able to answer the question “why”. The answer to the question "why" needs the knowledge of the limits to science.

“Qua deus hanc mundi temperet arte domum,

Qua venit exoriens, qua deficit, unde coactis

Cornibus in plenum menstrua luna redit,

Unde salo superant venti, quid flamine captet

Eurus, et in nubes unde perennis aqua?”

Michael de Montaigne in The Essays.

["By what artifice God governs this world, our home; where the moon comes from, where she does go and how she does bring her horns together month after month and so grow full; whence the gales spring which rule the salty sea, and what dominion does the South Wind enjoy; whence come those waters which are ever in the clouds?"-translation by M.A.Scr

MAJOR HEALTH PROBLEMS IN THE NEW MILLENNIUM.

ACTION PLAN.

“ Take up the White Man’s burden

The savage wars of peace-

Fill full the month of famine

And bid the sickness cease.”

Rudyard Kipling.

People all over the developed West are trying hard to sell to the third world the idea of a potential health disaster for us in the new millennium in the form of major degenerative diseases like heart diseases, high blood pressure, diabetes and strokes. On the surface it looks both frightening and insurmountable, unless we follow their action plan of screening for these in society and be ready with the drugs and hi-tech surgical techniques to combat the menace. Efforts are on to buy some of our good brains to spread this logic all over the third world, especially in India and China, where there are large untapped potential markets for drugs and technology.

They do not bother about our own drugs and health delivery systems, not to speak of the enormous potential of the available remedial preventive measures, even if the threat is real, instead of the top heavy palliative (not curative) measures!

Our priorities at the moment are: clean drinking water to our masses, toilet facilities in all our villages, avoidance of animal and human excreta getting mixed with human food, reducing atmospheric pollution in our metropolitan cities, and avoiding cooking fumes from getting into the houses in the villages endangering young childrens’ lungs, in addition to increasing our food output. The last is the most important since hunger is one of the main causes of death and disease in the poorer sections.

Poverty is now known to be the mother of all degenerative diseases, since the greatest human distress is not knowing where your next meal comes from. In addition, poverty also is a double-edged weapon. While it increases the incidence of all ailments from common cold to cancer, it makes the victim lose his working days by further pushing him into the bottomless pit of perpetual want. Third world countries should work overtime to economically empower their masses in the villages. These measures would, to a great extent, look after our immediate threat in the new millennium.

MEDICINE IN THE NEXT MILLENNIUM.

MANPOWER NEEDS.

Prof. B.M.Hegde,

Pro Vice Chancellor,

MAHE University,

MANIPAL-576 119.

The essence of medicine in the centuries gone by, today, and also in the new millennium remains the same. Pain, anxiety, disability, and death remain the major enemies of the medical manpower at all times. Medical establishment revolves round allaying anxiety; patient anxiety and doctor anxiety. If someone could find a solution for those two enemies, we will have won our war against illness.

Sir James Spence, a great medical brain of the last century, defined medical consultation as the pinnacle of all else in medicine. He went on to define consultation thus: “ man who is ill, or the man (used for the species and not sex) who thinks he is ill, tries to seek the advice of another man in whom he has confidence-this coming together of two human beings is called medical consultation.

Thus defined, one should get the correct idea of the manpower needs of the next millennium, nay for all times. In the conventional sense, one could discuss the manpower needs of the next millennium under two heads; quantity and quality.

Quantity of Physicians:

The numbers needed for the future could only be guessed roughly. It is impossible to predict the future accurately in any sphere of human activity; medical manpower needs would not be an exception here. We doctors have been predicting the unpredictable in our disease prognostication all these years, basing our reasoning on the linear mathematical data. The latter does not hold good in any dynamic system, human body being an ideal example.

Edward Lorenz, the Nobel Laureate physicist, realized this too late, when he propounded the Butterfly Effect, long after getting his Nobel Prize for predicting the weather in advance. If that were so in physics, the king of sciences, what of medicine, which is an art based on science? Butterfly effect occurs in the dynamic Universe everyday in every field of human endeavour!

Our population growth has outstripped our economic progress. This is one of the reasons why our Nation’s efforts at alleviating poverty have not been palpable. Using the linear data we can only guess the exponential growth of our population in the next millennium. Be that as it may, even now, according to the latest UNIDO report, nearly 80% of the world’s population does not have touch with modern medicine. Most of the money for health care in the developing world goes to the remaining 20% of the population who may not need all that effort! Even today, along with our politicians, our “leaders”- the medical politicians-harp on the five-star western type of medical facilities in our country. This tendency, named Inverse-Care-Law, by Edward Tudor-Hart, a thinking physician in the UK, is the bane of all our efforts at universal health care of doing most good to most people most of the time.

Even in the advanced West, there is awareness of this need for more and more general physicians. The Royal Colleges are trying to reorient their training programmes to achieve that goal. We, in India, are trying to produce more and more “super specialists’ who are not needed scientifically; they may even be counter productive when put in charge of patient care. For very sophisticated technological work specialists are needed but, they should just do that, and not dabble in clinical medicine. Then the results of their intervention would be better, with less mortality and morbidity, during inter-ventional work. Well-trained general physicians should do the bulk of clinical work. All over the world there is a resurgence of this new awareness. We would need to train larger number of general physicians for the next millennium.

I strongly advocate the need for the watchdog bodies, the Physicians College and the Association of Physicians, to take a lead in advising even the governmental sector to achieve this target. An American study of social behaviour has very clearly shown that the governments, in many parts of the world, would become irrelevant in the next millennium. The study also showed that the non-governmental organizations (NGOs) would really take over from governments most of their work, excepting foreign affairs and defense. The life of the common man would depend on the NGOs in the next millennium. There is already an awakening in this direction in our country. There are many non-governmental efforts at physician education, in addition to health care delivery system developments. There also we need to keep our heads on our shoulders, to see that we do not ape the wrong western model of five-star culture in the hospital sector. The larger hospitals in the West are closing down one by one!

Quality of Physicians:

Clinical medicine is in danger. The younger generation of physicians, trained in the five-star culture, are liable to depend too much on hi-tech gadgetry, instead of relying on the inexpensive,time honoured, bedside clinical art of medicine. Art of medicine is a very vague concept. Unless we are able to give the budding physician a concrete idea of the art of medicine, it would never impress him. It was Henry Edward Thoreau who defined art “ as that which makes the man’s day.” Medicine, in that sense, is more than an art, as it really tries to make the day for the patient in distress. We must remind our younger generation that medicine “cures rarely, comforts mostly, but should console always.” Patient care is simply caring for the patient!

A very well trained general physician could only accomplish that. Medical hi-tech is a misnomer. Lewis Thomas, former President of the Slaone Kettering Cancer Institute in NewYork, in his beautiful book The Lives of a Cell portrays most of the hi-tech stuff in medicine, as just mid-way technology to palliate and never to cure! Leading cancer specialist, Regius Professor of Medicine at the Oxford University, and the Chief Editor of the Oxford Text Book of Medicine, David Wetherall, in his recent book The Science of Medicine and its Quiet Art laments on the uselessness of most of our high powered stuff in medicine and compares most of them to the hi-tech branding methods used by our ancestors of yore in treating many an illness of their time.

At the end of the day what touches the lives of our millions of suffering brethren is the time-honoured and time-tested good clinical medicine. In an elegant study, double blinded and published by the British Medical Journal, of the role of clinical medicine, some of the best brains in clinical medicine in the UK now led by, Late Professor John Mitchell, have shown that “ 80% of the accurate final diagnosis and 100% of the management strategies, could be arrived at the end of reading the referral letter and carefully listening to the patient. This clinical accuracy could only be 4% more refined by all the physical examination, and only 8% more refined by all the investigations, including positron emission tomography!” These researchers have only “scientifically” reiterated their great teacher, Late Lord Platt’s dictum “If you listen to your patient long enough he/she will tell you what is wrong with him/her,” enunciated in 1949 AD.

Unfortunately the far cry for evidence based medicine seems to have become evidence burdened medicine today. Despite all the progress in the field of evidence based medicine, there is still need for good old fashioned clinical medicine. Another slogan Health for all needs, in addition a new slogan All for Health, if we try to practise American-style medicine in India in the next millennium. We will have to pump in all our resources only for health. It is also true that health of the society does not depend on hospitals and doctors. It depends on life styles, poverty, clean water supply, and avoidance of contact between human and animal excreta and the human food supply. Denis Burkitt very powerfully puts it in one of his recent papers “ To believe that health of a nation depends on hospitals and doctors is plain rubbish!”

Quality of the physician depends on the medical school education. We have not really given a serious thought to graduate education in our country ever since the days that it is brought here from Britain by the East India Company in 1857 AD, to start three medical schools in Madras, Bombay, and Calcutta. Much water has flown under the Hoogly Bridge since then. Our medical school teaching methods have nothing to recommend them for the future need of society. Much needs to be done in that area, but it is beyond the scope of this lecture to go deep into it. Suffice it to say that the earlier we change that for the better the better for the future doctors. Today we are producing good technicians, we should aim at producing better doctors i.e.: better human beings!

The Numbers Myth:

I have scrupulously avoided talking of actual numbers. I do not believe in the numbers game. It is only in business that numbers make sense. Roy Griffiths, chief of Sainsbury shopping chain, claimed that he had details of the contents of every Sainsbury outlet in the UK in his London office at 10 am daily. Medical manpower could never be assessed like that. It is flexible. In a country like ours the doctor patient ratio depends on what is meant by the word “doctor”. If one is talking about the whole gamut of “healing” we have one of the best ratios in the world, what with all types of registered medical practitioners, even the unqualified ones. General statements like the ones I have made earlier that we need more properly trained general physicians would suffice. The number of specialists that we have already trained is much more in excess of our real need. I am told, I have no documentary evidence, that there are DMs who have no jobs, and are looking at other avenues for `making money’. Let us stop training people with the sole idea of making it rich and big fast!

Finally, the experience of a senior western trained physician, after years of missionary work in Cameroon, Africa, is worth noting as it has many similarities to our set up in India; it is totally different from the experience of working in the West or in the westernized India five-star set up. Professor Ngu Blackett spent many years working in that country. “I think one has to be pragmatic, and also very honest with oneself…in a set up where alternative medicines thrive very well. In essence it comes down to the following: what kind of disease it is, what can I do about it? How can I transmit the necessary information to patients so that they can make an informed decision as to what treatment/management strategy is best for them? Is the disease:

one in which there is definite medical cure,

one with no known cure but which can be helped/controlled,

a self-limiting disease which will get better regardless,

one with no known cure,

a psychosomatic illness?

In the first two cases it is incumbent on me to ensure that my communication skills are adequate to get my message across. In the other situations I need to make sure that the alternative treatment chosen by patients is not going to do any harm. This too is a responsibility that we have, together with the patient and the vendor of the alternative system of medicine. After that, investigations could be done to see if any good is also produced. There are situations where anything that comforts is acceptable. Placebo effect or not. Faith can cure, and we should not remove this hope in getting better against all odds.”

This adequately verbalizes my own experience of nearly four decades in India. I feel that our medical education should take note of these in a big way. We will have solved our manpower problems in the proper perspective!

Further Reading:

Blackett KN. Medicine: alternative, complementary or competitive?

Jr. R.C.P.London 1997;31:152-57.

* Lewis Thomas: The Lives of a Cell….Bantum New Age Books 15thEd,1984.

Wetherall D. The Science of Medicine and its Quiet Art. Oxford Press, 1995.

Mitchell JR et. al. Role of history, examination & investigations.BMJ1985;I:657.

Hegde BM. Probity in Medical Sciences JIMA 1992; 90:166-67.

Hegde BM Unconventional Wisdom in Medicine, Bull. RCPS, Glasgow

1995; 19:292-295.

* Hegde BM Doctor’s Future. JIMA 1996;94:122-23.

COULD MANKIND TREAT MAN KINDLY?

I am convinced that everything has come down to us from the banks of the Ganges, astronomy, astrology, metempsychosis, etc. It does not behoove us, who were only savages and barbarians when these Indians and Chinese peoples were civilized and learned, to dispute their antiquity.”

-Voltaire.

I could add to the list provided by Voltaire, in addition to astronomy etc., the great Indian wisdom of peaceful methods of conflict resolution. This world is a wonder, a wonderful wonder. There are two kinds of people here. Some of us believe that we are so powerful that we could change the world; yet others, going on with their life believing that the world would remain the same but man could change to fit into this world. This world will go on, no matter what man does. This world is basically peaceful and tranquil but, my worry is, whether mankind would be there to enjoy the peace what with the hatred that we are letting loose on mankind.

Wars are born in the minds of men. If men become tranquil and start with the premise that the word mankind is derived with the notion that man would be (and could be) kind to another man. This world being a delusion (maya) what we are seeing is not what it is. President Bush is bent upon teaching Saddam Hussein a lesson, come what may. I am also given to understand that the cost of the Iraq war is estimated to be around $200 billion. If President Bush gives just half that money to Iraqis themselves, they would change the regime there without any loss of innocent lives. I have a gut feeling that if Bush gives one quarter of that money to Saddam himself, he would go away. The remaining three-quarters could be used to rebuilding a new Iraq with an egalitarian society there. No man could be safe on this planet unless the last man is also happy. Intolerance of any kind, including the intellectual intolerance that we see all around us today, is as bad, if not worse, than physical terrorism.

Mahatma Gandhi used to remind us that “the philosophy of an eye for eye would eventually leave all of us blind”. The Americans have been fooling the world all these years encouraging conflicts everywhere in the third world to get better market for their arms industry to get the share value of those industries go up. Ever since the Second World War they have given monetary aid to the poorer nations liberally, but a recent audit, published by the CATO institute in Washington, did show that almost 90% of that aid has been in the area of arms and ammunition. After all the common man there assesses his President with his performance as far as the economy goes. Americans could not care less for the means to get more money for themselves. The end is more important for them. Now, for the first time after 9/11, Americans have come to realize that the world does not seem to love them for all the aid that they claim to have given to the less fortunate but the world hates them from the bottom of the heart.

Americans are non-plussed about people hating them so much as to blow up the largest skyscrapers with hundreds of innocent people trapped inside. They do not have to go too far to search for a cause. They are now sowing the crop that they had sown all over the world. Their large ocean water insulation on all sides of the American continent seems no longer a barrier in the present day communication-friendly world, where distance is no bar to human ingenuity. The world has become a small neighbourhood now and it is the greatest need of the hour that mankind develops a wider vision to make it a large brotherhood (vasudai eva kutumbakam). The Second World War mentality would not work in the present world.

One would find it difficult to compare Saddam Hussein, who has a few war heads with the mighty Americans who have been doing what Saddam is supposed to do to the world, all these years with impunity. It was the American weapons of mass destruction that destroyed millions in Hiroshima and Nagasaki. It was their weapons that were aimed at the Russians in the Bay of Pigs. The same missiles are always facing Cuba, North Korea, and many other places in the Middle East. They also have the largest reservoir of chemical, biological and all known kinds of warheads along with the largest and the most potent nuclear arsenal in the world. One would be amused to see this devil reading the scriptures when it comes to a man like Saddam who, comparatively, is brandishing only a country made pistol, which is made out to be a weapon of mass destruction. Americans claim they have been using their military might to construct this universe into a large peaceful whole!

It all started with the declaration by President Carter to have control over the Gulf oil for world peace, the very man who got the Nobel Peace prize. Now the plan has grown under the three Republican Presidents-Regan, senior Bush and George W. Bush, into a mighty dream of world dominance like never before in the history of the world since the Roman Empire. Henry Kissinger, the cunning fox, was the architect of this grandiose plan. It is all for Iraqi oil, the second largest oil reserves in the Persian Gulf, after Saudi Arabia. The Americans are also dreaming of controlling world oil fields so that they need not pamper the rich Saudi Royal family’s spoiled kids. They are shouting from housetops that their plan for Iraq’s reconstruction for the good of the liberated people in Iraq is already in place. But what they mean is that all the contracts for oil exploration and exploitation in Iraq has already been signed with American companies at the Pentagon, with oil experts at the helm of affairs there! Who cares for the poor Iraqis? If we did have any concern for human beings we would not go to war in the first place, knowing full well that war could destroy millions of innocents. This war mongering would not succeed. Let the world wage a PEACE WAR against the military might of nations.

That apart, the whole bundle of lies and distortions of the facts are being projected daily in the name of liberating Iraqi people from a “cruel” dictator. Americans have recently brought forward a document of the questioning of General Kamel, son-in-law of Saddam, who once defected to the west. Kamel had categorically stated that while he left Iraq, the disarmament had been 98% complete. The post Gulf War Iraq did not have any weapon of mass destruction worth the name. Gen. Kamel was killed in Iraq in 1996 when he tried to return there. While he was in the west he did give these people all the details of the weapons in Iraq and he did say “what remains after the Gulf war are only the maps and computer graphics for weapons and not weapons ready for use”. Almost all the germ and poison gas weapons have been destroyed along with nuclear ones as well. However the Americans and Britain are now using late Gen. Kamel as their best evidence for the presence of large military arsenal of mass destruction that Iraq is hiding! This kind of propaganda was there before the Vietnam war as well, where even a fake encounter was created off the coast of South Vietnam and it was projected as the gravest danger to the world since the North Vietnamese attacked a Naval ship of the US etc. History now tells us that it led to death of more than two million people in the protracted war in Vietnam, where the American might did get a bad drubbing. Many Vietnam War veterans are now helping rebuild the destroyed people in Vietnam!

Dr. Robert Muller, former assistant secretary to the United Nations and now the Chancellor-Emeritus of the University of Peace in Costa Rica, feels that, for the first time in the history of this world, there is a new war on Peace waged by the people of the world against the mighty Americans. In this scenario he is happy that the United Nations Security Council, created in the year 1949, seems to be playing its major role. “We are not at war,” he says; “we, the world community, are waging Peace. It is hard work and it is a constant war: we must not let up. It has never happened before,” he feels very happily. New alliances are shaping up, thanks to the aggressive posture of the American establishment in the Pentagon, where all the old gang of oil company executives hold mighty positions of power, in the world like never before in the history of the world since the Roman Empire. It is almost a miracle. Russia and China, the archenemies are on one side in this battle as also the French and the Germans who fought bloody battles in the past. There are now two super powers in the world-the mighty Americans and the mightier MERGING AND SURGING VOICE OF THE PEOPLES OF THE WORLD.

Thinking people should warn the unwary Americans that time is ripe for all of us to unite to use those same weapons of mass destruction into those of mass construction. It would be a great crime to the future generations if we did not do that. It is the silent majority that is responsible for the small minority’s crime. When the former keeps quiet and gives an impression to the minority that they are very powerful, crime abounds. When power, absolute power at that, gets into a proud man’s head, he would sometimes lose his balance and the monkey within his glassy essence comes out to perform such fantastic tricks against the high heavens that might make even the angels weep! Wake up, arise, awake and try to make mankind love man for tranquility in this world.

This world would certainly become tranquil one day. My worry is that mankind might not be there to enjoy that peace, looking at the rate at which we are at one another’s throat. Universal compassion and altruism would alone keep this world going. I appeal to the conscience of the American President and his men in the government to spare mankind of these horrors of war and its after effects. Power will not last forever. It would create more hatred and might, at the end, defeat the very aim of war. This is a crucial time when all of us could pray for PEACE while waging the most powerful WAR FOR PEACE.

“Our ingress into this world was naked and bare,

Our progress in this world is trouble and care,

Our egress from this world would be no body knows where,

If we do well here, we would do well there.

HEALTH SCARE SYSTEM

The present day medical world is an enigma. I think the right name for the present system, which proclaims to care for the common man, would be medical scare system, as the main thrust here is to scare the hell out of the common man. One example is enough. Whereas any lump in the breast has a one-in-ten chance of being malignant in India, every literate Indian woman gets bombarded daily with scary advertisements in the so-called “health” magazines and news papers that unless she gets herself screened regularly she has a very high risk of dying from breast cancer. Nine times out of ten, a lump in the breast is not likely to be cancer and does not harm the owner! If this information is correctly disseminated, a lady with a breast lump might not die of fear. Fear does kill! No one bothers to tell the common man that drinking clean water could save more lives in India compared to all the cancer deaths put together. Only long experience in dealing with human suffering resulting from this kind of scare mongering would make one realize the gravity of the problem. Others might think this is only a minor aberration in the system, if at all.

Cancers grow very slowly taking as long as ten to twenty years before showing up clinically. It takes years for the seed of any cancer, the rogue DNA, to multiply and mature to show up as a lump etcetera, thanks to the defective suicide gene that normally should have assisted the ageing body cell to die by apoptosis at its appointed time, instead of letting the cell outlive its life span and mutate to become a rogue DNA, the seed of a future potential cancer. In that long interval, this “baby” cancer would die most of the time, if only one could make the environment inside one’s body hostile for the cancer to grow. Happiness of mind and frugal diet, mainly of fruits and vegetables, coupled with exercise, makes life miserable for the growing cancer cell, while fat loaded, high calorie diet, coupled with mental frustration and depression, does help the cancer cell to multiply and grow very fast.

Truth is bitter and does not influence people easily. In the present medi-business it is not a good idea to make the common man complacent about his future. We, in the medical world, spend most of our waking time in predicting the unpredictable future of man, based on the patchy information that we get of his dynamic wonderful body, without having any inkling into his genotype or his mind. The latter two make up around 70% of man. “Future predictions are possible in dynamic systems only when one could know the total initial state of that organism”, writes Professor William Firth, a great physicist, in the British Medical Journal of December 26^th, 1991. Doctors keep predicting the unpredictable immediate and distant futures of their patients daily, all the same. Reasons are not far to seek. There are a host of connected businesses that will have to thrive and make profit. The diagnostic centre, the mammogram manufacturers, the middlemen selling the equipment, the ancillary industries that feed the main plant making the mammogram, the financial institutions that fund the whole business and, of course, the doctors and hospitals. No one dares to destroy the “rice-bowl” (bias).

If one could be certain about one’s future, this world would be a miserable place to live, indeed. Nature, in its wisdom, kept the future of man uncertain, so that he could live with hope and be happy. Imagine a world where the future and death are all certain. Dr. Herbert Nehrlich, an Australian physician, writing in the British Medical Journal of the August 18, 2004, opines thus about this. I am tempted to quote him here.

“If we are going to be able to learn when we will have to put (as the Germans say) "the spoon down" then we will, hopefully, be advanced sufficiently to order replacements to carry on the tradition as well as the family name. I am talking about clones.

Imagine if we were to know the exact date of our death. How would we live our lives? Would the world be a better place, would we be nicer to each other? Would there be any need for doctors?

The Pharma Industry would surely hate it as no one would see the need for drugs, for screening or for the other shenanigans of what Professor Hegde calls the "Health Scare System". No more joggers, gymnasiums, but plenty of cigarettes, booze and recreational drugs. Unprotected sex, parachuting without a chute and swimming among the sharks would become routine. But no more wars !(Get shot today and live to tell the tale).As to everyone carrying their own computer and determining genetic desirability or feasibility before any mating can take place, this is certainly nothing new at all. Adolph Hitler was into this head over heels. He would (and did) (in his own words) "wipe the slate clean". "Mental misfits", "sexual perverts" (e.g. homosexuals) and other genetically undesirables would be (and were) exterminated. He called them "sub-humans" (Untermenschen). Screening is a double edged sword. Antenatal screening presupposes that responsible people are the norm.”

“To believe that doctors and hospitals help keep people healthy is plain rubbish,” wrote one of the great British physicians. “How to avoid modern medicine” is the title of an article written by Lord Platt in the early 60s. “More people make a living OFF hypertension than die OF it,” wrote Sir George Pickering, a former Regius Professor of medicine in Oxford, who also taught for sometime at the Johns Hopkins. He also wrote that the anti-hypertensive drugs robbed the patient of all that is enshrined in the American Constitution (Thomas Jefferson 1772) of “life, liberty and pursuit of happiness.” Life", Sir George said, "we are not sure, liberty the patient does not have, and happiness would be a thing of the past!”

Richard Asher, that great clinician who spent four decades teaching medicine at the Central Middlesex Hospital, London, wrote: “Riva Roci would grieve indeed, if he were to look at the abuse and misuse of the little box that he invented, which makes life miserable for human beings now.” in his wonderful book Talking Sense. All this was long before the “HOT Study” and the ALLAHAT study. We are not told why the HOT (Hypertension Optimum Treatment) study was prematurely stopped and the results analyzed by “intention-to-treat” method, while quite a few patients that started the study had dropped off by then because of intolerable side effects. Re-analysis of the famous UKPDS study showed how the authors were “seeing what they wanted to see” in the study. “Eye of the Beholder”, is a good re-analysis of the “good” that bypass surgeries were supposed to do.

CAST (Coronary Arrhythmia Suppression Trial) study showed that all that glitters is not gold in any drug arena. Statins are made out to be a panacea for all ills, while everyday a new dangerous side effect comes to light in the statin field, so much so there is a whole web site devoted to the dangers of statins alone. Whereas there seems to be a pill for every ill; in reality, it is the other way round. Every pill has an ill, if not more, following it! A recent analysis of the immediate post heart attack revascularization showed that “getting admitted after a heart attack to a hospital with coronary bypass facility was the greatest risk factor (four fold increase) for strokes in the near future. This risk was much greater than hypertension, diabetes etc.! Swan-Ganz catheters, albumin infusions and, some key-hole surgeries have all come to grief sooner than expected. AIDS research is four times “richer” than cancer research and so is the retroviral drugs market! More and more people jump on to the AIDS bandwagon these days than the numbers that get interested in cancer.

Good health needs very few things: clean drinking water, three square healthy meals, better sanitary facilities for the poor, clean surroundings for dwelling, tranquility of mind, and moderate exercise on a regular basis. None of these are the concern of modern medicine. Health is our birth right. Our inbuilt immune system will keep us going as long as it could. In the unlikely event of it failing only should doctors intervene to “cure rarely, comfort mostly, but console always.” Modern medicine’s biggest curse has been “not letting the well alone.” Screening the healthy for early diseases and intervening has been the bane of modern medicine although it has been a boon to the industry. The safe bet for the common man would be not to go to a hospital when healthy. One should see his/her doctor at the first sign of anything going astray with one’s body or mind. The greatest discovery in science of this century is the discovery of man’s ignorance. Our philosophers were not far off the mark. Michel Montaigne, the great French philosopher, put the idea in a nutshell thus: “Men are but vain authorities who can resolve nothing.”

“Whole body scan is the most fashionable of gifts and perhaps particularly suitable for a 50th, 60th, or even 40th birthday. You might be giving your loved one the supreme gift of extra years of life. Unfortunately, you may be more likely to give him or her a lorry load of anxiety and a series of invasive, painful, and unnecessary investigations.

Whole body scanning is currently being intensely marketed in the United States and the enthusiasm will surely spread. The "sell" is simple. You might have something horrible lurking in your body. The scan will show it and allow early treatment. Or the scan will give you the all clear, providing the perfect excuse for an expensive dinner.

The problems lie in medicine's difficulties in defining normality, the devil of "false positives," and our limited understanding of the natural history of disease. The commonest way of defining normal is that the measure lies within two standard deviations of the mean. So in a set of measurements from a normal population 5% will be classed as "abnormal." The whole body scan will produce hundreds of measurements. So you have almost no chance of emerging as normal, but which of your abnormalities signify serious disease?

Stephen Swensen describes his experiences of using computed tomography to screen for lung cancer-within the context of a major trial. His team has found 700 ancillary findings within its cohort, but most were false positives and led to "adversely affected quality of life" and "unnecessary diagnostic and interventional procedures."

A. E. Raffle and others analyse the outcomes of a form of screening that we understand much better, screening to prevent cervical cancer. They show that 1000 women have to be screened for 35 years to prevent one death. This means that one nurse performing 200 tests a year would prevent one death in 38 years. "During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, [and] over 53 would have abnormal biopsy results." During this time one woman would die of cervical cancer despite being screened. These authors also point out that over 80% of cases of high grade dyskaryosis and of high grade dysplasia do not progress to invasive cancer. The same may well apply in other organs, and the prophylactic removal of colons, ovaries, breasts, and gullets may be killing people without benefit.” wrote Richard Smith, the then editor of the British medical Journal in his editorial.(BMJ; 326:26^th April)

Now the reader could better appreciate what I wrote in the beginning about the natural history of cancers. If a cancer takes decades to manifest finally, where is the urgent need to scare the whole population about cancer screening? Early screening to get better outcome from cancer treatment should aim at screening a person when the single cell outlives its time! This is humanly impossible, as all of us have a cancer or two starting in us everyday. Many of them die a natural death inside, depending on our life style and mental equanimity. If one were to worry about the possibility of cancer death, he/should get himself/herself screened everyday even if the medical world discovers a method of detecting the mutated rogue DNA in the body as it gets born!

Medical science is based truly on the “Doctrine of Probabilities” of Blasé Pascal and not on the faulty “Laws of deterministic Predictability” of Isaac Newton. We would, however, like our patients to believe that it is a deterministic science. Everything is based on statistical methods and models. Statistics do not help single individual patient. Statistics apply to groups of individuals. A patient sitting across the table from the doctor with his/her problem could only be helped by the doctor’s wisdom, vision and his past experience and not by statistical calculations. One would shudder to know that a recent Institute of Medicine report in the US, quoted by Barbara Starfield, in her commentary in the leading medical Journal of the American Medical Association (2000; 284: 483-485), showed that the third most important cause of death in the US is the medical establishment-doctors and hospitals-after heart attack and cancer in that order.

Does the reader now want to believe that everything we do is based on altruism? It is very important to stress here that modern medicine is a panacea in any emergency, surgical or medical. Medical world has succeeded in relieving pain, the biggest enemy of mankind, under all circumstances. Mankind should be grateful for that. We doctors have a great responsibility to intervene in anyone that comes to us with any kind of suffering, even though knowledge in that field might be incomplete. We have advanced to the stage of even transplanting damaged organs. Advances in disease management have been phenomenal in the last half a century. If only we had left the “well” alone, we would have been shown as the people who save human lives and would have reversed the Institute of Medicine report, reported earlier, in our favour.

We will not be able to change the future of man on this planet. We have not increased human life span but, have increased life expectancy, though, mainly because of better food, cleaner surroundings, education and, economic empowerment of the masses. Future medical world should avoid interfering in the lives of those that are well and productive. We should stop playing God to keep people alive here for ever. We will never succeed. There are certain inflexible laws of Nature that man can’t change. Science is only trying to unravel nature’s mystery. No body invents anything in science; we only discover the secrets of nature. That should make all of us humble.

MENTAL OBESITY.

Culture is “to know the best that has been said and thought in the world.”

Mathew Arnold.

Increase in body weight disproportionate to the height, with excess fatty deposits under the skin, known to the lay man as obesity, has become a menace to society these days especially in the affluent west. It is difficult to see a really obese poor person in our villages. It is also rare in certain societies like the Japanese. Obesity has reached its zenith in the US where almost every other person seems to be obese. It has become a good money spinner for the pharmaceutical, technology and the food industry. Almost every day you get to see the advertisement of a new gadget, a new drug, or a new crash diet claiming to get rid of your extra flab without any effort in a very short time! Most, if not all of them, are only tall claims. In reality none of them would succeed on a permanent basis. Some of them are down right risky and could even kill. The fear of obesity and the mad rush to look thin, has resulted in many western girls developing a new disease where they hate food and vomit at the very thought of food, eventually getting depressed. Bulimia, as it is labeled by doctors, is a new disease of the present century.

Every health related magazine and even news papers seem to be full of stories about the dangers of over eating and obesity and there are wonder cures for the condition galore. The latest fad seems to be low carbohydrate, otherwise called the low-carb. mania. It is estimated by The Times Magazine that nearly 1558 low-carb. products have been introduced in the US alone in the last two years, with an estimated sale of more than $30 billion a year. To give the reader a different perspective, this is about five times the gross domestic product of many smaller countries. Then there are hundreds of other low fat, high protein diets that ruin the health of the literate public and increase their anxiety levels. It is not what one eats that kills one, but it is what eats one, one’s negative thoughts, the very heavy mental flab, that kills in the end. Overwhelming evidence today points to the primacy of the mind in the causation of all the killer diseases, starting from heart attack, cancer, stroke and what have you. Obesity is no exception to this rule.

Many of us overeat when we are not happy and/or are depressed. Similarly many people lose weight and do find it difficult to eat when they are being troubled by extreme anxiety and guilt. Even when one is very, very happy appetite could get depressed. There are a few who depend on food to satisfy their psychological cravings and get obese consequently. While these are novel medical wisdoms, our ancestors in all societies and in all the major religions have been proclaiming to the world the real cause of man’s misery due to illnesses. Whereas modern medical science says: “you are what you eat,” the science of spirituality goes to say that: “you are what you think.” In short, it is the content of the human mind that weighs heavier than the content of food fat etcetera in the final outcome of obesity and other diseases. This wisdom was the essence of the science of Ayurveda that has existed for “time out of mind” in this holy land, India. The bija mantra, the foundation, of Ayurveda is: “prasanna aathma indriya manaha, swastha ithyabhideeyathe.” As long as the mind is free from all the dangerous negative thoughts and is filled with universal love, good health will be guaranteed. Patanjali’s Yoga Shastra with its advocacy of the sattvic diet and chitta vritti nirodhah (control over ones greedy desires) would, of course, be the ideal recipe for ideal body weight and good health.

Mary Baker Eddy wrote a treatise Science and Health with Key to the Scriptures wherein she quotes extensively from the Bible. Jesus Christ taught, rightly so, that it is not what goes into one’s mouth that creates problems but, it is what comes out of it that is dangerous to human health. And in Luke's Gospel he says, "Do not worry about your life, what you will eat; or about your body, what you will wear. Life is more than food, and the body more than clothes" This counsel about food anxiety by Jesus sounds extraordinarily contemporary. The Bible talks about the inner hunger for spiritual satisfaction that might be at the root of either overeating or self-starvation. The biology of the physics of obesity might have to do with eating but the meta-physics of obesity might depend on the inner discontent with a heavy mind full of the massive load of the negative feelings like hatred, jealousy, ego, pride and anger. Universal compassion might be the best and inexpensive antidote to today’s epidemic of obesity. Rather, it is the mental obesity that manifests as physical obesity in reality. The holistic approach to obesity starts with spiritual management by a thinking doctor. That, when coupled with a sensible simple diet, would cure obesity permanently. All other quick-fix methods like the crash diets would necessarily come to grief in this background.

“Feast on giving. Happiness consists in being and in doing good," Mary Baker Eddy observed, "only what God gives, and what we give ourselves and others through His tenure, confers happiness: conscious worth satisfies the hungry heart, and nothing else can." “Find contentment in who you are and what you already have. The most vital truth about each of us is that we are God's own daughters and sons. The most filling thing we all have is God's constant love. To understand ourselves as loved children of God is profoundly satisfying. Each of us mirrors our Maker in wonderfully individual ways. We can dine on that reality. Snack on it in needful or reflective moments.” wrote the Christian Science Monitor some time ago. How true? My good friend Major Solanki, through his Inquest Foundation, Bangalore, is doing God’s work in spreading the message of obesity management through spiritual means-sans crazy diets and weight reducing gadgets. May his tribe increase for the good of humankind.

In the Sura V of the Holy Quran, the verse 96 is very explicit in this direction.

“On those who believe

And do deeds of righteousness

There is no blame

For what they ate (in the past)

When they guard themselves

From evil and believe,-

And do deeds of righteousness,----“

English Translation by Abdullah Yusuf Ali.

There is a subtle symphony in what appears to be repetition. In fact, relationship of such simple regulations like food etc has to be explained vis-à-vis man’s duties to his fellowmen. The essential message of this verse in the Holy Qumran is that food is less important for human health than righteousness. In short, all the scriptures in every religion proclaimed to the world that it is the man’s mind with his awareness of his higher duties to God’s creations (other fellow human beings) that determines one’s happiness or ill health on this planet.

If one unloads the mind of all these destructive heavy negative thoughts, one quickly realizes that not only truncal obesity but all other physical illnesses will get corrected with additional sensible changes in life style. This will take away the risk of having to take potentially dangerous pharmaceuticals for every minor or major deviations from normal health. While there is no pill for every ill, every pill has an ill following its prolonged use under all circumstances. Our modern medical quick fixes are all fine in an emergency. Barring that one of the major causes of hospitalization in the US is adverse drug reactions (ADR). Just as a bath is a necessity to keep the body clean, a cleansing bath for the mind by washing away negative thoughts would be good for the mind and good health in turn. Physical overweight (obesity) is not as serious a disease as mental overweight (obesity), where the mind is bogged down by the heavy destructive emotions.

“The best of man is he from whom good accrues to humanity.” Prophet Mohammed.

NATIONAL DEVELOPMENT THROUGH SCIENCE AND TECHNOLOGY.

It is very difficult to define science. Many have defined science in their own way, but none of those are satisfactory. Science is the organized curiosity to understand the secrets of Nature in its variegated forms with, of course, a touch of logical skepticism. With limited budget for research these days all over the world we will have to ration scientific research to have direct relevance to mankind’s immediate needs. Technology, on the other hand, is the application of scientific knowledge to benefit mankind. It is a moot question if these aims are really met in the present day scientific world! Market forces might twist these altruistic motives, though. Young nations should watch out to avoid this happening.

Although science is good for mankind, scientists and their mentors might use scientific knowledge for power. When Oppenheimer, Niels Bohr, and Otto Frisch were trying to split an atom their teacher, Max Bohm, a Nobel Laureate physicist, had this to say: “I am proud of my pupils’ cleverness; how I wish they had used a bit of their wisdom, in addition. This atom which they are trying to split would one day teach mankind a bad lesson.” How prophetic were the words!

Martin Luther King Jr. had rightly felt that science without a touch of spiritualism would sink mankind into the valley of moral nihilism, but spirituality without a scientific touch would take man into the valley of illogicalism.” Mahatma Gandhi, the father of our nation, was of the firm belief that India should pursue micro development through all round village development, since more than eighty per cent of India lives in the villages. That has yet to happen. We are making great strides under the present rulers in that direction as well, albeit slowly.

Indian science of yore, which probably led the world thousands of years before the Universities in Europe, was in its pristine glory in the eighteenth century. The Royal Society in London sent twenty of their great scholars to study Indian Science and Technology. Their observations reveal the greatness of Indian science at that stage. The best steel, the finest cloth, blast furnaces, advanced mathematics and astronomy, astrology, metempsychosis and, even, medicine were recorded by them.

The only disease mankind has been able to eradicate thus far, small pox, was achieved through very low tech. method of vaccination which was in practice in India for “times out of mind,” wrote Dr. T.Z. Holwell, FRS. He was the one that recommended to the Royal College that the anecdotal experience of Edward Jennner be given permission for wider use, based on the Indian experience that he had in The Bengall Province of the Raj of those days for twenty years prospectively. The original document of Holwell is still preserved in the archives of the College in London. It has providentially survived two great fires since 1747 AD.

Today India stands on the threshold of scientific development of the most advanced type in every field of scientific endeavour, starting from agricultural revolution to cutting edge research in human genome mapping. Our space programme could match the best in the world as also our atomic and defence research facilities. In the area of pharmaceuticals, definitely in numbers, we lead the world. Modern science and technology have taken a backward India in the 1940s to one of the most advanced nations today, barely half a century lapsing in between! Soft ware development is our forte. We also are leaders in textile, and are very comfortable in the core sectors like cement, steel, automobiles and many other infrastructural areas. Although our fossil fuel reserves are not really very large, we have a large area yet to be explored and the work is going on. In addition, we hope to harness large quantities of diesel from a plant source in the not too distant a future.

The talk would throw light on India’s efforts to give better living standards for its citizens through science and technology since Independence with, of course, a touch of moral values to our scientific research, the hallmark of Indian education. We have a long way to go, miles to go, miles to go, before we sleep. This world will never have permanent peace until the lowest of the low have three square meals a day and have the basic minimum needs met. This could be achieved through judicious use of our existing scientific knowledge to do most good to most people most of the time. We, in India, believe that this whole world is but one large family and would, therefore, be most willing to share our knowledge and wisdom with those that need them. Jordon and India have been great friends for a very long time. May our friendship grow from strength to strength for the mutual benefit of our peoples? May science and technology also come to help cement that bondage further?

OUR BIOSPHERE

If one stretches one’s imagination a bit too far, one would realize that the whole bio-sphere, the so called earth, inhabited by living organisms including man, is only a thin film of bio-plasma, resembling an oil slick in the sea. Curiously, at its thickest part this film is just twenty miles wide, while the radius of this whole is around 4000 miles in length. In short, the thickness is just 0.5% of the radius, even at the highest part of the atmosphere and the lowest part of the bottom of the ocean. Within this space the whole gamut of creation, maintenance and destruction occurs, at a phenomenal pace.

This is run exclusively by the only source of energy, the kingpin of the solar system, the sun. There are billions of other planets and galaxies but we are not able to communicate with them for the simple reason that they are billions of light years away from us. May be, there are more intelligent creatures in one of those planets, wanting to speak to us, but that looks rather remote for now. Let us be satisfied with learning about our planet and try to keep it going for our progeny.

Every single second of the existence of this biosphere there goes on hectic activity in all fronts. The basic units of all that exists are the elements carbon, hydrogen, oxygen, nitrogen and some trace minerals. Basically, all energy for all the happenings in this bio- sphere comes from the sun’s rays through the greatest of all laboratories, the green leaf, where carbon dioxide combines with water to produce the green pigment, chlorophyll-the basis of all foods.

Man, proud man, with all his scientific achievements, is not able to replicate this one simple chemical reaction in his laboratory, however sophisticated the latter might be. All the energy sources that we tap, the fossil fuels, are also derived originally from the sun’s rays. Chlorophyll forms the basis of all food; consequently man is basically a vegetarian to begin with. Our infrastructure, the body, is built to digest vegetables only and not meat!

We have no idea how the building blocks the, DNA, is built from the elements mentioned above, although we claim that we can clone a man. How does the cell get formed, in the first place, is still a mystery and might remain so for ever. Reductionist science teaches us the methods to study an organ through the study of its component parts but given the component parts we would not be able to reconstruct the same organ from its bits and pieces. The bits may not make the whole! There is something more than what meets the eye here.

However, we have some idea as to what happens after death in the natural set up. Prof. Jerry A. Payne studied a wild pig, which died in its natural habitat in the forest in Tennessee. The body lasted for eight days and every day he studied with the help of other scientists the multiplicity of organisms that visited the body, excluding himself and his colleagues. When at the end of eight days there were only the teeth, bones, and the dry skin of the pig left behind by millions of other organisms that fed on the dead pig. Nothing really goes waste in this closed network of the biosphere where there is always an interaction between the living the non-living things that go to make the living things in the first place.

Denis Flanagan, the co-founder and editor of the Scientific American sums up this process in his inimitable style thus: “Payne got the carcass of the pig that died of natural causes…over the eight days Payne regularly sampled the carcass for the organisms that had come to them (not including himself). He identified a total of 522 species, representing 3 phyla, 9 classes, 31 orders, 151 families and 359 genera. Of the 522 species, 422 were insects.”

The impact of some of our mindless actions for temporary gain is seen in our use of chemical fertilizers for the so-called green revolution. It has now come to a pass that none of the dead animals in the villages get destroyed as easily as the pig in the Tennessee forests. Chemicals must have themselves destroyed most of the species that come to visit the carcass. Even the earthworm, the farmers’ friend, is no more there to burrow into the land. The earth can not now breathe to remain as fertile as it wants.

Ecological imbalance in the species could eventually make man perish from this planet. There are islets of hope still. I recently met a farmer in Hyderabad who gets more returns from his land, which no one in the world could match. His family for generations has not used artificial fertilizers at all. He gets four times the normal yield in his paddy (rice) fields! Similar is the story of his fruit trees.

The antibiotic use in human infections since the early 40’s has now reached a stage where most, if not all, the germs seen in some hospital intensive therapy units have become resistant to all the available five hundred antibiotic molecules! A good example of the ecological imbalance in the symbiosis between man and germ, both being good friends in the normal ecological balance, is evident now because of the misuse of anti-biotics. Some hospitals in the UK and USA had to close down their operating theatres for want of better methods to sterilize the instruments.

The Times London carried an article on the Antibiotic Time Bomb, which might explode any time. The story of tuberculosis, which once ravaged mankind, has reared its ugly head again. It is threatening to be the most dangerous epidemic in the west in the next century, bringing back to memory the horror of the great epidemics of the White Death, in contrast to the Black Death of plague. It was called white because most patients dying of TB were both young adolescents and had bled so much during their last few weeks that they all looked pale and white after death!

Our ancestors must have known all this. We have been making all our durable things like bags, belts, wallets etc from dead animal skin, as the latter lasts long and resists quick degradation like the soft tissues. In fact, it is the skin of man that keeps all the internal organs safe from invading germs; but ironically skin hosts millions of them on its surface always to keep them going, true symbiosis. W.H.Auden wrote a poem on the theme:

For creatures your size, I offer

a free choice of habitat,

so settle yourself in the zone

that suits you best, in the pools

of my pores or the tropical

forests of arm-pit and crotch,

in the deserts of my fore-arms,

Or the cool woods of my scalp.

While we boast that we could easily clone a man, we are still not able to get the whole man. Clone is only a twig and the man we clone would only be a look alike but not the whole man, as the latter has another big dimension to him, that of his consciousness that shapes his personality and all his actions. That apart we are far from evening knowing how to put the atoms together to make a molecule and the to put the molecules together to make organs etc. Our reductionist science only teaches us how to break things down but not how to build things up.

One would have, by now, realized that the thin film bio-plasma churns out every life on this planet and then at the end of the day recycles the dead organisms into its bosom for recycling. This should teach us the greatest lesson of our lives. The more we abuse our bio-sphere with non-degradable artificial matter like plastic, more we would drive ourselves towards upsetting this normal cycle of birth and death and could one day end up destroying the very base of our existence. Man, with his proclivity for comfort and his passionate greed, would eventually destroy every natural resource in this biosphere.

Ozone depletion, warming up of the global atmosphere, clogging the atmosphere with all kinds of gases emitted from burning fossil fuels, deforestation depleting the top soil, artificial fertilizers and antiseptics killing all kinds of germs needed to keep the earth breathing for plant survival, plastic waste choking the soil and also the larger animals who eat them, would certainly upset the ecological balance in the bio-sphere.

Although man does not know how to create life, he has enough indication that he could upset the process of both creation and eventual decay by altering the ecological balance. I am reminded of what Emerson once said: " If there is an end for man on this planet, it would through civilization." The monetary economy of getting more and more and hating one another man has been systematically driving himself more towards the animal instincts rather than refining him to be human and humane.

Mankind, I am afraid, will have to pay a very heavy prize, otherwise. The study of our biosphere must be a very important part of school education. It is in that age group that students could be converted to the correct line of thinking. Many scholars call themselves ecologists, but I wonder if they realize the gravity of the situation! Many of them take it to ridiculous levels of irrationality that attracts non-compliance. We can not ask man to go back to the forest to live in tune with nature. We have to find a way out of these two extremes. It would be possible to have the same economy keeping in mind the need to preserve our environment.

RECIPES FOR HAPPINESS.

“All who joy would win

Must share it-happiness was born a twin.”

Lord Byron.

Most of us have read many recipes for cooking and have also been excellent cooks using these recipes. Very few seem to know the recipe for happiness-that elusive state of mind-that mankind has been in search of. In a small but beautiful book by the same name, the International Board of Yoga at the Yoga Bhavan, SantaCruz East, Mumbai-400055 has brought out the recipes for all to enjoy. This write up draws heavily from that book for the common reader to benefit.

The Recipe:

Ingredients:

* Two heaped cups of patience

* One heart full of love

* Two hands full of generosity

* One head full of understanding.

Method:

Mix all the ingredients, sprinkle generosity and kindness.

Add faith and mix well.

Add a dash of laughter spread over a longer period.

Serve smiling to everyone you meet to spread happiness.

Having given you the recipe for happiness, I go on to give you the simple guidance about having good food for good health. Our ancient rishis could look into the secrets of nature very easily using their yogic powers and clairvoyance. If one wants to have any proof of this, since modern reductionist science needs proof for everything, one could read a great book written by two physics teachers in Cambridge in the early part of the last century, who later became great Indians-Annie Besant and her friend Charles Leadbeater. Their book Occult Chemistry describes very accurately the structure of the atom of nine elements starting from Hydrogen to Helium in 1920, when the structure of the atom was not known to any one of the scientists. One would be surprised to know that the great explanation of the atomic structure by the great Nobel Laureate physicist, Neils Bohr is not correct! Annie Besant and Charles could attain Yogic Siddhi and could see the inside of those atoms. Read the book for the pleasure of knowing what those sidhi were like.

Our ancient rishis and yogis divided food into three types-sattvic, rajasic and thamasic. Sattvic foods are natural and are easily digestible. They also generate energy for the system. Fruits, seasonal vegetables, cereals of all kinds, pulses and sprouted cereals, ginger, turmeric, and cumin seeds (jeera) excluding chilies and hot spices are all sattvic. Honey and jaggery area also included in this category.

Rajasic food is difficult to digest but generates plenty of energy leaving one in a disturbed state of mind with anxiety and excitement. It creates all the negative feelings like anger, jealousy and pride. Meat products of all kinds, fish, eggs, any other non-vegetarian food, soya bean and chick peas, urd dal, chana dal and tur dal along with spices like chilies and pepper, onion and garlic. Garlic and onion, although rajasic, have many important medicinal properties and, as such, could be used by the needy.

Any food that is left over for more than twenty-four hours or foods that are processed and stored are all thamasic. These foods are difficult to digest and give rise to feeling of fullness, dullness and lethargy. Tea, coffee, cocoa, alcohol, and other stimulants come under this category. White sugar, iodized salt, bread and bread products including cakes, white sugar, polished rice, biscuits, chocolates, jams, pickles, soft drinks, deep fried and reheated foods come under this category.

I have left out milk in this list as I personally think that milk as such is not a good food for humans as no species in nature drinks the milk of another species. Milk proteins that are foreign to the human system might be the cause of many of our acquired abnormal immune problems starting with simple allergy to the dangerous auto-immune diseases. Milk as food could be one of the great time-bombs ticking away slowly but steadily. However, denatured milk, where the protein is either denatured as in buttermilk or is totally removed as in pure ghee, could be good for health. Ghee (clarified butter) in particular is described in the science of Ayurveda as the best food which gives good health. Having said that I must hasten to add that the total fat intake should not exceed twenty per cent of one’s total calories intake per day.

How Many Times Should One Eat Per Day?

More times but less total food per day would be good but ideally five to six times would be very healthy. Three meals but small ones with three small meals of fruits in between would be a good idea. Mid-morning, evening and late night supper could be fruits. Breakfast is a must and must be the largest meal of the day. Make the intake less and less as the day progresses.

Meal Times:

Meal times should be happy times. That should be the time to sit with the family and enjoy their company. Tell each one some good things that makes their day. Never eat when you are tense and are in a hurry. Take it easy. Water half and hour before and after could be a good idea. If one is overweight one could reduce the total intake but not the number of meals. One should sleep on half full stomach and not on either full or empty stomach. Exerting after a meal is not good idea as every meal touches the heart and makes it work harder-a hearty meal. Larger the meal greater the strain on the heart. Old elderly should rest a while after the meal in the same position before getting up from the chair.

Once in a way you could enjoy something that you like without feeling guilty, but on a daily basis the above tips could help. Have nice meal times folks!

“I earn what I eat, get what I wear, owe no man hate, envy no man’s happiness, glad of other men’s good, content with my harm.”

William Shakespeare.

SCIENCE, RELIGION, AND HUMANISM.

“Science without religion is lame, religion without science is blind.”

-Albert Einstein

The war in Iraq is over, next one would be in Syria, America says. For a change this time round it was a shorter course of human destruction. One could say that the scientific techniques of warfare have won this time, the Iraq war being the pilot study to see if the newer technology does really perform as predicted by the scientific formulae behind them. Religious fanaticism did win the war last time on September eleventh, in shaking American confidence in their invincibility. That did the trick many times in the past as well. One could philosophize to say that in every war one or the other of the two schools of thought should win, anyway. Who, then, are the permanent losers? Mankind, of course.

Both science and religion started off with very laudable motives. Whereas science tries to unravel the mysteries of the outer world of man that he could assess with his five senses-all in the “eye of the beholder” and, religion, on the contrary, attempts to dive deep into the unfathomed depths of man’s inner world, which is beyond the reach of our senses. In short, both of them seem to unravel the mysteries of Nature. Science has progressed so much that it is claimed to have made man’s existence on this planet that much easier. Religion, on the other hand, has been aiming to make man tranquil and sociable, transforming the monkey in man into a cultured human being.

Both science and religion seem to have a few people sitting on the fringes who want to make the best use of their power. In this power game of one-upmanship science lost track of its great responsibility of doing most good to most people most of the time, and went into the business world. Every research finding of value is today patented and used for gaining more power and more money. Religion did not lag behind, either. It realized the enormous power potential of influencing people in the name of God and a whole New World of ritualistic fanaticism came into existence. Who are the losers in the bargain? Mankind again, of course.

Wars are born in the minds of men. The people who sacrifice their lives are the innocent citizens, the common man on the street and the passionate soldiers, who are being brainwashed to believe that they are being patriotic and should die for their motherland! The powers-that-be that go to war always claim that the loss of life has been minimal every time, as if they had expected the whole of mankind to be wiped out otherwise. The truth, however, is that for the man who dies and for his near and dear ones it is total irreparable one hundred per cent loss, though. Statistics are used every time when one wants to take the common man for a ride. Thousands lost their lives in Afghanistan and recently in Iraq.

People, who could not care less to kill others, either in the name of a “just” war or compelled by the burning religious passion, could be classed along with the serial killers who enjoy in following a particular modus operandi in liquidating their victims. Both could be clubbed in that old fashioned classification in psychiatry as psychopaths. This would be socially unacceptable to many. A more recent, and, a more parliamentary, word for them would be “anti-social personalities”. This class of human beings does not believe in truth and they do not have any guilt feelings. Most of the politicians, the world over, belong to this category. There are, of course, exceptions at every time and every nation. The exceptions are not politicians: they are statesmen.

History of mankind is replete with biographies of such men and women in power who took pleasure in manslaughter-the Asuras of our Puranas, the “Noblemen” of the Roman empire, the religious fanatics of the present and, of course, the war mongers who want power with an excuse, though. The last group takes care to proclaim to the world that they wage every war for liberating the oppressed people in this world, as if God has given them the mandate to be His executioners on earth! They do not even deserve the name of yamadoothaas since they do not follow any niyama, nor do they have any dharma. It would be a travesty of truth to even remotely associate them with the just King of death, Yamadharmaraaya. All these people, down the ages, belonged to one class with a special unnatural trait of sadism in enjoying the fruits of others’ death and destruction!

May be science, one day, would unravel the mystery by discovering a new gene in them, the killer gene to exonerate them. Recently Balkis, the tigress, in an American zoo, killed her caretaker. When the wife of the dead man sued the zoo authorities for damages, scientists came to their rescue by discovering a new gene in the dead tigress that made the animal a man-eater! Lo and behold, science won the war again and the court ruling went against the poor lady who lost her husband. Human genome is born the other day, after full gestation, with all fanfare. Unlike scientific predictions of more than one hundred thousand genes looking after every single human function, the newborn baby has shown only thirty-five thousand odd genes; just about double that of a round worm. There may not be enough to go round, anyway. In the meantime news has come that the first three children treated with engineered genes to control their intractable genetic diseases have all come up with unusual cancers and the study has since been stopped! Our much celebrated cloned “Dolly” has been sent to meet her Maker by her “human creator,” Ian Wilmot. Scientists who have been threatening both politicians and religionists that they would clone a man have been rather muted these days after the death of Dolly and many other mishaps in the field of genetic research.

“Art is man’ s nature; nature is God’s art.”

- P.J.Baily.

Wars have been very fertile grounds for scientific medical research. Wars have been a great stimulus for basic scientific research as well. Unfortunately, our present scientific mindset is such that we recognize only profitable areas of research and try and sweep under the carpet those that do not benefit the benefactors of science-the grant giving bodies. Grants for research today come mostly from private business in every field. Governmental funding for research is dwindling everywhere. Naturally, there are bound to be strings attached. Whereas we have learnt a lot from war time experiences in the progress of medical science as also other sciences, a recent experience seems to have been swept under the carpet deliberately.

An audit of the Vietnam war and Falklands war lately has shown that the per capita death of the wounded soldiers was marginally less in Falklands where the British did not have all the hi-tech methods for immediate treatment of the wounded. In many cases the wounded soldiers were left to lie in snow for hours before they were picked up for attention. On the contrary, in Vietnam, the American army had the best five-star hospital in Saigon, minutes away from the war theatre, for the wounded soldiers to be airlifted and managed “most scientifically” without loss of much time. The study did show that too much interference, immediately after major injury, might come in the way of the body’s natural healing mechanisms modulated by the autonomic nervous system, thereby increasing mortality! This experience could be clubbed with that obtained in Israel recently where doctors went on strike for three months. Death rates and morbidity did fall down significantly during the strike period only to go up again to its original level after the doctors came back to work.

History repeats itself with regularity. If we do not learn from history we will have to relive history. Florence Nightingale and her nurses arrived on 4^th November 1854, in Scutari, across the Bosphorus from Istanbul, the English theatre during the Crimean War (1854-56), where nearly two thousand wounded and sick lay in foul rat-infested wards. This was in response to the demand of The Times, London correspondent, William Russell, who wrote: “ Not only are there not sufficient surgeons…. Not only are there no nurses and dressers…There is no linen to make bandages.” The Times and the nation demanded action. Florence Nightingale offered her services to her friend Sidney Herbert, the Secretary of War. A party of thirty-six nurses-ten Roman Catholic sisters, eight Anglican sisters, six St.John’s House nurses, and fourteen from various London hospitals were with Florence. As she was fighting her battle with the wounded, the Battle of Inkerman raged and the hospital was soon deluged with more wounded. She got another eighty nurses as reinforcement. Three hundred scrubbing brushes were summoned. Florence provided meals, bedding, and saw to the laundry. “I am the kind of General Dealer in socks, shirts, knives, forks, wooden spoons, tin baths, tables, cabbages and carrots, operating tables, towels and soap,” she wrote in her diary.

Within six months, and battling against military resistance, she slashed death rate from about 40 per cent to just 2 per cent!

“A lady with a lamp shall stand,

In the great history of the land,”

Wrote H.W.Longfellow.

Field Marshall Sam Maneckshaw once showed me his abdominal wall, pulling out his shirt. The whole place was full of multiple ugly irregular scars. He then told me that the Japanese pumped in more than eighteen bullets into his tummy in the Burma front, during the Second World War, and left him in the forest for dead. His soldiers took pity on him and carried him in gunny bags all the way to Calcutta. By then his abdomen was stinking with so much pus that the doctors there refused to do anything except first aid. He eventually reached Madras General Hospital in a moribund state. Col. McRoberts kept on operating and removing the bullets one by one and draining the pus in buckets over a period of six months thereafter. The maggots that had settled in the wound in the forest saved Sam’s life, was the opinion of Col. McRoberts. History has repeated itself. Maggots, cultured in the laboratories scientifically today, only could kill the super-bugs, brought on by scientific overuse and abuse of antibiotics these days in hospitals. In the olden days Nature used to culture maggots for the good of the wounded or sick animals and the wounded hunter-gatherer man in the forest!

As we had seen earlier, under all circumstances of war or peace, mankind suffers the ultimate consequences. Even in the olden days man suffered due to all that happens in society. “The spiritual and intellectual life of Europe was always subject to violent change. It favored and created divisions and discontinuities, and indeed dramas, always with the aim of building a better world.” wrote Fernand Braudel in his classic, A History of Civilizations.” Today’s warmongers do the same. They profess to do all that they do for building a better tomorrow for the next generation, only to create chaos and misery for, at least, the present occupants of the world.

The word humanism is ambiguous and needs clarification lest the reader should mistake it for various other related words like humanity etc. It is a learned expression coined by a German historian in the year 1808 AD. Pierre de Nolhac, the author of Petrarch and Humanism claims to have introduced this word in French University in 1886 in the course of his lectures at the Ecole des Hautes Etudes. Braudel claims that by the year 1930 the following different types were known in Europe. New humanism, Christian humanism, pure humanism, technical humanism, scientific humanism as also humanism of Karl Marx and Maxim Gorky. I introduced the word Medical Humanism in my article in the Proceedings of the Royal College of Physicians of Edinburgh in the year 1995 and later in my inaugural lecture to the medical students at the White Memorial Centre in Los Angels in 1996. For the purpose of understanding humanism in the context of the present write up, I shall borrow the broad definition from Augustin Renaudet, the historian of Tuscan and European humanism.

“The name humanism can be applied to an ethic based on human nobility. Turned towards both study and action. It recognizes and exalts the greatness of human genius and the power of its creations, opposing its strength to the brute force of inanimate nature. What is essential remains the individual’s effort to develop in himself or herself, through strict and methodical discipline, all human faculties, so as to lose nothing of what enlarges and enhances the human being. “Reach towards the highest form of existence,” said Goethe at the beginning of Part Two of Faust, “by dint of uninterrupted effort.” Similarly, Stendhal said to Eugene Delacroix in 1850: “Neglect nothing that can make you great.” Such an ethic based on human nobility requires of society a constant effort to embody the most highly perfected form of human relations: an immense feat, an immense cultural achievement, and an ever-greater knowledge of humanity and of the world. It lays the foundations of individual and collective morality; it establishes law and creates an economy; it produces political system; it nourishes art and literature.”

Humanism is against exclusive submission to God; against a wholly materialistic worldview, against anything that neglects humanity and against anything that denigrates human nature. Sociologist Edgar Morin left the Communist Party and was asked why he did so? His answer was all revealing. “Marxism, my friend, has studied economics and the social class. That’s marvellous, my friend. But it forgot to study humanity.” The same could be said of today’s science and religion. They have studied everything that needs to be studied in their respective fields but forgot to study humanity and its needs. That is why humanism is the need of the hour. The world is standing at the threshold of self-destruction, by the mindless search for the materialistic utopia through scientific and religious route. If humanism does not make its forceful impact on both those groups the future is very bleak, indeed. Now I would crave the indulgence of the reader to see the prophecy of these two stanzas in the Rg Veda, the mother of all human wisdoms for all times.

“Satyam, brihad reetam ugram,

………..vishwam dharayaanthi.”

[Truth and ethics of the highest order, applied sternly to our lives only could make this world go on forever.]

“etad vaco jaritar mapi mrishtha

a yat te ghoshan uttara ugani.”

[Forget not, Singer! this word of thine, which after ages will resound.]

How true, indeed! Let the warmongers and the materialistic scientists listen to this advice of the Rg Veda. Humanism does not neglect scientific research, but by no means gives it higher priority than human needs. Similarly, humanism does not exclude God, but holds human needs above the ritualistic tenets of religion. Humanism, in its true sense, is spirituality in essence. To understand this statement one must know that spirituality simply means sharing and caring. In short, it is to live and let live. Let us move from science to scientific humanism, hi-tech medicine to medical humanism, from war to peace, hatred to debate, suspicion to understanding and from religion to spirituality, the other name for religious humanism, to save this world from annihilation.

“Ask God’s blessings on your work, but don’t ask Him to do it for you.”

Dame Flora Robson.

SOCIETAL DHARMA.(OBLIGATIONS)

Man started living in groups, mostly on the banks of rivers, close to fertile ground. This is the beginning of the present concept of a society. Having been a hunter-gatherer until then, he took to ploughing the field to increase the yield of food articles to feed all the members of the society, the real beginning of altruism. Until then he lived only on food that grew on the land, in addition to the animals he hunted. In such a sustenance society, our ancestors followed the dharma (obligations) of a just order. Even food distribution was equitable, bearing in mind the varied needs of different sections of the people. Pregnant ladies got relatively better food and the old and the infirm were spared of the burden of sharing in the collection of food.

Although the stress of living in such unfriendly surroundings could have been worse than today, not knowing where their next meal came from, the camaraderie and the sense of belonging in such large groups (families) must have more than offset any distressful effects of the environment on the human system.

May be, in our present concept, our forefathers did not set the river Ganges on fire in areas of science and technology, but neither do we seem to have much to write home about our ultimate achievements in the same fields even today. Our palpable gains are not a match to the overt and covert fallout of the same science and technology. The inhuman qualities of head and heart that the present era seems to have built around us threaten to be the forerunners of our doom! It was Emerson who wrote that “if human race were to have an end it shall certainly be through the present day civilization”. One could not agree more. He has hit the bull’s eye.

The earlier we reverse this trend the better for mankind. Trouble started for man from the day the monetary economy was conceived. Today money is our God and making money is our religion. Nothing else really matters. The goal thus achieved, the means do not seem to bother us any more. When society respects only money, the younger generation, nay all of us, are in a hurry to make it big fast, irrespective of what we do. Ethics and good manners are things of the past. Fair means to earn money are also forgotten. In this game merit and authenticity are the two prime casualties. All the crime in society is connected directly or indirectly to money. Greed, passion, pride and ego play the most dominant role in our lives; consequently, society as a whole suffers with the less endowed and less fortunate being the worst victims of this new mania.

There is, at least, one scientific study that has proved the point about money being at the root of all our troubles. “Failure of Scientific Medicine-the “Innu” Community Study” was an excellent exposure of the fallacies of the monetary economy, published in the Journal of Canadian Family Physician years ago.

The “Innu”s were an aboriginal race living in a group of islands off the coast of Saskatchewan in Canada. They had their detailed records on stone slabs. Innus lived long and had hardly any major illness in their natural habitat. Their end came usually because of old age. Centenarians were a common sight then. Their sustenance economy was egalitarian. They lived like a large family without any dependence or fear, except that of predation. Their problems started first in 1732 AD when a priest from mainland Canada brought the love of God and consequent dependence. Years later came the Williams Company dealing in hide to tech the Innu the barter trade. Eventually monetary economy came to Innuland when they became citizens of Canada like any other Caucasian.

With the onset of monetary economy, life totally changed for the Innu. Now they have all the conceivable diseases that a Canadian Caucasian is heir to, just about ten to twenty years prematurely. These precocious illnesses could be traced back to the origin of the monetary economy and acculturation. Recently many scientific studies have repeatedly shown that negative human feelings like greed, jealousy, hatred, and anger are at the root of all human illnesses and misery; while love, camaraderie, compassion and altruism could even reverse diseases! Man, perforce, acquires all the negative feelings in a society that respects only money. Most societies have given a go by to ethics and authenticity as yardsticks for respect and have, instead, replaced them with money or things that money could get.

Most societies have modified their educational systems to suit the present philosophy of dog-eat-dog concept. Knowledge and arrogance have replaced wisdom and humility, which were the catch phrases in education of yore. We have very few seekers in the educational institutions, we have instead degree crazy youth in a hurry to get labelled, to start earning money by fair means or foul. Adam Smith's original definition of total education as that process which prepares a man to " act justly, skillfully, and magnanimously under all circumstances of peace and war" does no longer hold good. We now have the banking type of education where text books are printed like coins in a mint and the printed knowledge (not wisdom) is deposited in the students head to be used to earn a living, just as people deposit currency notes printed in the mint in their bank accounts for day today living! The real education should be the midwifery type where the teacher makes the student want to learn for himself, bringing to surface the best that is already in him, just as the midwife, standing by the side of the pregnant mother, encourages her, coaxes her, cajoles her, empathizing with her to make her deliver at the end of it all. The latter really inculcates humility in the student and makes him realize that wisdom is truly humble because it knows no more!

Another area of society that makes man inhuman is the game of power, mostly political power that gives one an edge over the millions of his countrymen. We have over the years built institutions, basically to empower the powers-that-be to ride roughshod on everyone else in society. Be it democracy, aristocracy, plutocracy, autocracy or communism, the system is so built that it is advantageous to those in power. They would then mould it in such a way to get what they want under all circumstances of peace and war. The four pillars that the so-called democracy has built around it-the parliament, the judiciary, the media, and the bureaucracy- each has its own agenda to safeguard its self interest and rights, least concerned about the hapless victims in society, the common man. Elections are but a farce in truth; the cunning politicians could easily manipulate them. The politicians are special class the world over that "make even murder look respectable" and get away with it. While they normally promise a bridge even where there is no river, "they could give solidity even to pure air".

Ritualistic religion is another fraud on the public. While in theology all religions preach the same philosophy of universal love, and each one is full of wonderful ideals, in practice they hate one another, basically because the rituals built around each religion are done to safeguard the individual ambitions of the leaders to have manipulative power over the poor people. Obviously the more people they have in their fold the better for them! There is no religion that I know of that preaches hatred. All of them, without exception, have such laudable ideals that any religion could be as good as any other, provided one uses religion for his personal development and happiness. When religion is used as a surrogate method to have power over others the problem for society starts. How I wish each one of us understood his own religion in depth to love other religions equally well.

One at times wonders if it is good to have a sober society that follows all the norms of good behaviour! Life might become monotonous and boring in such a set up would be a good argument against the above line of thinking. If one were to extend this thinking a little further and vote for continuing the present "civilization" to continue unabated, there would be no future for mankind. Today even high school students in the West, aged around fifteen, settle individual scores taking recourse to parental guns! Young children, starved of parental love, try to depend on drugs and tobacco. Unfortunately for the business economy-advertising tobacco to the young would fetch the Pulitzer award. The chief of BAT Company got the award a couple of years ago for the best manager. This kind of moral dichotomy can not and would not last long. We need transparency in our dealings. We must not just be authentic but appear to be authentic as well for the future good of mankind and to save it from annihilation as predicted by Emerson. Love all to live well.

UNCERTAINTY IS THE ONLY CERTAINTY

Richard Smith, the then editor of the British Medical Journal, was lamenting, in one of his recent editorials, about the poor communication skills of the doctors in general and their incapacity to deal with the uncertainties in medicine. Doctors have been predicting the unpredictable outcomes of their interventions to patients all along. Time evolution does not depend on the patchy knowledge of the initial state of the patient. This myth of wrong future predictions is at the root of patients losing confidence in their doctors. If one is well and healthy at any given time it is because of chance: if, on the contrary, one is unwell it is again because of chance. This concept is well appreciated in Islam, InshAllaH and AlHamdullillaH mean exactly the same. In fact, the word chance simply signifies God without His signature being affixed.

The answer to this is to teach medical students in training that doctors, like everyone else, are fallible and could make mistakes, but should try to learn from them to avoid repetition. Being honest about the mishap and sharing one’s joys and sorrows with the patient could ease the situation and enhance communication. The crux of the healing process is the coming together of two human beings-the one who thinks s/he is ill or imagines that s/he is ill and the other in whom the former has confidence. This coming together of two human beings with mutual trust is the summit of medicine from where all other aspects like diagnosis, therapy, future management etcetera follow. It is here that the patient gains confidence in his/her doctor.

Sincerity, honesty and being open about the hollowness of the myth that the medical profession could even bring back people from the jaws of death would create a better rapport between the doctor and the patient. Technology, in the last half a century, has deified the medical profession sending wrong signals to patients to expect the sky from their doctors-one of the reasons for the burgeoning consumer suits in the west against the medical profession. This has transformed the holy doctor-patient relationship into that of a seller and a buyer, resulting in the market forces uprooting medical ethics. “Cure rarely, comfort mostly, but console always” was a good Hippocratic advice. It is not what the doctor tells the patient that counts but what the doctor really does that impresses the patient. When once the patient realizes that his doctor does walk his talk, patient confidence could easily be won.

William Osler had this to say to the young medicos of his time that the doctor needs two great qualities of head and heart-imperturbability and aequanimitas. His speech on the occasion of his retiring finally from Johns Hopkins- Aequanimitas-is a piece worth its weight in gold for all times to come.

If the doctor knows the communication skills well, diagnosis becomes a pleasure on the bedside. “If you listen to your patient long enough, he/she will tell you what is wrong with him/her,” wrote Lord Platt in 1949. Recently, five of his old students, conducted a prospective study using the latest research methods to confirm the truth of Platt’s statement in an article in the BMJ in 1975 on the role of history taking and other methods of diagnosis on the bedside!

Confidence builds on the doctor’s capacity to listen to the patient. Listening is a very difficult art. Every medical student should be trained to master the art of listening. Most of us are good talkers but poor listeners. True listening is to be attentive while the patient pours out his sorrows with appropriate responses as and when needed. Prof. Calnan in his very good book Talking with Patients elaborates on the art of listening. Henry David Thoreau wrote, “To affect the quality of the day-that is the highest of arts.” The art of listening to the patient is the capacity of the doctor to enhance the quality of the patient’s day!

Listening to the patient is not confined to listing the patients’ symptoms, past history, his social and family history. The crux of the art of listening is to understand patient’s fears, his religious, spiritual and social beliefs, his cultural upbringing and, more than all that, even his irrational obsessions in terminal illnesses. Even if the doctor is a rationalist and thinks that medicine is a pure science, he/she will have to try and understand the irrationality of the patient’s thinking to respond to that to the patient’s satisfaction. The medical profession has to understand that the only truth, even in the king of sciences, physics, is the uncertainty principle of Werner Heisenberg and not the Newtonian deterministic predictability laws or Einstein’s relativity.

Watenchap is wot whatenchoppen doen-science is what the scientists do-is the real truth and science is not the truth. “Say not” wrote, Kahlil Gibran in his The Prophet “I have found the truth”, rather say “I have found a truth.” Science is only a search for the truth. When the chips are down even the best of rationalists become irrational. Rock Hudson, once President of American Rationalists’ Society, was quietly going to drink the holy water in Lourdes when he was seriously ill, I am told. People swallow their skepticism when death stars them in the face. If a doctor could understand all this, it is easy to deal with uncertainty on the bedside. Modern medicine also started five thousand years ago as magic, witchcraft and sorcery on the banks of the river Nile, anyway!

The “quiet art of medicine” does stimulate the human immune system that really heals. Healing is universally possible while curing is rarely an attainable goal in medicine. A healer must have a large heart coupled with a strong and well trained head. Combining humility and wisdom together is not impossible, albeit difficult. One should follow the advice given by Jesus to his followers. “Be ye therefore wise like a serpent but harmless like a dove.” One of the good books that I could recommend to doctors is On Doctoring by Richard Reynolds and John Stone (Simon and Schuster, New York)

My personal experience since 1956, when I first started seeing patients as a medical student, has been that if I have a genuine interest in the patient’s welfare, the patient would have full faith in me. This matters a lot in the final outcome of illness, uncertainty notwithstanding. Faith heals.

WHAT AILS HIGHER EDUCATION IN INDIA?

Higher education in India, nay in many parts of the globe, suffers from many ailments, but the most important are the following.

Student curiosity is discouraged and the student is not allowed to study what he/she wants to.

Students are not given the necessary infrastructure and support to do just that.

Students are not being protected from many of their teachers who have fossilized notions about their chosen specialties!

The goal of higher education should be the acquisition of wisdom to transform the young mind to act justly, skillfully, and magnanimously under all circumstances of peace and war. As a byproduct, education could also make him/her earn a decent, ethical living. However, the latter should not be education’s sole goal, at the exclusion of the laudable aim pointed out earlier.

Today higher education breeds arrogance of knowledge, in place of the humility of wisdom. Even the arrogance of knowledge is replaced by pride of information. Tolerance has been replaced by hatred as was seen from the terror let loose on America on the 11^th September 2001.

Time is ripe to replace paternalism in education with partnership for mutual benefit and for the good of society at large.

This system needs to be changed-the earlier it is done the better for our future generations. There are institutions of higher learning in many countries; there were many in India in the distant past that encouraged true learning and genuine education. Time was when the white man was still roaming the forests, we had such great centres of learning in Taxila, Nalanda etc. Why not regain that lost glory by building excellent centres again?

Science Education:

This seems to be at the crossroads today. Reductionist science, that ruled the world ever since the beginning of University systems in Europe around the twelfth century AD, has been found to be wanting in many areas. Unfortunately, our science education does not seem to have realized this truth even today. We still hang on to the time-honoured concept that “science is measurement and measurement is science”. Science need not be only hypothesis refutation. There is much more to science than that. One must bear in mind that scientific methods are only one of the many routes to human wisdom. Science is not the only route.

Much water has flown under the Yamuna Bridge over the centuries and sea changes have overtaken conventional science teaching. Science is change; anything that does not change can not be science. The etymological root of science has to be changed from the Greek, sciere=knowledge to the present root skei=to cut into. Curiosity with logical skepticism is the root all discovery. If one properly organizes one’s curiosity, the resulting organized curiosity with logical skepticism becomes the other name for scientific research.

One sees the unorganized curiosity in every innocent child with normal development. A child inspects, feels, licks, smells and destroys toys with innocent curiosity. This unorganized scientific curiosity of a child has to be nurtured and organized by our educational system. On the contrary, our present system kills this curiosity on the first day at school, by feeding information from outside about the outer world and continues to do up until the end of higher education. It is only an exceptional student that tries to unlearn what he had learnt at school and college and relearns the real stuff. Today education, science education at that, is only replication. Knowledge does not progress by repeating known facts; it could do so only be refuting false dogmas. There are innumerable myths in science that needs to be demolished forthwith!

One quick example would exemplify the above statements. Friday, the 13^th is an inauspicious day for most Christians. Scientists, naturally, think it is only a superstition. A couple of years ago, a retrospective study of all the Fridays that fell on the 13^th of a month were examined with computerized data for two measures in England. The deaths due to accidents on the motor way M25, and the sudden unusual deaths in the North Thames Group of Hospitals in London for five years. There were 20 such Fridays in five years. The results were a revelation to the scientists.

* Only 50% of people used the M 25 on those days, showing that 50% of the population believed in the so-called superstition and stayed indoors, even today in Briton.

Despite that the accidental deaths doubled on the road on those days. Statistically death rate would have quadrupled had all of them used the road that day.

Death rate due to unusual sudden deaths went up three times on those days.

The scientific conclusion of the study was that Friday, the 13^th is inauspicious to 50% of Britons!

Another study that would baffle the rationalist is published in the most prestigious Archives of Internal Medicine from the USA. This study prospectively studied two comparable groups of patients admitted with a heart attack to a University hospital of nearly 5000 patients. Without the patient’s knowledge and the treating cardiologists' knowledge, one half of them was prayed for at a distance (intercessory prayer). All other treatment and interventions remained the same for both the groups as the doctors were blinded as also the patients (double blind study). The prayed for group at the end of five years had all coronary care unit scores significantly reduced compared to the not prayed for group. That included death and disability as also going back to the original employment after recovery. On an average the prayed for group stayed for a shorter time in the hospital. The conclusion of the study was that intercessory prayer did help patients after a heart attack! I am sure our reductionist scientists would become sad after reading this! This is precisely why I wrote that human wisdom does not get confined to the five senses only, as is presumed by reductionist scientists.

The good news is that the new science of “holism”, called the science of CHAOS, would chalk out new paradigms in science for the future and it would use non-linear mathematics for calculating the power of future predictions. Quantum physics has been changing for the better for a long time now. The trend took a turn after the “Uncertainty Principle” of Werner Heisenberg and new concepts of Ervin Schrodinger and others in that field.

“In the twentieth century, however, physics has gone through several conceptual revolutions that clearly reveal the limitations of the mechanistic world view and lead to an organic, ecological view of the world, which shows great similarities to the views of mystics of all ages and traditions. The Universe is no longer seen as a machine, made up of multitude of separate objects, but appears as a harmonious indivisible whole; a network of dynamic relations that include the human observer and his or her consciousness in an essential way.” Wrote Fritjoff Capra in his celebrated book “The Turning Point.”

He further went on to say that “ the Cartesian view of nature was further extended to living organisms, which were regarded as machines constructed from separate parts….. The contributions of such founding fathers of science as Francis Bacon, William Harvey, Rene Descartes, Thomas Hobbes, and Isaac Newton must be re-evaluated…The idea of life as an ongoing struggle for existence, which both Karl Marx and Darwin owed to the economist Thomas Malthus, was vigorously promoted in the nineteenth century by the social Darwinists…..overlooking the fact that all struggle in nature takes place within the wider context of co-operation.” How true!

Medicine and other sciences should have taken this lead and changed their attitude taking into consideration the all important human consciousness (the mind). If one does that one quickly realizes that science comes closer to eastern mysticism than any other view of man’s existence on this planet. Recently many important studies did reveal the fact that it is the human mind that is at the root of all human illnesses and keeping the mind tranquil is the best preventive strategy. In short, it is not what you eat that kills you; it is what eats you that kills you.

This is where the science of astrology comes to fore. People get mad when astrology is referred to as a science. Many of these people feel that science is their personal property and any intrusion from sources inimical to them should not come into the fold of science. This is the greatest blow to science. As mentioned above, science is just curiosity and organized skepticism. Let us measure astrology by these yardsticks. The objections to astrology are mainly the following.

Future predictions do not come right!

Sun and Moon are not planets.

Raahu and Ketu do not exist like other planets.

People born at the same time do not have similar time evolution.

Celestial bodies can not have any effect on human life.

Charlatans use astrology to fool the gullible public.

Let us analyze all these scientifically.

Future predictions: can not come right in any field, be it physics, astrology or medicine. To be able to predict the future we should have all the details of the initial state of the organism. If a doctor has to predict the future of his patient he should know the patients physical state, his mental state and also his genome and his response to the different celestial bodies. All these are unattainable with our present state of knowledge. We have, of course, been predicting the unpredictable. With all the supercomputers, weather predictions of short duration rarely come right. Edward Laurenz himself propounded the “butterfly effect” to get round this problem. We are where we were. Before rationalism and reductionist science coming on the scene we were all Pascalanians, believing in the Law of Probabilities. In reality, it is only probabilities that matter in future predictions. Let us not, therefore, blame astrology alone!

Sun and Moon are not planets: So what? We are not dealing with planetology. We are dealing with astrology. The latter deals with astrol (a heavenly body regarded as exerting influence on mankind and events-Webster’s Dictionary) where sun and moon also are included. In fact, sun was a planet in the olden days.(Gr. Planetes=wanderer.Webster) By another meaning the moon also becomes a planet. (Any one of the heavenly bodies revolving about the sun and shining by its light-Webster). Astrology does not deal with planets but with gruhas (astrol).

Raahu and Ketu do not exist: Similarly, the North Pole and South Pole do not exist on the planet but they are mathematical reference points. Similarly Raahu and Ketu are reference points where, when a particular Gruha (astrol) reaches the effects on mankind and events are specific and defined. They are reference points for calculations only and are not planets in the true sense of the word.

People Born at the same time do not have similar time evolution: Time evolution in any dynamic system, as stated above, depends on the total initial knowledge of the organism and as such even if one is born at the same time and has similar astrological charts their future might not be identical as their consciousness (mind) and their physical body features (phenotype) could (should be) different. It is in agreement with the laws of nature. Imponderables being what they are future prediction (Achilles heal of astrology) need not come true!

Celestial bodies do not have any effect on the human system: is a statement made by the so-called scientists who do not seem to know their science well. Many studies have shown the significant effect of the moon on the human system to give only one example. Lunatic as a word denotes the knowledge of even our forefathers about the role played by moon’s phases on the mental attitude of psychiatric patients. While the moon’s gravitational pull could displace billions of tons of water in the oceans producing high and low tides to say that the same moon does not have any effect on the human body, made up of water to the extent of nearly 80%, looks ridiculous. Scientific studies have shown how elective surgery done during the full moon day vis-à-vis new moon day has significant difference in blood loss. So many such studies could be cited.

Charlatans misuse astrology and dupe the gullible public: Are there no charlatans in main line science? Fraud in scientific research is rampant. A recent estimate in medical literature threw up the possibility that majority of published data could be fake! Only those who are inside science circles know how faking is done and how fakes get even awards and prizes-or is it that they get it many more times compared to the genuine ones! The 1927 Nobel Prize for Medicine went to Wagner Juregg, who later was found to be a cheat! Why make an exception of astrology. As long as there are dishonest people in society there will be their share in every walk of life-astrology included.

If one were to analyze the recent horrible human tragedies in the USA one would come up with the following conclusions. Our rational and scientific education has brought out bright engineers and scientists that have been able to build airplanes and sky scrapers using linear mathematics and the Laws of Deterministic Predictability, but did not impart the proper education of co-operation in human existence not to collide the two to kill their own brothers and sisters. The terrorists must have studied the Darwin’s theory of “the survival of the fittest” and also about the “socialistic” norm of struggle for existence. These are the things we teach in main stream education and oppose spirituality in education as something poisonous. Spirituality is sharing and caring and that has nothing to do with religion. If only we had inculcated the values of sharing and caring the human tragedies that overtook innocent humans in NewYork and Washington would have been avoided.

Education must inculcate human qualities of head and heart in every student and make him human and humane, taking him away from his animal instincts. The present Macaulay style education only teaches competition and not co-operation. Both Darwin and the socialists took their lessons from Thomas Malthus, the economist, who taught struggle as the basis to come up in life. Little did the Malthusians realize that all struggle originates in co-operation! Our social Darwinists should realize this fact and the earlier they did it the better. Now that the big brother, America, is flexing its muscles, the results could be further sorrow to the innocent people of the world. Only love will win a war and not hate. This is true education.

At least now our die hard social Darwinists would agree that education should include spirituality in it. One of our good education ministers in the past, Moulana Abdul kalam Azad, in his letters to then powers-that-be did urge the need for spirituality in education. He warned that “if we do not do that, fanatics in each religion will teach and interpret their religion in a dangerous way, making life miserable for people. It is only when one understands his/her religion well does he/she love all other religions. The need, therefore, is to teach spirituality and not religion in schools and colleges in addition to the three Rs.” ( India’s Moulana –ICCR publication ed. Veena Sikri)

Darwin’s Theories have been found wanting now. There are certain species that alter the features of their offspring in the womb to withstand dangers in future life. A variety of lizard, when pregnant, on smelling an enemy snake, changes the smell organ of its foetus in such a way that the new born would be able to smell a snake at ten times the distance the mother could do. So many such instances could be given. This goes against the very foundation of the survival of the fittest theory. In man, the mother, who is ill fed during the first trimester of pregnancy, brings out an infant that has poorly built heart, blood vessels and pancreas. Such a child gets heart attacks, high blood pressure and diabetes at an early age, precociously. This also goes against Darwinism. Many more examples could be given. But the establishment wants to sell Darwinism at any cost. There is a department of “Science Communication” in Oxford that does just that. One has only to read the book The Blind Watch Maker, by Richard Dawkins, the head of that department, to know how they bend over backwards to sell science in its present avatar. It is sad that our gurus do not want to know the truth!

Scientists and pseudo-scientists please take note that science has not found its Holy Grail and is not drinking from it. Far from it. The growing weight of specialization and sub-specialization is slowly disintegrating the present science of reductionism. We need to have a holistic view of the Universe for the future good of mankind that takes into account all aspects of life, including economics, sociology, the environment and spirituality. It is the coming together of all these that would make this world tranquil-the dire need of the hour in place of

WHAT SHOULD BE THE SCIENCE OF THE FUTURE?

Anything that man does on this planet should be guided solely by the holistic interest of mankind. Science so far has been trying to do just that but got derailed somewhere en route and got bogged down by monetary interests and the fame attached to scientific discoveries. Science, in the true sense of the word, only means organized curiosity to understand the secrets of Nature. "Nature", said a great thinker, Chakravarthi Rajagopalachari, " is like your mother and if you respect her she will feed you and look after you; on the contrary if you treat her as your mistress she would kick you in the back!" A genuine scientist, who is an infracaninophile, should, therefore, think of the future generation and not of the immediate glamour, awards, monetary gains, and honorary doctorates and such like.

Studies even in the West have shown that there are vested interests that bring pressure indirectly on innocent researchers to see that they get their desired results at the end of the day! Science Without Sense by Stephen Milloy is one such book that bares the ugly face of medical science research. A recent article in the British Medical Journal (24^th June 2000) issue reads like a horror story. The title is revealing Seeing What You Want To See in Research! More recent editorial in another leading journal The Lancet entitled Influence of Drug Company Money on Medical Education in the USA, exposes the hollowness of our scientific ethics and morality. Ethics are there only in absence. Morality seems to be a dirty word in science.

I am sure that the story is no better in other fields. May be it is different. There have been instances of genuine researchers suffering because of their trying to uphold the truth. Most of the research for which poor taxpayer's money is spent is replicative in nature; consequently, it could not add any new knowledge to the existing pool. That apart all research in a poor country like ours must have direct relevance to the people. A small field could be examined. Whereas chemical fertilizers and pesticides could give apparently better results in the short run do they not deplete mother earth of all its potency? Do they not destroy the ecological balance? If earthworms are destroyed who would burrow the earth to make it breathe oxygen? What would be the long-term effect of pesticides on human health? DDT alone must have been responsible for human misery of unimaginable dimensions!

Nature intended wide-ranging cross-fertilization to get robust offsprings in any area of reproduction, including humans. Genetic engineering, to bring quick results, would negate this natural concept by narrowing down the genetic selection process. The resulting strain could be vulnerable to even slight change in the environment and a time might come when we may not have any crop at all. Are there not natural cousins of the two common edible cereals in nature? I understand there are hundreds of varieties of cereals in the wild, which are very closely related to rice and wheat. If they are investigated and found fit for consumption it would a great boon to mankind. Just to preserve the shelf life, potato has been engineered using a gene from a virus from the arctic region. If only this eventually mutates to make the edible potato into a poisonous variety of which there are many in the forests, we would lose even the few that are edible! Greed is the key word in every field.

Scientific greed is still worse. When I first came to know about the pulls and pushes applied even for the Nobel Prize, I lost all faith in scientists. The story of the Nobel Prize in Medicine in 1927 to Wagner Juregg is an example. I am sure there are many more. If that were so what of the lesser awards. Less said about them the better. Fraud in science is rampant. Some of the most prestigious journals had to retract important articles from "star performers" in the field. John Darsee affair stands on the top of the list. While science in principle is laudable many scientists even of repute have feet of clay. A rare unfortunate fellow gets caught, while the majority goes about as great scientists of repute. They are the ones who manage to get top ranking posts in all areas as they are the masters in the art of living in this make believe world. Society blames only the poor politicians for all our ills, while many of our problems could be traced to greedy scientists who connive with the manufacturers of various technologies and the like.

What is the remedy?

Shakespeare had once said that man, whether in the palace or pad; castle or cottage, the same passions and emotions ultimately govern his actions. Our educational system teaches the new comer into the system, even as early as in the kindergarten stage, all the negative emotions of greed, anger, jealousy, hatred, and pride in the name of competition. While these bring on all the diseases in later life, they also make life miserable with all the crimes included. The present system never gives one the truth about the oneness of all that exists on this planet. The king of sciences, physics, now understands that there is nothing solid here and all of us are but bundles of jumping lepto-quarks, which keep changing from one to another. When one realizes the significance of this scientific truth altruism, per force, gets rooted in the young mind. While the present system is very good in teaching objective, external, intellect based education, it totally fails to impress upon the virgin human mind of the wonderful arena of the subjective, internal, and intuition based altruistic knowledge.

The remedy lies in rewriting the syllabus to be based on the latter idea of inner world of man. Total education includes the essentials of humane cultural moorings. Culture could be defined as that which remains with us when all that we studied in school and college is forgotten. This must prepare mankind to act with equality, justice and beauty under all circumstances. Scientific bent of mind is the one that has all these qualities plus that element of curiosity. If one could combine this curiosity with a judicious dose of skepticism and logic one becomes a wonderful scientist. The latter would in addition have an authentic trait that would drive all his actions with altruism as the guiding principle. Society must learn to respect authenticity and not fame and power. Power of all kinds corrupts the mind-it could be money power, muscle power or brain power that many scientists now possess in good measure.

HUMAN NUTRITION AND BRAIN DEVLOPMENT

“All things are artificial, for

Nature is the art of God.”

Sir Thomas Browne.

One of my old students, a very good one at that, is a professor in the University of Minneapolis. This boy, Raghavendra Rao, has done a lot of good work on brain development; he is a neo-natologist: a doctor who looks after the new born. His extensive work in rats and its extrapolation to human beings has revealed that the part of the brain that looks after human memory and many other crucial activities, the hippocampus, depends on the supply of iron for its early development both within the mother’s womb and outwith it.

He has been working with American mothers who have usually full blood haemoglobin, the iron containing blood pigment, that carries oxygen to all parts of the body. Raghavendra’s work deals with women that have marginally lowered haemoglobin levels. (Below 11 Gm%) In addition, all American baby foods have much higher iron content than Indian ones. If in that environment premature baby’s brain development gets affected due to lack of iron supply, what of the babies born in India to mothers whose haemoglobin content, in the villages, is very low indeed. Americans can not believe that our patients with such low haemoglobin levels are alive! I keep telling my European friends that they are not only alive but they are kicking!

Nutrition is the key to early development. The above mentioned work is only a microscopic part of the holistic development of a child. A recent survey in India showed that seventy per cent of Indian children have only fifty per cent haemoglobin. Mothers are still worse. While the poor diet that the less fortunate get in the first place is bad, the bigger enemy is the hookworm that parks itself in the human duodenum, (the first part of the smaller intestine) where majority of absorption of iron takes place, to eat what little the host gets in the first place. The hookworms develop well at the cost of the host. Most children in India harbour the hookworms as most of us are exposed to the larvae of the worm in wet soil. One need not have a break in the skin to let the larva get in. It could enter even intact skin. The usual periodic deworming is no answer as the worm re-enters the host again and again. The free for all defecation results in the ubiquitous presence of hookworm eggs. Rains help them to get evenly distributed all over for the steady supply of hookworm larvae to children and adults alike.

It is no wonder that we have not produced another Tagore or Raman. While the vast majority of Indian children are born to mothers whose haemoglobin levels are abysmally low, they, in addition, play host to our friend hookworm described above. This is a deadly combination. It is a wonder that despite all these we still have made a mark in the intellectual field in the international arena. The story is no different in the sports field. We seem to be doing the wrong thing at the wrong time. We spend lots of money to train sportspersons in India, while their blood oxygen supply is stifled because of the hookworms. How could we get Golds in the Olympics? If our Ushas and others had their mothers full blooded they would have beaten Roger Bannisters hollow. Many more would have come up both in the intellectual field as also in sports.

That is not to be as the powers-that-be do not seem to bother about my cry in the wilderness about our priorities- toilet plus for every home to eradicate hookworms followed by clean drinking water and smokeless house with three square meals for the poor, uncontaminated by human and/or animal excreta. Many of our leaders, even medical politicians, think that hospitals, technology and doctors keep the health of the public. The truth is otherwise.

Doctors and hospitals label healthy people as ill and help the drug and the instrument industry’s business. They harm human health in the bargain. Studies have shown that in places where there are more doctors, there is less health and vice versa. Education of girls and empowering women economically, in addition, would obviate the need for hospitals and expensive hi-tech procedures in our country. This will also bring down our much needed birth rate as a bonus! Unfortunately, even after more than half a century of political independence the poor pay for their poverty with their lives.

Building toilets to eradicate hookworms is not a very hi-tech stuff that can not be done indigenously. It there is a will there is a way. One could easily transform our poor villages into heavens for people to migrate back from the cities that are bursting at the seams. Our villages still have the best environment without pollution while the pollution rate in some of our cities is so high that children below the age of five could hardly survive there. This kind of reverse acculturation is the need of the hour if India were to go forward. Technological advances and economic prosperity alone are only an illusion of growth. Real growth comes from human growth, both physically and spiritually.

Monetary economy, ignoring human development, would ruin us in the long run. North America is a good example. Whereas the Americans, who form a small fraction of the world’s population (one third that of India), control and consume eighty five per cent of the world’s wealth and resources, the rest of mankind will have to make do with just fifteen per cent of the resources. Are the Americans happy? Far from it-very far indeed. The biggest epidemics there are suicides and divorce. While the rich there suffer from all diseases because of the fear of the poor, the latter, on the contrary, die because of the greatest stress to mankind since the time of the Yangtze Valley peasants of China-not knowing where the next meal comes from. To cap it, the gulf between the haves and the have nots is widening there by the day! Suppression, oppression and denial are the mothers of all kinds of terrorism that America is feeling the pinch of these days.

Wise people learn from their mistakes while the wiser people learn from others’ mistakes. Should we not learn from history to build an egalitarian society with the modest means at our command? This is a great country with the largest human resource and enormous natural resources. We have to build our human resource both physically and spiritually in the future to build India-the world leader in the past-into a great nation of good human beings who love the whole world as their own large family.

“It is better for a city to be governed by a good man than by good laws.”

HEALTH CARE VS MEDICAL CARE.

I am amused at the interpretation of the present day medical world as health care world by the learned reviewer of this book.

Doctors do not have anything to do with health care at all. We do medical care of trying to mend the broken glass with some glue that we think would make it work again.

“To believe that doctors and hospitals help keep people healthy is plain rubbish,” wrote one of the great British physicians. “How to avoid modern medicine” is the title of an article written by the Late Lord Platt in the early 60s.

“More people make a living OFF hypertension than die OF it,” wrote Sir George Pickering, a former Regius Professor of medicine in Oxford, who also taught for sometime at the Johns Hopkins. He was a great hypertensinologist who had written that great monograph on hypertension. He also wrote that the anti-hypertensive drugs robbed the patient of all that is enshrined in the American Constitution (Thomas Jefferson 1772) of “life, liberty and pursuit of happiness.” Life, George said, we are not sure, liberty patient does not have, and happiness would be a thing of the past!” How true?

Richard Asher, that great clinician, who spent four decades teaching medicine at the Central Middlesex Hospital, London, wrote, “Riva Roci would grieve indeed, if he were to look at the abuse and misuse of the little box that he invented to make life miserable for human beings.” The BP apparatus that he was talking about. All this was long before the “HOT Study” and the ALLAHAT study.

We are not told why the HOT study was prematurely stopped and the results analysed by “intention-to-treat” analysis while quite a few that started the study had dropped off by then because of intolerable side effects.

Re-analysis of the famous UKPDS study showed how the authors were “seeing what they wanted to see” in the study.

“Eye of the Beholder”, is a good reanalysis of the “good” that bypass surgeries were supposed to do.

CAST study showed that all that glitters is not gold.

Statins are made out to be a panacea for all ills.

It looks as if there is a pill for every ill; while in reality, it is the other way round. Every pill has an ill, if not more, following it!

A recent analysis of the immediate post MI revascularization showed that “getting admitted after a heart attack to a hospital was the greatest risk factor for stroke. This risk was much greater than hypertension, diabetes etc.!

Swan-Ganz catheters, albumin infusions and, some key-hole surgeries have all come to grief sooner than expected.

AIDS research is four times “richer” than cancer research!

Health needs very few things: clean drinking water for all mankind, three square healthy meals uncontaminated, clean surroundings for dwelling, tranquility of mind, and moderate exercise on a regular basis. None of these are the concern of modern medicine.

Health is our birth right. Our inbuilt immune system will keep us going as long as it could. In the unlikely event of it failing only should doctors intervene to “cure rarely, comfort mostly, but console always.” Modern medicine’s biggest curse has been “not letting the well alone.” Screening the healthy for early diseases and intervening has been the bane of modern medicine although it has been a boon to the industry-the medi-business.

When healthy never go to a hospital. One should see his/her doctor at the first sign of anything going astray with one’s body or mind.

The greatest discovery of science in this century has been the discovery of man’s ignorance.

MEDICAL EDUCATION IN INDIA

PRESENT SCENARIO:

The same old syllabus, brought here by the East India Company in 1857, to start three Medical colleges in the then Madras, Bombay and Calcutta cities, with very minor variations here and there, remains the basis of our present teaching.

Teaching is predominantly didactic-theory based.

Practical training is mainly inside the four walls of the tertiary referral hospitals.

Innovation is not possible in this Permit Raj with the watchdog bodies breathing down one's neck.

Most teachers have not had any training in teaching techniques.

Emphasis is only on the examinations and never on the real life situations out in the real world.

Very few role models for students in the medical schools.

Textbooks are western (written with money from drug and technology manufacturers) with stress on technology and the philosophy of a "pill for every ill".(ref: Lancet 2000; )

Too much to teach and very little time for the student to think and learn for himself.

Research is mostly repetitive and rarely refutative.

Stress is not on our local and regional problems like malaria, tuberculosis, filariasis, AIDS, malnutrition, Hookworm infestations, anaemia, poverty related diseases, lung diseases due to cooking smoke and diarrhoeal diseases.

Research stress is on transplants, stem cells, infertility etc-funded from the west with strings attached.

PROBLEMS:

Too many examinations with very little time in between for students to concentrate on practical solutions. Every subject (specialty) is an examination subject now.

Too much information and no time to have any hands-on empirical knowledge and experience.

No training in research methodologies.

The teaching and learning are alien to Indian ethos.

Teaching based on hi-tech methods making the young student mind to be totally technology oriented.

Very little knowledge of PUBLIC HEALTH-HEALTH OF THE PUBLIC.

Pharmaco-economics, ideas about the capacity of the buyer to pay for the drugs and technology is not being taught at all.

Human emotional and cultural aspects (including the spiritual part of illnesses) are not taught. Bereavement is another area that is untouched in the present syllabus.

SUGGESTED SOLUTIONS:

Make the syllabus need based for Indian conditions.

Give more time for students to learn for themselves.

Provide them with all the facilities to learn.

Lessen the didactic lectures and introduce only small group tutorials.

More time to be spent in unraveling the mysteries of human illness in direct contact with the "real-world patients", putting student in charge of patients as the first contact person, under careful supervision.

Emphasis in teaching should be on methodology and not on factual data. The latter changes very fast in medicine with new knowledge pouring in at 7% per month, through thousands of bio-medical journals. PROBLEM BASED LEARNING, IN THE COMMUNITY (NOT IN THE HOSPITAL SET UP), WHERE TEACHERS AND STUDENTS ARE PARTNERS IN CARING FOR THE SICK, SHOULD BE THE FUTURE METHOD OF TEACHING. This will make the new doctor confident to practice medicine anywhere, even in the remote villages.

Scientific studies have shown that careful listening to the patients and then bedside examination gives 80% accuracy in final accurate diagnosis. All the hi-tech stuff just refines it eight more per cent. Medicine, of the highest order, could be practised even in a remote village without any gadgets and laboratories, if the doctor is properly trained! The best gadget and the best laboratory are both situated in a well-trained human brain. Doctors must be trained to be human and humane, in the first place. Rest of the theory of medical practice could be acquired easily as one goes along in life.

Continuing Professional Development (CPD) must be an integral part of a doctor's life and the responsibility of every medical school in the area in the new set up.

Next plan should lay emphasis on PUBLIC HEALTH RESEARCH. AND

DRINKING WATER TO EVERY CITIZEN BY THE PLAN END.

THREE MEALS A DAY FOR THE POOR-NOT CONTAMINATED WITH HUMAN AND/OR ANIMAL EXCRETA.

TOILETS IN EVERY HOUSE TO AVOID HOOKWORMS EATING THE PRECIOUS LITTLE PROTEIN RESULTING IN 70% OF INDIAN CHILDREN HAVING ANAEMIA EVEN IN 2001!

To reduce the monetary burden of health care delivery, we have to evolve a new system of INNOVATIVE medical care using the best in many different systems of medicine, selected after careful scrutiny of the scientific validity of the claims in many systems of medicine. 10% of emergency quick-fix solutions must, per force, come from modern hi-tech medicine. Rest could be managed with help from Ayurveda, Homeopathy and Sidda and Unani etc.

WE MUST REALIZE THAT HEALTH CARE IS NOT SYNONYMOUS WITH MEDICAL CARE.

RESEARCH MUST BE PREDOMINANTLY ON OUR LOCAL AND NATIONAL PROBLEMS AND NOT BASED ON THE WESTERN NEEDS. WE SHOULD NOT ALLOW INDIANS BE USED AS GUNEA PIGS FOR WESTERN NEW DRUG OR TECHNOLOGY TESTING AT ANY COST.

PLANNING COMMISSION COULD ALLOT MONEY SEPARATELY FOR RESEARCH ON TUBERCULOSIS, MALARIA, AIDS, RHEUMATIC FEVER, NUTRITION, -ESPECIALLY PREGANANCY NUTRITION, HERBAL MEDICINES RESEARCH ETC.

SPECIAL INSENTIVES AND PRIZES MUST BE INSTITUTED IN THESE AREAS TO ATTRACT TALENT TO THE FIELD.

RESEARCH IN A BIG WAY IS THE URGENT NEED TO VALIDATE THOUSANDS OF HERBAL MEDCICINES OF GREAT VALUE IN OUR ANCIENT TEXTS TO MAKE DRUGS INEXPENSIVE.

CHANGE THE SCENE FROM 20% PEOPLE ACCESSING HEALTH CARE IN THIS COUNTRY TO 100%.

PUBLIC EDUCATION ON HEALTHY LIFE STYLES THROUGH MEDIA WOULD REDUCE DISEASE BURDON MORE THAN ALL THE ABOVE METHODS AND IS THE NEED OF THE HOUR.

MENTAL OBESITY.

Culture is “to know the best that has been said and thought in the world.”

Mathew Arnold.

Increase in body weight disproportionate to the height, with excess fatty deposits under the skin, known to the lay man as obesity, has become a menace to society these days especially in the affluent west. It is difficult to see a really obese poor person in our villages. It is also rare in certain societies like the Japanese. Obesity has reached its zenith in the US where almost every other person seems to be obese. It has become a good money spinner for the pharmaceutical, technology and the food industry. Almost every day you get to see the advertisement of a new gadget, a new drug, or a new crash diet claiming to get rid of your extra flab without any effort in a very short time! Most, if not all of them, are only tall claims. In reality none of them would succeed on a permanent basis. Some of them are down right risky and could even kill. The fear of obesity and the mad rush to look thin, has resulted in many western girls developing a new disease where they hate food and vomit at the very thought of food, eventually getting depressed. Bulimia, as it is labeled by doctors, is a new disease of the present century.

Every health related magazine and even news papers seem to be full of stories about the dangers of over eating and obesity and there are wonder cures for the condition galore. The latest fad seems to be low carbohydrate, otherwise called the low-carb. mania. It is estimated by The Times Magazine that nearly 1558 low-carb. products have been introduced in the US alone in the last two years, with an estimated sale of more than $30 billion a year. To give the reader a different perspective, this is about five times the gross domestic product of many smaller countries. Then there are hundreds of other low fat, high protein diets that ruin the health of the literate public and increase their anxiety levels. It is not what one eats that kills one, but it is what eats one, one’s negative thoughts, the very heavy mental flab, that kills in the end. Overwhelming evidence today points to the primacy of the mind in the causation of all the killer diseases, starting from heart attack, cancer, stroke and what have you. Obesity is no exception to this rule.

Many of us overeat when we are not happy and/or are depressed. Similarly many people lose weight and do find it difficult to eat when they are being troubled by extreme anxiety and guilt. Even when one is very, very happy appetite could get depressed. There are a few who depend on food to satisfy their psychological cravings and get obese consequently. While these are novel medical wisdoms, our ancestors in all societies and in all the major religions have been proclaiming to the world the real cause of man’s misery due to illnesses. Whereas modern medical science says: “you are what you eat,” the science of spirituality goes to say that: “you are what you think.” In short, it is the content of the human mind that weighs heavier than the content of food fat etcetera in the final outcome of obesity and other diseases. This wisdom was the essence of the science of Ayurveda that has existed for “time out of mind” in this holy land, India. The bija mantra, the foundation, of Ayurveda is: “prasanna aathma indriya manaha, swastha ithyabhideeyathe.” As long as the mind is free from all the dangerous negative thoughts and is filled with universal love, good health will be guaranteed. Patanjali’s Yoga Shastra with its advocacy of the sattvic diet and chitta vritti nirodhah (control over ones greedy desires) would, of course, be the ideal recipe for ideal body weight and good health.

Mary Baker Eddy wrote a treatise Science and Health with Key to the Scriptures wherein she quotes extensively from the Bible. Jesus Christ taught, rightly so, that it is not what goes into one’s mouth that creates problems but, it is what comes out of it that is dangerous to human health. And in Luke's Gospel he says, "Do not worry about your life, what you will eat; or about your body, what you will wear. Life is more than food, and the body more than clothes" This counsel about food anxiety by Jesus sounds extraordinarily contemporary. The Bible talks about the inner hunger for spiritual satisfaction that might be at the root of either overeating or self-starvation. The biology of the physics of obesity might have to do with eating but the meta-physics of obesity might depend on the inner discontent with a heavy mind full of the massive load of the negative feelings like hatred, jealousy, ego, pride and anger. Universal compassion might be the best and inexpensive antidote to today’s epidemic of obesity. Rather, it is the mental obesity that manifests as physical obesity in reality. The holistic approach to obesity starts with spiritual management by a thinking doctor. That, when coupled with a sensible simple diet, would cure obesity permanently. All other quick-fix methods like the crash diets would necessarily come to grief in this background.

“Feast on giving. Happiness consists in being and in doing good," Mary Baker Eddy observed, "only what God gives, and what we give ourselves and others through His tenure, confers happiness: conscious worth satisfies the hungry heart, and nothing else can." “Find contentment in who you are and what you already have. The most vital truth about each of us is that we are God's own daughters and sons. The most filling thing we all have is God's constant love. To understand ourselves as loved children of God is profoundly satisfying. Each of us mirrors our Maker in wonderfully individual ways. We can dine on that reality. Snack on it in needful or reflective moments.” wrote the Christian Science Monitor some time ago. How true? My good friend Major Solanki, through his Inquest Foundation, Bangalore, is doing God’s work in spreading the message of obesity management through spiritual means-sans crazy diets and weight reducing gadgets. May his tribe increase for the good of humankind.

In the Sura V of the Holy Quran, the verse 96 is very explicit in this direction.

“On those who believe

And do deeds of righteousness

There is no blame

For what they ate (in the past)

When they guard themselves

From evil and believe,-

And do deeds of righteousness,----“

English Translation by Abdullah Yusuf Ali.

There is a subtle symphony in what appears to be repetition. In fact, relationship of such simple regulations like food etc has to be explained vis-à-vis man’s duties to his fellowmen. The essential message of this verse in the Holy Qumran is that food is less important for human health than righteousness. In short, all the scriptures in every religion proclaimed to the world that it is the man’s mind with his awareness of his higher duties to God’s creations (other fellow human beings) that determines one’s happiness or ill health on this planet.

If one unloads the mind of all these destructive heavy negative thoughts, one quickly realizes that not only truncal obesity but all other physical illnesses will get corrected with additional sensible changes in life style. This will take away the risk of having to take potentially dangerous pharmaceuticals for every minor or major deviations from normal health. While there is no pill for every ill, every pill has an ill following its prolonged use under all circumstances. Our modern medical quick fixes are all fine in an emergency. Barring that one of the major causes of hospitalization in the US is adverse drug reactions (ADR). Just as a bath is a necessity to keep the body clean, a cleansing bath for the mind by washing away negative thoughts would be good for the mind and good health in turn. Physical overweight (obesity) is not as serious a disease as mental overweight (obesity), where the mind is bogged down by the heavy destructive emotions.

“The best of man is he from whom good accrues to humanity.” Prophet Mohammed.

MOTHERS, BABIES, AND KILLER DISEASES.

“A mother is a mother still,

The holiest thing alive…..”

Coleridge

Thanks to a dedicated community nurse midwife in Hertfordshire County in England, Ethel Margaret Burnside, who despite all the drawbacks tried her best to reduce the infant mortality in the early part of the last century, before the First World War. She was known as the bicycle nurse as she did not have a car to go about. The meticulous records of every birth there, recorded in indelible ink in her best handwriting, gave new insight into the possible triggering factors of major killers like heart attacks, vessel blocks, high blood pressure, and diabetes etc. Of course, you would wonder as to what is the connection between the two! Another equally tenacious researcher, Professor David Barker of the Southampton University, who was born in that County, chanced upon those records when he went in search of his sister’s birth details. The records are the property of the archives now. They are not to be disclosed for another fifty years. Because of his sister’s birth, David could access the records.

He tried to get all the medical records of those babies, now in their 80s and 90s if alive, and also the death details of those who had already gone to meet their maker. Luckily, all this was possible in that country. Having obtained the details David then went on comparing their medical details with their birth details not knowing that he would stumble upon one of the rare discoveries. Those babies that were born underweight were the ones that had premature heart attacks, diabetes and vascular diseases as also other medical problems in later life.

David went into greater details of these smaller than normal babies only to discover that they were born with very large placentae. He was able to fish out the details of the mother’s pregnancy of these babies as well, thanks to the efforts of Ethel mentioned above. Almost all the mothers of the babies that were born small with very large placentae came from either a very poor background where they did not have proper nutrition during the first trimester of pregnancy when all the foetal organs get formed inside the womb or had a rare disease called hyper emesis gravidarum-pregnancy vomiting-resulting in the mothers not taking sufficient nutritious food. May be nature, in its wisdom, tried to keep these babies alive inside the womb of a poorly fed mother by increasing the size of the placent two to three fold to see that the baby gets much more blood to somehow keep it going.

David Barker put the pieces of the jigsaw puzzle together and came up with his hypothesis that underweight babies whose mothers were undernourished during pregnancy, especially the first trimester, did not have properly built organs like the heart, blood vessels and the pancreas which, in later life, especially if the hapless offsprings put themselves in the food-plenty environment, could result in premature vascular damage, heart diseases, as also diabetes.

Although the hypothesis was attractive, vested interests would not accept it without proof. David was lucky twice. He found out that a veterinary researcher in New Zealand was studying the same problem in ewes prospectively and had come up with the data that if the mother is deliberately kept undernourished during the time of the formation of foetal organs, the foetus would either die in utero or the surviving foetus is kept alive by nature through extra supply of blood to the growing foetus through a larger than normal placenta. This was the much needed support that David obtained for his serendipitous discovery of the Hertfordshire county retrospective data. David has helped similar study in India at the Holdsworth Memorial Hospital, Mysore, where similar records are available. This hospital was founded in the name of a Hertfordshire county nurse whose husband kept the memory of his late wife alive in a city where his wife worked as a missionary nurse.

This has a great lesson for the developing countries like India where majority of women, especially from the socially deprived classes, would have poor nutrition during pregnancy. Rich ones also might not eat well due to pregnancy vomiting or due to the new fad of thin figure as a beauty symbol. This could be one of the important contributing factors for premature diabetes, heart attacks and high blood pressure in young Indians these days. The truth is more obvious in those individuals who migrate to the western countries or to the Gulf for earning their bread. They inadvertently put themselves into a food-plenty atmosphere there. This kind of food-gene mismatch results in their becoming diabetics early in life. Deformed small blood vessels also lead to premature clogging and raise the pressure early on in life. The additional stress of present day living adds to the burden to result in premature death and disability due to heart attacks. The conventional much touted risk factors have very little to do with this newer disease profile as is very clearly shown by many studies in the west of Asian Immigrants there.

The moral of the story is that pregnant mothers need very good nutritious food all through pregnancy, but more so in the first three months of pregnancy. Our knowledge of pregnancy and child birth has advanced so much more to the point that we now know that the pre-natal consciousness is influenced by the environment in which the pregnant woman lives. A tranquil home, good relations and good work environment could bring forth a bright child. The child starts to learn right from day one inside the mother’s womb. That would be for another article at a later date. Suffice it to say that our lives depend very much on our pre-natal life in our mother’s womb. Future mothers must have this knowledge lest they should take their pregnancy nutrition very lightly. We could look forward to a world of good humans if our pregnant mothers are well cared for.

“One of the essential qualities of the clinician is interest in humanity,

for the secret of the care of the patient is in caring for the patient.”

Francis Weld Peabody 1881-1927.