From The Ganges To The Thames

Today my blogging attempt will be to touch your heart with facts that should make you proud of your race & the
country. Let me begin by asking you a few questions:

Who is the General Manager of Hewlett Packard (HP) ?
A. Rajiv Gupta

Q. Who is the creator of the Pentium chip (needs no introduction as 90% of the today's computers run on it)?
A. Vinod Dham

Q. Who is the third richest man on the world?
A. According to the latest report in Fortune Magazine, it is Azim Premji, who is the CEO of Wipro Industries. (the Sultan of Brunei is at the 6th position now!)

Q. Who is the founder and creator of Hotmail (Hotmail is the world's No.1 web based email program)?
A. Sabeer Bhatia

Q. Who is the president of AT & T-Bell Labs (AT & T-Bell Labs is the creator of program languages such as C, C++, Unix to name a few)?
A. Arun Netravalli

Q. Who is the new MTD (Microsoft Testing Director) of Windows Vista, responsible to iron out all initial problems?
A. Sanjay Tejawrika

Q. Who are the Chief Executives of CitiBank, Mckinsey & Stanchart?
A. Victor Menezes, Rajat Gupta, and Rana Talwar.

We Indians are the wealthiest among all ethnic groups in America, even faring better than the whites and the natives:

There are only 3.22 million Indians in the USA (15% of population) .. Yet,

38% of doctors in USA are Indians, 12% scientists in USA are Indians, 36% of NASA scientists are Indians, 34% of Microsoft employees are Indians, 28% of IBM employees are Indians, 17% of INTEL scientists are Indians, 13% of XEROX employees are Indians.

Some of the following facts may be known to you. These facts were recently published in a German magazine, which deals with world history facts about India:

1. India never invaded any country in her last 1000 years of history.
2. India invented the Number system. Zero was invented by Aryabhatta.
3. The world's first University was established in Takshila in 700BC. More than 10,500 students from all over the world studied more than 60 subjects there. The University of Nalanda built in the 4th century BC was one of the greatest achievements of ancient India in the field of education. Our present President wants to take up a teaching post in this University after he finishes his post.
4. According to the Forbes magazine, Sanskrit is the most suitable language for computer software.
5. Ayurveda is the earliest school of medicine known to humans.
6. Although Western media portrays modern images of India as poverty striken and underdeveloped through political corruption, India was once the richest empire on earth.
7. The art of navigation was born in the river Sindh 5000 years ago.. The very word "Navigation" is derived from the Sanskrit word Navgatih.
8. The value of Pi was first calculated by Budhayana, and he explained the concept of what is now known as the Pythagorean
Theorem. British scholars have accepted officially in 1999 and published that Budhayan's works dates to the 6th Century which is long before the European mathematicians.
9. Algebra, Trigonometry and Calculus came from India . Quadratic equations were by Sridharacharya in the 11th Century; the largest numbers the Greeks and the Romans used were 106 whereas Indians used numbers as big as 1053
10.According to the Gemological Institute of America, up until 1896, India was the only source of diamonds to the world.
11. USA based IEEE has proved what has been a century-old suspicion amongst academics that the pioneer of wireless communication was Professor Jagdeesh Bose and not Marconi.
12. The earliest reservoir and dam for irrigation was built in Saurashtra.
13. Chess was invented in India
14. Sushruta is the father of surgery. 2600 years ago he and health scientists of his time conducted surgeries like cesareans, cataract, fractures and urinary stones. Usage of anaesthesia was well known in ancient India .
15. When many cultures in the world were only nomadic forest dwellers over 5000 years ago, Indians established Harappan culture in Sindhu Valley ( Indus Valley India in 100 BC).


In the recent history, very rarely India has come across a situation, all at a time, an ascending economic trajectory, continuously rising foreign exchange reserve, reduced rate of inflation, global recognition of the technological competence, energy of 540 million youth, umbilical connectivities of 20 million people of Indian origin in various parts of the planet, and the interest shown by many developed countries to invest in our engineers and scientists including setting up of new R&D centers. Above all India as the largest democracy in the world, has a reputation for its democracy and for providing leadership for the one billion people with multi- cultural, multi-language and multi-religious backgrounds. Our
technological competence and value systems with civilizational heritage are highly respected. Foreign Institutional Investors find investing in India attractive. Indians are also investing in companies abroad and are opening new business ventures. Tata's Corus & Kumaramangalam Birlas take-overs are just a preview of what is going to follow. As per the report titled "From the Ganges to the Thames" which states that the Indian Foreign Direct Investment in British capital is second only to that of the US and Indian FDI project in Europe has increased from just 5 to 119 during the period 1997 to 2004. The Government is also committed to economic development by ensuring growth rate of 7% to 8% annually, enhancing the welfare of the farmers and workers and unleashing the creativity of the entrepreneurs, business persons, scientists, engineers and
other productive forces of the society. We must use this opportunity for transforming India to a globally competitive developed nation before 2020. This calls for the agriculture, manufacturing and service sectors becoming globally competitive leading to an economically competitive environment. What then would be the profile of the globally competitive developed India?

1. A Nation where the rural and urban divide has reduced to a thin line.
2. A Nation where there is an equitable distribution and access to energy and quality water.
3. A Nation where agriculture, industry and service sector work together in symphony, absorbing technology thereby resulting in sustained wealth generation leading to greater high value employment opportunities.
4. A Nation where education is not denied to any meritorious candidates because of societal or economic discrimination.
5. A Nation which is the best destination for the most talented scholars, scientists, and investors from all over the world.
6. A Nation where the best of health care is available to all the billion population and the communicable diseases like AIDS/TB, water and vector borne diseases and other stress diseases, cardiac diseases, cancer and diabetes are brought down.
7. A Nation where the governance uses the best of the technologies to be responsive, transparent, fully connected in a high bandwidth e-governance grid, easily accessible and simple in rules, thereby corruption free.
8. A Nation where poverty has been totally eradicated, illiteracy removed and crimes against women are absent and the society feels unalienated.
9. A Nation that is prosperous, healthy, secure, peaceful and happy and continues with a sustainable growth path.
10. A Nation that is one of the best places to live in, on the earth and brings smiles on a billion plus faces.

It is indeed a big challenge of high magnitude. For achieving such a competitive profile for India, we have a vision of realizing this goal in a time bound manner. Only a heathy nation will transform into a developed nation. Unless the maternal & child health statistics compare with the developed world, we will never achieve that status. Here is where we obstetricians and gynecologists come in. We are indeed the pillars upon which the the health of the nation rests on. Let us work with the government in transforming our BIMARU states across timelines and bring them at par with healthcare in the metros. This is achievable. The administration is committed and irrespective of the party in power, the reforms will go on. The type
of mission in front of us is very complex and challenging. Let us share a great thought propounded by Saint Maharishi Patanjali in the Yoga Sutra in 500 BC:
"When you are inspired by some great purpose, some extraordinary
project, all your thoughts break their bounds. Your mind transcends
limitations, your consciousness expands in every direction, and you
find yourself in a new, great and wonderful world. Dormant forces,
faculties and talents come alive, and you discover yourself to be a
greater person by far than you ever dreamt yourself to be."

But we need to do a RDB (Rang De Basanti) to go ahead - Today I wish Sanjay Gandhi was alive.

Testicles Forever?

A recent report on possible therapeutic uses of testicular stem cells helps to highlight the level of confusion and lack of focus
in stem cell biology today. Sources of stem cells such as embryos, testicles and ovaries are technically difficult to manipulate and have worrying, potentially malignant properties should they ever be transplanted to a human being. These stem cells also carry significant moral, ethical, legal and religious objections to their creation and use. UK researchers have been given the go-ahead to investigate the potential of human testicle stem cells to develop into other types of body tissue. The Human Fertilization and Embryology Authority (HFEA) has licensed the team, based at the Hammersmith Hospital in London, to
study the cells in order to find out if they are as versatile as stem cells isolated from early embryos. The scientists hope that the work may eventually lead to new therapies for conditions such as heart disease, Parkinson's disease and spinal injury.
Last year, German researchers isolated cells from adult mouse testicles that share some of the characteristics of embryonic stem (ES) cells. The team isolated stem cells that normally grow into sperm, and coaxed them into producing many different types of body cell. The researchers, based at the Georg-August-University of Goettingen, published their findings in the journal Nature. However, at the time, other scientists cautioned that stem cells from human testes might not behave in the same way as their mouse counterparts. The Gottingen team used genetically altered mice in which the sperm stem cells were permanently 'tagged' with a fluorescent protein, to enable them to isolate the elusive cells from mouse testes. They then grew the cells in the laboratory, and found that some of them resembled ES cells. These cells, which they dubbed multipotent adult germline stem cells (maGSCs), were able to grow into several different types of body cell - including heart, brain, liver and skin. The scientists also found that the maGSCs were able to form different tissues and organs when injected into mouse embryos. The ongoing controversy surrounding research into human ES cells in Germany, where such work is banned, and many other countries, has lead several groups to seek alternative sources of cells that can potentially develop into a wide range of different tissues. Even in countries where ES cell research is permitted, it hinges on the availability of donated human eggs.

There is another source of stem cells which is hardly ever mentioned in the news and is currently being discarded on a daily
basis. It has no moral, ethical, legal or religious objections to use and it has been transplanted safely over 6,000 times to date to treat 45 different diseases. This source of stem cells is human umbilical cord blood. Cord blood can be collected at every birth with no risk or pain to the mother or baby. Once collected cord blood is processed using tried and tested technology and can be frozen in liquid nitrogen for many years. Current applications of these stem cells are in the treatment
of leukemia, related blood disorders and the repair of the bone marrow following high dose chemotherapy for cancer. Perhaps the most important aspect of cord blood is that it contains mesenchymal stem cells capable of producing many cell types including neuronal and muscle tissue. These cells have an availability and potential far greater than embryonic or testicular stem cells and we must focus our time, energy, resources and expertise on the full utilization of these priceless stem cells. Cord blood stem cells are currently being assessed in a clinical trial in Canada in the treatment of multiple sclerosis. The umbilical cord itself also contains stem cells capable of producing a range of tissue types, most
notably bone tissue. If stem cell biology is to advance we must begin to collect, store and carry out research on as much cord blood as possible. According to advocates of umbilical cord blood banking, we have a readily available source of stem cells with massive potential which is currently, for whatever reason, being ignored by researchers, media and politicians alike. “We must stop talking about esoteric sources of stem cells and focus on cord blood stem cells as the source of stem cells for current therapeutic applications and ground breaking therapies of the future.”

Commenting on the planned research at Hammersmith Hospital, stem cell expert Professor Harry Moore, of Sheffield University, said: 'In this country, the ethical issues of obtaining stem cells from cloned embryos are really covered by the
HFEA, but there is still the major problem of where do you get eggs that are high enough quality and in sufficient quantity. The advantage of this work on human testicular cells is that it avoids both of these issues'. If testicular stem cells prove to be as versatile as their embryonic counterparts, it may be possible for men to bank testicular tissue early in life, and later use it to repair damaged or diseased areas of the body. Such tissue could also potentially be used to provide cell-based therapies for any men who share the same tissue type. Professor Chris Barratt, of the Birmingham Women's Hospital told the Guardian newspaper: “There are a lot of testicles around and you don't need a staggering number to have enough variety to match nearly all of the population”. In India, we have much larger numbers.

Asymmetrical People make Jealous Lovers & Handsome Men have the best Sperm!

Asymmetry could account for a fifth of the variation in romantic jealousy from person to person, says a Canadian researcher. Just about everyone is lopsided to some extent. But in recent years, a series of animal and human studies have suggested that the implications of asymmetry go far beyond struggling to find shoes that fit both feet. It seems that people who are more symmetrical are not only healthier, more fertile and perhaps even smarter - they are also more attractive. This led William Brown at Dalhousie University in Halifax, Nova Scotia, to wonder about jealousy. "If jealousy is a strategy to retain your mate, then the individual more likely to be philandered on is more likely to be jealous," he speculated. And if people who are less symmetrical are less desirable, they are more likely to be cheated on. To test his theory, Brown looked at 50 men and women in various kinds of heterosexual relationships, comparing the sizes of paired features such as feet, ears and fingers. The volunteers then filled in a questionnaire already used in other studies to assess romantic jealousy. He found a strong link between asymmetry and romantic jealousy. Asymmetry could account for over a fifth of the variation in romantic jealousy from person to person, he says. To make sure less symmetrical people are not simply cursed with more jealous personalities, Brown also assessed their propensity to be jealous outside the relationship, in the workplace for example. But the less symmetrical people were no more likely to be jealous in general, he found, than more symmetrical folk.
A separate study by UK researchers has revealed that women with the most alluring voices have the most attractive faces. Sarah Collins and Caroline Missing, at the University of Nottingham, played recordings of 30 young women to men who later saw their photos. The men judged women with attractive voices as the best looking, reveals the study published in the latest Animal Behaviour.
Beauty really is in the eye of the beholder. Rather than always chasing the best-looking members of the opposite sex, some animals prefer mates that the majority find decidedly unattractive. Studies of how birds, fish and people choose mates have found that members of the same species tend to find the same things attractive. For instance, peahens prefer to mate with brightly colored, long-tailed peacocks, while women prefer tall men. Those attractive traits are supposed to signal beneficial characteristics such as an increased chance that any offspring will survive. Male lions with long, dark manes are more attractive to females and more intimidating to rivals, US research involving dummy animals shows. Manes vary from light blond to black and can be up to foot long. The research team planted pairs of life-sized toy lions with different types of mane near males and females in the Serengeti National Park in Tanzania, and monitored the lions reactions to the 'intruders'. In all cases, males preferred to approach dummies with lighter, less shaggy manes. But females did the opposite. They preferred to approach darker males, suggesting they are a better bet as a mate. Next, the team examined data on blood samples from several dozen males that had been sedated. They found a strong correlation between blood testosterone levels and mane color.
According to a recent news story in the New Scientist, 'handsome men have the best sperm'. And how do we know this? Because researchers recruited 66 women in Valencia, Spain, who looked at the faces of 66 male students and happened to identify as the most handsome those men who also have the best sperm. The authors of the study conclude: 'Our study has shown that women are able to recognize reproductively fit males on the basis of their facial appearance alone.'
It's difficult to see how they could come to such a conclusion. In the study, 66 women made a subjective assessment of the attractiveness of 66 men; and the men they judged to be most good looking happened to have more motile and more morphologically normal sperm. All the research shows, therefore, is that in a small sample of young men, good looks seems to correlate with good sperm. What we don't know from the New Scientist story is other information that might be relevant, such as how much the men smoke or drink. Intriguingly, the study doesn't show a correlation between good looks and a good sperm count - a measurement often used as an indicator of male fertility.
Studies such as these are becoming increasingly common in the media today. But why we are so interested in them? Perhaps drawing grand conclusions from such research findings fulfils a need in us to find causes for our behavior that are not the result of our own free will and for which, consequently, we don't have to take responsibility. In this case, our search for causes of human behavior that are beyond our control leads us to conclude that women are attracted to handsome men for sound biological reasons. It can't possibly be that we are simply driven by such shallow reasons as the desire to be surrounded by beautiful things, can it?

The Great Verna Promotion from Hyundai Motors

I recently became a sucker to full page advertisement promotions by Hyundai Motors India Limited. Let me tell you this interesting story. In fact it will be more readable as I take you along-with two letters that I wrote to the "customer relations" of Hundai motors & am yet to receive any feedback. Letter 1 - "I am a gynecologist practicing in the city of Mumbai. I have
previously owned cars from the Maruti Co., Honda as well as the Mercedes Benz. On May 16, I booked the Verna CRDi Sx model from Jayabharat Automobiles. I was told that the waiting period is two weeks but if I make a complete down-payment for the car, I would probably get the car within 10 days. I gave them the full payment by check on May 16, 2007. The car was booked in my personal name. No one contacted me till I went to the dealership myself after 6/7 phone- calls in the first week of June 2007. Everytime I would make a call, someone would promise me they would call back and never did call. The car was finally delivered on June 13, 2007. The dealership is a shame on your company. The attitude of the staff is like a Government of India office ten years ago. No one is driven or is customer attentive- the whole atmosphere is Babu-like!
My car has two major problems. The auto function of the Climate-Controlled A/C is not working and the polyglass covering the Milometer-Odometer panel is defective (opaque in parts like some chemical has corroded parts of it. I wonder how did it get past the quality checks. Never before for any of my previous 8-9 cars did I ever have a problem in a brand new purchase.
I do not want to get any services or trouble-shooting done with Jayabharat. Please recommend another dealer/workshop where I can send my vehicle for the rectification of problems.
I hope your customer care is not like the dealership:(
I look forward to hearing from you.
Sincerely yours,
GNA"
I got a reply that someone from Jayabharat would contact me. The story continues thus-I wrote again to the "customer relations" cell - Letter2 -
"I got a call from the Jayabharat workshop and had visited the same. Mr Ashokan there was extremely courteous and receptive to the complaints. He mentioned that the polyglass is not available separately and the entire milometer/odometer assembly needs to be ordered from Chennai and he would write to the factory. I have not heard from them again.
The "automatic" climate control problem could not be solved! He made me speak to a Hyundai Motors representative who explained that the A/C was not defective but was set to European standards & nothing canbe done about it. Let me explain again what the problem is to me &possibly to all end-users. Till 21 degrees Celcius, the A/C works as an automatic climate controlled A/C and automatically adjusts the blower speed to reach the preset temperature between 17-21 degrees Celcius. The moment we set the temperature to 22 degrees or more, the Automatic Function is disabled automatically & the A/C moves automatically to the Fresh-air mode and starts pulling in air from the outside! Imagine driving in Mumbai with the temperature set to 22 degrees and getting Diesel & Petrol fumes being sucked in. This is very unfair to the customer. I was explained by the Hyundai representative, that after 21 degrees, I could very well move to a manual function!
Sir, the only reason I paid some extra money for the CRDi Sx model was the climate controlled A/C. If I wanted to use the regular car A/C, I would have bought your regular diesel Verna. I drive other vehicles like the Honda CRV, Honda Accord, Mercedes Benz C 220 CDi -all with automatic climate controlled A/Cs, but none of these A/Cs switch to a manual mode after 21 degrees Celcius! Please give me a satisfactory explanation. I'm sure your engineers can set the problem right. There is no other vehicle on the Indian roads with a malfunctioning automatic climate controlled A/C such as in the Verna CRDi Sx model if the above explanation is true. I look forward to your response."
I have since written twice more to their "customer-relations" cell, but there is no response. The company believes in no customer-relations. Their existence is only till the great Indian customer reads their color ads in National dailies & color hoardings in the city and buys one of their cars. Post sale, there are only suckers like me writing letters to the motor company, blogs & letters-to-the editors of National dailies, hoping someone exposes the mighty Koreans.

Stem cells: Miracle postponed?

In the light of the Korean stem-cell scandal, many big claims about stem cells are looking decidedly doubtful. Hyeoni Kim believed that the miracle cure for his paraplegia was around the corner. He had been paralyzed at just 8 years old when he was hit by a car on his way home from school. So when South Korea's science superstar, Woo Suk Hwang, asked if his team could take skin cells from Kim and use them to obtain stem cells that might one day provide a cure, Kim and his family were delighted. When Hwang visited him in hospital in April 2003, the boy, then 9, asked him if he would walk again. "I promise," Hwang replied. That promise became immortalized in a Korean postage stamp showing a man rising from his wheelchair. But it was always highly questionable. Even if Hwang had managed to derive cloned embryonic stem cells (ESCs) from the skin cells of Kim and 10 others - as he claimed in May 2005 - he would still have been a long way from mending Kim's paraplegia.
Stem cell science has been hailed as modern medicine's best hope - to treat the untreatable, to keep us fit in old age and even, perhaps, to help the severely disabled to walk again. But scandal in South Korea has rocked this science - with one of its leading proponents labeled a fraud, and as the scientists reflect on the ethics of their work and its practical limits, where does this leave all of us, the potential patients?
Stem cells, unlike ordinary cells, have the unique power to re-create themselves when they divide. There are two types: the first, adult stem cells, are cued up to become particular cell types - say nerve, blood, bone or heart. These can carry out valuable repairs - but only in their specialist part of the body. The second group is embryonic stem cells. Found in the early human embryo, these are highly sought after because they can re-create themselves indefinitely. Also, since they are not yet switched to become specific cell types, they have the potential to repair damaged and diseased organs anywhere in the body.
Dr Hwang claimed to have created 11 stem cell lines from human embryos, cloned so that the cells exactly matched an individual patient - the Holy Grail of stem cell science. It turned out much of his work was fake, and crucially that he'd had to use far more human eggs than he'd said. The challenge now, for embryonic stem cell scientists at least, is to find ways to make stem cells without using vast quantities of human eggs - in short supply and, for some, ethically questionable. Until now, scientists have relied on creating stem cells from left over embryos from IVF. Before the Hwang expose, researchers had hoped to join the elite club of scientists using cloning to study the cellular processes behind disease. Now, to avoid using up human eggs on an uncertain technique, most workers have a plan for a new - and potentially controversial - way around that: cloned human-animal hybrids. Researchers now would like to use non-human eggs - for instance rabbit eggs. But therapies are at least 10 years away. A team at the University of Cambridge has another plan. Roger Pedersen, director of the centre for stem cell research at the university, told us about a plan that avoids cloning, and fresh human eggs, and relies instead on off-the-shelf matches from a bank of stem cell lines from selected donors. Then there's the man with a third way to avoid the need for human eggs. Mohammed Taranissi runs one of the UK's most successful fertility clinics. He's promoting what he calls "stem-brid" technology, which uses the stem cell line itself as a surrogate egg. But there's a new realism now among embryonic stem cell scientists about how long it will be before they can help people.
That leaves their counterparts working on adult stem cells. They now expect to deliver treatments much sooner. One team, at the London Chest Hospital, is using adult stem cells taken from a patient's own bone marrow to try to repair the damage caused by a heart attack. Dr Anthony Mathur is the cardiologist in charge of the trial - the largest of its kind in the world. He is quoted as saying: "My passionate feeling here is that this type of therapy, cellular therapy, is going to revolutionize the way we practice medicine." Half the patients are treated with stem cells and half with just the fluid, or growth factor in which the cells are found. Neither Dr Mathur nor the patients know who's getting what but that's crucial in order to gather definitive, scientifically controlled data. Across London, another adult stem cell trial could yield results within months. At the Institute of Neurology, they hope to use unique adult stem cells from the lining of a patient's own nose to treat nerve and spinal cord injury. Professor Geoffrey Raisman, who's leading this research was quoted on BBC: "The interest in embryonic stem cells has led to adult stem cells being very much neglected. And whereas I think for embryonic stem cells we're talking about a long time ahead before these cells are going to be in use, in our case we're thinking of clinical trials within this year." It would seem a safe bet that adult stem cells will deliver first - but the enthusiasm for this science as a whole is still there, despite the reality check brought about by Dr Hwang.
I agree completely with Prof. Roger Pedersen from Cambridge who says: “We hope that discoveries that are made quietly and without the glare of lights... will ultimately change the way we treat diseases”.

Cytoplasmic Transfer

It was recently reported in the journal "Human Reproduction" that cytoplasmic transfer could be used to transfer healthy mitochondria (small structures that power the cell) into certain infertile women's eggs. This has resulted in 30 healthy children that were "born from three parents". This pioneering work into fertility treatment was conducted at Institute for Reproductive Medicine and Science of St Barnabas, in New Jersey. The 30 children born were actually the first human babies ever whose genetic makeup has been artificially altered. Even though the babies were born healthy (and without this novel technique would not have existed at all), the cytoplasmic transfer technique was condemned as unethical by some opponents, who said it amounted to human cloning (BBC). However, cytoplasmic transfer and nuclear transfer are NOT the same thing, and the genetic makeup of mitochondria does not govern key aspects of the child's development, like intelligence, personality or physical form. These things are predominately determined by nuclear genes, and these genes were not altered in the children. Cytoplasmic transfer is certainly not cloning, as has been suggested, but it is a useful fertility technology for certain women affected with mitochondrial diseases. Cytoplasmic transfer is a logical extension of assisted reproduction, a procedure that represents a hybrid between in vitro fertilization in its traditional form and IVF using donated oocytes. As the IVF procedure has improved, several groups of patients continue to pose huge challenges. One such group is characterized by normal FSH levels and normal responses to stimulation. Patients have lots of follicles when stimulated and high estradiol levels, but poor subsequent embryo development. For years these women, after numerous failed cycles, had no alternative but to discontinue treatment. Oocyte donation, now a common procedure, offered these women a viable procedure, one with a high pregnancy rate. Unfortunately, oocyte donation includes the disadvantage of losing the mother's genetic link to the child, as the genes of the donor are passed on to the child born through the procedure.
Two potential reasons account for poor embryo development. Studies of the genetic component of many of the eggs in women with persistent poor embryo development showed that eggs with abnormal chromosomes often made poor embryos. However, this was not always true. Many eggs with normal chromosomes also developed poorly. Logically, the reason may lie in the cytoplasm, the area within the shell of the egg that lies outside of the nucleus, outside of the region that contains the genetic material or DNA. The cytoplasm includes several components. One component is mitochondria which provide energy to the cell, fuel for many of its functions including, presumably, cell division. In theory, a deficiency in mitochondria may leave a cell without the necessary fuel to power its own division after fertilization, resulting in abnormal division. This abnormal division then results in an accumulation of fragments from the dividing cells and a poor chance of further development after embryo transfer.
Another important component of the cytoplasm is the spindle apparatus, a sort of railroad track within the cell, along which the chromosomes separate. The steps in cell division include the duplication of the chromosomes and the subsequent distribution of the genes equally between the two daughter cells. If an egg contained normal chromosomes but had inadequate mitochondria to power cell division or a defective railroad track system for the chromosomes to divide, would this not result in poor embryo formation? And if the cause of the egg problem was in the cytoplasm, then why not replace just the cytoplasm instead of the whole egg, thus keeping the mother's own genetic contribution to the pregnancy? This is the premise behind the development of cytoplasm transfer by Jacques Cohen & his group from St. Barnabas, New Jersey, USA. But the journey from good idea to actual pregnancies has been long and complex. As in many of the procedures in assisted reproduction, much of the initial research came from our colleagues in veterinary medicine. Two methods of cytoplasm transfer were developed, one which transfers a small amount of cytoplasm by tiny needle from the donor to the recipient egg, the other transfers a larger amount of cytoplasm which is then fused to the recipient cytoplasm with electrical impulses.
As a step forward in the refinement of assisted reproduction it is a huge step, and presently, only a relatively small group of people will benefit from it. As the process of cytoplasmic transfer is further refined it will help many others. Important questions need to be clarified. What we most want to know is how will this technique work with the poorer responders? Can cytoplasm transfer affect the poor results we consistently see in patients with elevated FSH levels? And what exactly is in the cytoplasm that might make the eggs "better?" Can we someday hope to find a source of that substance that does not
require the expensive and cumbersome process of using a donor's eggs? For now, we can only give the unsatisfying answer that we'll have these answers sometime in the future. For those of us struggling with the frustrations of infertility now , we can only hope that the future is sooner rather than later.

Cloning: New high-tech and ancient morality

Ethical discussions of cloning and other high-flown technologies don’t seem to get to the heart of things; they tend to be too fine-grained. When Dolly first became known to the world in 1997, people at large began naturally enough to speculate on human cloning. Several medical doctors and at least one physicist are already planning to offer a clinical service. One well known professor said he would like to be cloned out of curiosity, as if this was justification enough, and another said that human cloning “raises no new questions of ethics”.
At present, cloned human beings exist only in science fiction, lurid tabloids and in the boastful and bogus claims of sham scientists and cult kooks. For now, the only destiny for cloned human cells is to help scientists understand and cure diseases. The reason to clone embryos is that the resulting cells and tissues will have the same genetic makeup as the person they come from. Therefore, they can be transplanted back to the person without fear of rejection. The reason that adult stem cells do not offer an equally valuable alternative is that embryonic cells are the only cells capable of turning into all the various types of cells that are needed to fight disease, disability and death. And no one has figured out yet how to get adult stem cells to revert back into this omnipotent state.
If your child is dying, you want all research avenues pursued and that includes both embryonic and adult stem cell research. The bottom line is that cloning for cures has the potential to do enormous good by saving the lives of millions of people and ending agony for millions more. These human beings and their loved ones aren’t interested in pieties and abstractions and science fiction. They are desperately seeking help for their ailments and they need to have medical scientists free to pursue those answers and cures. Banning all human cloning would be a highly unethical thing to do. The needs of children confined to wheelchairs, of parents dependent on oxygen tanks to breathe and of friends imprisoned by the creeping paralysis of Parkinson’s far outweigh the moral status of cloned cells that will never leave the Petri dish. Myths should not be the basis for public policy when cures hang in the balance.
The latent totipotency of adult mammalian nuclei suggests that it may be feasible to reprogram adult human cells for use in the treatment of disease. Thus, investigators may be able to develop strategies to facilitate the repair and regeneration of human tissues. Nucleo-cytoplasmic interactions that restore potency to differentiated cells are an important research focus with great potential in treating diseases such as cancer, diabetes and neurodegeneration.
Another potential application of mammalian cloning is the production of clones of genetically-engineered domestic animals, such as sheep, pigs and cattle. For example, bovine nuclei could be engineered so that medically-significant proteins would be selectively secreted into the milk of cattle produced by nuclear transplantation. Presently, the Indian Council for Medical Research(ICMR) has banned all forms of human cloning while the USA and Israel have put a moratorium for four years on research in human cloning. Cloning is a difficult topic, fraught with empirical uncertainties and uncertain moral boundaries. Indeed, we agree with those countries who would impose a moratorium on cloning – only we wish the ICMR would impose a moratorium, and not a ban, on all cloning, keeping the debate open on all of its possible applications.

Polycystic Ovary Syndrome: Lessons learnt from Atkins Diet & Alternative Medicine

PCOS is a common condition that affects up to 10% of all women of reproductive age. It is characterized by enlargement of the ovaries, irregular menstrual cycle, failure to ovulate, obesity, high levels of insulin in the blood and insulin resistance, excessive hair growth (due to increased testosterone), and infertility. More than 50% of all women with PCOS have high insulin levels, which may be a risk factor for diabetes, high blood pressure, blood clots, and heart disease.
Simply following a low carbohydrate diet can offer effective relief from distressing symptoms. In a report to the Endocrine Society 2005 meeting, Dr James Hays demonstrated that polycystic ovary syndrome (PCOS) is linked to a phenomenon called insulin resistance, which can be successfully reversed by reducing carbohydrate intake. Continually eating high carbohydrate meals and snacks can make your body's cells become less sensitive to insulin, so that more and more is required to do the job. Having a high level of insulin in your bloodstream eventually makes your ovaries and adrenal glands over-produce male sex hormones. These high levels of male hormones can cause the symptoms of extra body hair, acne and moodiness and increase your risk of heart disease. They also interfere with the normal release of hormones from the pituitary gland in your brain, which regulate the process of ovulation and the production of female sex hormones in your ovaries. This can cause absent or irregular periods and infertility.
The first step one should take to relieve symptoms of polycystic ovary syndrome (PCOS) should involve cutting down on carbohydrates. Doing so will mean that your insulin levels will naturally fall and other hormones in your body will gradually begin to balance out again. In his book, Dr Atkins' New Diet Revolution, Dr Atkins identifies a low carbohydrate diet as being central to the natural treatment of polycystic ovary syndrome (PCOS). He says, "It all goes back to lesson one in don't cause your metabolism to struggle incessantly with high insulin levels, weight gain and looming health tragedies". So remove all refined sugar products from your diet, such as cakes, confectionery, sweet drinks, honey and starchy foods such as bread, pasta, rice and potatoes. The good news is that you won't feel hungry since you can eat all the chicken, fish, seafood, omelettes, rich creamy sauces, crisp salads and green vegetables you want. Just make sure that you drink at least 2 liters of water a day, to flush away harmful toxins that will be released as your body breaks down fat. Dr Atkins also views nutritional supplements as an essential part of his diet plan, particularly in the treatment of polycystic ovary syndrome (PCOS). One that has recently proved its worth is N-acetyl cysteine, or NAC. Women with polycystic ovary syndrome (PCOS) and high insulin levels who took between 1.8 and 3 grams of NAC a day for five to six weeks, were found to have a significant reduction in their insulin levels and improved insulin sensitivity (Fertility and Sterility 2002; 77: 1128-35). Dr Atkins also recommends the amino-acid glutamine to prevent sugar cravings. Animal studies have shown that it helps combat insulin resistance too. Researchers at Vanderbilt University in the US found that glutamine improved blood sugar control so dramatically that they concluded "glutamine has potential benefit as a nutrient adjuvant during clinical situations associated with insulin resistance" (J. Nutr. 1996; 126: 273-79). A daily dose of 500mg is recommended. Chromium is a very important mineral if you have polycystic ovary syndrome (PCOS), since it encourages your liver to produce a substance called glucose tolerance factor (GTF), which increases the effectiveness of insulin. Chromium deficiency has been shown to produce symptoms of insulin resistance and diabetes (Health and Nutrition Breakthroughs, Sept 1998). In one study, chromium supplements combined with an exercise program reduced insulin and cholesterol levels (J Nutr Biochem 1998; 9: 471-475). Take 200mg to 400mg of chromium picolinate a day. The B vitamins are also important in helping to correct the symptoms of polycystic ovary syndrome (PCOS). B3 is a component of glucose tolerance factor (mentioned above), B5 helps to control fat metabolism and B6 balances hormone levels. A relative of the B vitamins, called d-chiro-inositol, increases the effectiveness of insulin in patients with polycystic ovary syndrome (PCOS), reduces male hormone levels and restores normal periods (NEJM 1999; 340: 1314-20). This compound is not available yet in the west as a nutritional supplement, but it is present in soya lecithin. Dr Atkins advises patients to take a B-complex supplement and one tablespoon of lecithin granules a day. In India, a traditional Indian ayurvedic drug being advocated for hyperinsulinemia in PCOS called Hyponiid (Charak Pharmaceuticals, India) also contains large amounts of D-chiro-inositol and could be used as a supplement.
There is no cure for PCOS, but doctors often recommend birth control pills, which help decrease the levels of testosterone, estrogen, and progesterone, thereby reducing hair growth and shrinking the cysts in the ovaries. However, birth control pills have not been shown to improve insulin resistance. N-acetyl cysteine may be useful in picking up where birth control pills leave off, by increasing insulin sensitivity. While it is possible that birth control pills and NAC could work in conjunction with one another, the interaction between the two treatments is unknown.
In this preliminary study, 31 women with PCOS were given 1.8 to 3 grams per day of NAC for five to six weeks. Blood measurements for glucose and insulin were taken before and after a glucose tolerance test, both at the start of the study and at the end of the treatment period. No dietary modifications were made during the study.
Initial measurements showed that 14 of the 31 women had normal insulin levels, while the remaining 17 had abnormally high levels of insulin. Women with high initial insulin levels who took NAC had a significant reduction in insulin levels following the glucose tolerance test and also showed improved insulin sensitivity. On the other hand, those with initially normal insulin levels had no improvement in any measurement. This suggests the benefit of NAC in women with PCOS may be restricted to only those women who already have high insulin levels to begin with.
NAC is an amino acid that has commonly been used as a treatment to break up mucus in the lungs. It is also a precursor to glutathione, a powerful antioxidant in the body, which has been shown in other studies to improve insulin sensitivity. Although glutathione levels were not measured in this study, the improvement in insulin resistance seen in the group taking NAC may have been due to increased amounts of glutathione; however, future studies will need to clarify this issue.
Some physicians recommend taking NAC on an empty stomach, so it does not compete with other amino acids in food for absorption. People taking single amino acids should also make sure they eat adequate amounts of protein, to prevent upsetting the balance of amino acids in the body. In addition, some doctors recommend that long-term supplementation of NAC (more than a few weeks) be accompanied by 15 mg of zinc and 2 mg of copper per day, because preliminary evidence suggests that NAC might deplete these minerals.
N-Acetyl Cysteine (NAC), an antioxidant with insulin-sensitizing properties, may boost the effectiveness of other pharmaceutical treatments for polycystic ovary syndrome (PCOS), according to a new placebo-controlled, double-blind, randomized trial (Fertil Steril. 2005 Feb;83(2):367-70). Researchers studied 150 women who suffered from PCOS that was resistant to clomiphene citrate, one of the drugs used to treat this condition. The subjects, ages 18-39 years, were all undergoing therapy for infertility. The researchers randomly assigned the patients to receive either 1.2 grams of NAC per day or a placebo. Each of the two groups also consumed 100 mg per day of clomiphene citrate for 5 days starting at day 3 of the cycle. The combination of clomiphene citrate and NAC significantly increased both ovulation rate and the pregnancy rate in women with clomiphene citrate-resistant PCOS. The NAC-treated subjects experienced a 49.3% increase in ovulation compared to only a 1.3% increase in placebo-treated subjects. The NAC treated subjects also experienced a 21.3% pregnancy rate whereas none of the placebo-treated subjects were able to conceive. Two of the NAC-treated patients who were able to conceive, however, did eventually miscarry. Although agents that stimulate the ovaries sometimes cause ovarian hyperstimulation syndrome (OHSS), a serious condition that causes pain and potentially life-threatening consequences, no cases of ovarian hyperstimulation syndrome were reported in the NAC group. The researchers concluded that NAC is safe and well tolerated.
Even in the West & the rest of the developed world, researchers & doctors & health authorities are looking at alternative medicine with an open mind. Dr HS Palep is presently lecturing American Universities on the benefits of Ayurveda. I wonder why such draconian laws have been passed in a country like India against Gynecologists using traditional Indian medicine!

The Tata Indicom Apathy

This might be just the place to put out a scam that seems to be prevalent in the Bandra area. In the second week of December 2006, some Tata Indicom marketing executive slipped some Tata Indicom Broadband promotional literature under our main door. On checking with the building manager, he said that the Tata Indicom people had distributed such pamphlets to all flats not only in our building but in the entire area. There were two mobile numbers on the pamphlet alongwith an illegible small rubber stamp of some agency on the reverse page of the pamphlet. I needed the internet connection and called one of the two cell numbers namely- 9821774463. One Mr Sameer Ahmad answered the cell and promptly came over to my consulting room the next evening(19.12.2006). He helped me select the appropriate internet plan & I gave him a "crossed" cheque favoring "Tata". I specifically asked him if I need to complete the Payee name as Tata Indicom or Tata
Broadband, but this gentleman insisted that they are collecting all checks as only favoring Tata. I gave him a check for Rs. 4580 favoring Tata drawn on State Bank of India(Carter Road Branch) bearing Number 476910 dated 19.12.2006. He assured me that my internet connection would be connected within a week. After 10 days of this man collecting the check, we started chasing him on the two cell numbers we had. He would not take any calls & most of the times the number would be unavailable. In January first week, we realized the numbers have been disconnected & in a few days more the numbers were apparently re-allocated to some new customers. Next we called the Tata Indicom helpline & were told that my name was no-where on their records. We confirmed our bank statement that clearly showed that this crossed cheque was cleared on 20.12.2006 itself. We had a mini-struggle to try and trace out the account where this check was encashed. My receptionist followed up with one Mr Salvi at the SBI, Carter Road Branch persistently till he traced out the beneficiary of this check who had an account with UTI bank in Marol. We asked Mr Salvi to get us a copy of my issued check. I could finally get hold of this copy only in April 2007 and to my horror, my check was forged (over-written) to read the payee as Tofail Ahmad Siddiqui. Tata was touched up with a pen to read as Tofail. I personally called up the customer service helplines of Tata Indicom to complain about this scam. The tele-executives were polite but said they could do nothing about my complaint. I pleaded with them on more than one occasion that this group might have collected lakhs of rupees in this way from one locality, but they were helpless. They even took my cell number upon my insistence and request to ask one of
their senior managers to talk to me, but no one ever called. I wrote to customer service but received no reply. Finally, I went personally to the VSNL headquarters in Fort & the receptionist there directed me to the Tata Indicom Prabhadevi office. I bumped into an old friend Mr Rashid Baba who is now a senior officer with Tata Indicom & handed over the following set of documents to him:
1.My Email correspondence with Mr Rajesh Chathnath of Tata Indicom
2.My Tata Indicom Broadband Receipt No 0980657 dated 19.12.2006
3.My SBI Passbook copy showing that the amount was debited from my savings account on 20.12.2006
4.Copy of the encashed check upon which forgery was performed.
He assured me someone from the vigilance team would get back to me. I was hoping that the vigilance Department of Tata Indicom takes up this matter seriously because it is a big slur to their image, with their own agents running such a scam. I have become disheartened with the Tata Indicom response to my complaints & have also approached my local police station. The Police station was another story. No one was ready to register the complaint & a kind soul suggested that since the culprit was traced by my clinic to Marol, we must register the police complaint at Marol Police Station. Felt like doing the RDB dance there. I got frustrated and sent a copy of my complaint to Office of the Addl. Commissioner Police-Economic Offences Wing, Mumbai. On two subsequent occasions after December, I have seen this man carrying some folders/papers on Hill Road. Probably, this group is still active & ruining the Tata image completely. But no-body is bothered. Life goes on.
Just when I thought nothing is ever going to happen, I received a letter from the Office of the Addl. Commissioner Police-Economic Offences Wing, Mumbai asking me to go and meet the Sr. Inspector of Police, Bandra Police Station who might investigate the complaint. I will go there on the coming Monday.
I ask myself why am I going the distance. Why dont I just forget the 4K & concentrate on my patients. I don't know... maybe I want to make a difference to my city, my country. Hope someone gets the culprits to book. I promise to give it my best shot.
Jai Maharashtra. Jai Hind.

Corporate Hospitals & Mortal Doctors

Escorts & Naresh Trehan hogged all the TV channel headlines & print headlines for over a fortnight. I was remembering my own recent stint at a Corporate Hospital. This is just to reiterate that run-ins with Corporate hospitals can be damaging to your career. About three years ago I was offered a challenging portfolio in a Corporate hospital to set-up a state-of-the-art IVF unit. It was hard work but I enjoyed the challenge of getting the team together & the act together. We had to our credit India's first Trans-ethnic surrogate pregnancy recorded from this young unit. A Singaporean couple went home with a healthy baby boy who spent 9 months in an Indian mother's womb. The hospital Press - Release was as follows:
An overseas couple who are ethnically Chinese, had opted to undergo surrogacy at the Center for Human Reproduction in 2005. An Indian surrogate mother delivered a healthy baby boy on 19.05.06 at 3:30am. Both baby and mother are healthy and doing well. This is the first documented Trans-ethnic Surrogacy Pregnancy successfully delivered on the Indian sub-continent. The doctors who led this successful medical breakthrough are Dr.Gautam Allahbadia, Chief Consultant , Center for Human Reproduction and Dr. Yashodhara Mhatre, Consultant, Center for Human Reproduction. The team included Dr. Anita Soni, who was the Obstetrician who delivered the baby.
In 2007 March , I was shocked to read the Hospital Magazine released on their annual day. The Trans-ethnic surrogacy case was one of the three achievements of the hospital since inception. In the "Our Achievements" section, an entire color page was dedicated to this medical miracle with a one inch title credit. And to my surprise, the title credit carried only my erstwhile associate's name. What disheartened me most was that everyone connected with the hospital knew that I was the IVF team leader & had planned the protocol & done the Embryo Transfers. No one spoke up for me. Immediately there-after I was told I was not getting enough work to the Dept. & that I was travelling excessively & the hospital wanted a full-time doctor who would not practice outside the hospital. I left with a smile on my face & a tear in my eye. I loved the challenge of setting up a successful Dept.
Anyways destiny always takes care of its own children! I loved the place & continue to refer patients there. God Bless!

Are Indians Genetically Inferior?

I remember my first meeting with Prof. VN Shrikhande at the Bombay Hospital when I had joined as a visiting research fellow in 1992. The first topic we discussed in the Surgeon’s room was “Are Indians genetically inferior?” and “Why no Indian working in India has ever been awarded a Nobel prize ?”. Well, his theories were wonderful & ICMR should give him an oration on this topic? But it is a fact that India is the only country where cows stroll across runways & bullock carts cross National Highways with impunity☺
Once we understand why we have been backward, and why we still are backward, we should be on the way to success. In many areas of space technology, defence systems, nuclear engineering, telecommunications and the like, we are admittedly at the cutting edge of technology. At the same time, it is proper for us to enquire why we built temple halls with a thousand pillars a millennium after others had mastered the design of the arch. Or, consider why we built the great sundial in Jantar Mantar long after telescopes had become commonplace, and why even today we remain the only manufacturers of vintage cars. When Alexander bore down on us with his swift horses, we stood stuck in the mire with elephants. We learnt no lessons from our defeat at his hands. 1700 years later, we lost again to Babar because, in all those intervening centuries, we had remained loyal to elephants and further had nothing better than muskets to counter Babar's cannons. Even in 1962, the Chinese humiliated us because they had modern arms and we had none. Why do we stick to obsolete technology all the
time?

Let me illustrate the issue with a couple of stories. The first concerns a dhabha where, as is to be expected, the food was delightful. A guest after enjoying the meal, washed his hands and asked for a towel to dry them. The towel that was proffered was so filthy that he was driven to protest. The dhabha owner was perplexed. He replied "Saab! Hazaron log use kiye hain; abhi tak koi complaint kiye nai!". The second concerns a seller of gud in a mandi in Rajasthan. Noticing that the whole mound of gud was covered with flies, a young police officer asked the shopkeeper to do something about it. The shopkeeper was unperturbed. He said: "Wo kitna kha sakta hai, saab!" (How much can they eat, sir!) .
These anecdotes tell us a great deal about our culture. One, as in the case of the dirty towel, we are content with the barest minimum utility and have no concern for quality. Two, as in the case of flies, we measure what is irrelevant. We are backward in technology not because we do not have the materials, not because we do not have the talent, not because we do not have the money, not even because we cannot get the technology. We are backward because, as Sardar Vallabhbhai Patel has postulated, our culture makes us think poor.

Technology innovation is like a baby. As you know, a baby is defined as an alimentary canal with a loud voice at one end and no responsibility at the other! Likewise, technology innovation is a conduit for digesting natural resources - with environmental disturbance at one end and science at the other. Further, in the Indian tradition of caste, imparting knowledge to the undeserved is prohibited. So, textbooks are not written with the fear they may fall into wrong hands. Unfortunately, we were also taught that innovation requires intuition that comes out of a form of Immaculate Conception. That needs a miracle. Unfortunately, in the strict sense, technology permits no miracles. Instead, as Kuhn points out, revolution is actually the culmination of continuous evolution - it is always one last straw that breaks the camel's back. In our culture, in theory, we may question but as we do not experiment, we have no logical way of doing so. That is why we still manufacture cars exactly the way they were designed nearly half a century ago. In this respect, Indian intellectual culture is similar to that of ancient Greeks. They too felt that the best way to develop new ideas is to sit under a tree and think and think and think until realisation comes like a bolt of lightening.

There is the story of Aristotle decreeing that women had less number of teeth than men. Such was Aristotle's reputation in the Western world that, for centuries, people did indeed believe that women had fewer teeth. They could have easily verified whether that was true or false by asking their wives to open their mouth. They did not because in those days they too did not believe in experiments. Eventually, they started experimentation, and progressed. We do not do so as yet. So, we remain stuck. Not many people are aware that the first rockets ever used in war were of Indian origin. Almost exactly two hundred years ago, Tipu Sultan stuck terror among British troops with his rockets. Unfortunately, his rockets were so primitive and so uncontrollable that they devastated Tipu's own troops as often as they hurt the enemy. So, Tipu Sultan abandoned his rockets instead of trying to improve them. (As a matter of curiosity, the only sample of Tipu's missiles is not in India, but in the British War Museum.) The moral of the story is, generating ideas is not the same as converting ideas into usable products. The latter needs patience, time, determination and above all empathy.

Many of us have been fascinated by the extraordinary progress of East Asian countries. As Lawrence Summers has explained, the East Asian success is attributable less to technology innovation and more to higher application of capital. East Asian countries operate with technologies that are available for sale, not with innovations of their own. However, a large country like India cannot become rich by selling TV sets and notebook computers based on somebody else's design. Then, what can we, who missed the bus of post-war expansion, do? The story of drug industry indicates the way out. Drug prices often fall to less than a tenth the moment their patents expire. That is an indication of the power of technology innovation. Monopolies are always profitable. However, in that respect no commercial monopoly can hold a candle to technology monopoly. That is, what India needs most is technology of her own. India can become rich not by exploiting labour, not by borrowing capital but only through technical innovation.

As it has been said, it is better to be approximately right than to be precisely wrong. Let me give one example. It is said that Howard Hughes the self-made billionaire of yester years approached a banker for a loan to build an aeroplane. According to the story, the banker refused to lend him the precisely calculated amount the gawky youngster wanted. He insisted on lending him a lot more because a new venture is always uncertain, and there will always be unexpected demands. Compare that banker's wisdom with the way our bureaucrats and the government lending agencies operate. Our administrators pare down financial support to the barest minimum in the expectation the returns will then become maximum. As we know, more often than not, our bankers and our government lose everything. In contrast, Hughes's banker not only saved all his investment, he made millions for himself and for Hughes too. Once again, precise answers are wrong, approximate ones are right! Our country will march forward in technology only when our managers stop insisting on assured returns, and prepare to gamble to lose all --- or win the jackpot!

Then, there is the even more startling case of the Xerox Corporation offering to sell to IBM the patents of the Xerox copier. In turn, IBM turned to Arthur D.Little, the famed management consultants, for advice. Those management experts calculated that even if the Xerox copier took away 100 percent of the existing market for carbon paper and for dittographs, it will not be financially viable. So, IBM turned down the offer. Against such advice, Xerox persisted. The rest is history. The flaw in the management approach of Arthur D. Little was, there is no way of conducting market research on a product that does not exist, a flaw nobody in India appreciates. As Schumpeter pointed out over eighty years ago, "innovations do not as a rule take place in such a way that first new wants arise spontaneously in consumers ... It is the producer who as a rule initiates economic change, and consumers ... are taught as it were to want new things.
It would be nice if our managers, whether in the government or in industry, ask of themselves every day, and day after day, "Am I using this technology because it is good, or is it because I am used to it?" As Robert Frost has written: Two roads diverged in a wood, and I took the one less travelled by, And that has made all the difference.

In one of the most evocative passages in our Upanishads we are given the advice:
Shraddhaya deyam, ashraddhaya adeyam. Hriya deyam, bhiya deyam, sriya deyam, samvida deyam. (Give with reverence; do not give disrespectfully. Give with humility, give with a sense of awe, give generously,give affectionately.)

We are not good at giving. That is why we ourselves get so little. Authority is exercised both when you say "Yes!" and when you say "No!" I can assure you, it is more joyful to exercise authority by saying "Yes!" than by saying "No"

Dare To Dream

According to scientists, it is the ability to think which distinguishes man from other animals. They say that the basis for everything that makes man unique is thinking, for other animals can run faster, swim and climb trees better, and can fly without the aid of flying machines. But while I am not going to argue this, I do not completely agree with it either. For I believe there is one more thing that makes man unique. It is my belief that man is the animal that thinks and dreams. I feel that the one major reason for man attaining the heights which he has today is because man dreams. It was because Columbus dreamed of finding a new way to the Orient that he discovered America. It was because man has had an endless dream to fly that the Wright Brothers invented the airplane. I could give an endless list of such discoveries and inventions which are the end result, whether through foresight or by chance, of man's dreaming but will refrain from doing so for the very reason that it is endless. But, it is because man dreams that "great leaps for mankind," as astronaut Neil Armstrong said when he stepped onto the surface of the moon, have been made. I believe this is what is wrong with society in India today. All , everybody is looking for is stability, few people have a dream to work towards. Many young people blame this on the so-called "Age of Apathy," which they claim is the present period. To me this claim ridiculous. Not having a dream or not working for something you believe in is not something which can blamed on others. The only one you can blame is yourself. It is you who have to do something, nobody is responsible for you. It is up to you to discover something to work for and it is up to you to bring forth the will power to reach that something. You may wonder how to go about creating a dream for yourself and how to achieve it. But this, too, is something no one can give you any help with. All I can say is that you ought to try to set up something big as your dream. Something which would call for all that you have in you, or perhaps more. Something which would demand that you give your total devotion, something which you believe you want to obtain most of all. This can be anything, it doesn't really matter how big it is as long as you believe you can devote yourself to it and are capable of achieving it. It can be something like wanting to perfect a surgery, to something as big as working towards the Nobel Prize. The importance lies not in what you are working for, but in the fact that you are working towards something. Nor does it really matter whether you succeed or not, as long as you believe you have given your utmost. Because through this process alone you are improving yourself and developing your capabilities. I can think of nothing more satisfying or important.
I was particularly impressed by one of President Ronald Reagan's memorable quotes: Aim for the top, Pray to God & Hope for the Best. That should be our philosophy & it should be our endeavor to strive for excellence in all aspects in our life. I would conclude with a story that applies to all of us in the medical profession. In ancient times there was a philosopher who had many disciples. One day a cynical young man decided to humiliate him by asking him a question he couldn't possibly answer correctly. The cynic put a recently hatched chick in the palm of his hand and asked the philosopher, in front of a large audience, whether what he had in his hand was dead or alive. His intention, if the philosopher said `alive,' was to crush the chick to death and show the master to be wrong. If the philosopher said `dead,' then he planned to let the chick live--to prove the great man wrong.
In response to the question, the philosopher looked the cynic in the eye, smiled, and calmly replied: `The answer, my son, lies in your hands. Well, like that young man, the future of our profession lies in our hands. Our actions over the next few years will determine whether allopathic medicine--as we know it today--will be alive with research. . . and will thrive. . . or only a memory. Education is simply the soul of a society as it passes from one generation to another. And scientific meetings such as our annual meetings (www.sisab.net/tubes2007) are soul keepers of the society.

My Teacher

"A teacher affects eternity; he can never tell where his influence stops."
--Henry Brooks Adams
I was remembering my days in Israel, where I had gone to fine-tune my skills in Assisted Reproduction. Those were the turbulent years in Tel Aviv with suicide bombers causing havoc. The spirit of the citizens was remarkable - that is one brave race. I was really lucky to work with the finest teachers in the subject. There are over 25,000 IVF cycles done every year in Israel with a population of 4 million. The State pays for IVF till every patient has completed her family with two kids. If she divorces and re-marries, she again has the support of the state to have two more children to complete her new family. As a result, the public IVF centers have huge volumes of patients and the trainees & junior specialists can hone endocrinological & surgical skills. The practical experience that these fertility physicians imbibe is unrivalled in any other country. I remember the tips & tricks handed down to me by Prof. Danny Seidman, Dr Ariel Weissman, Dr Adrian Shulman & Prof. Ilan Tur Kaspa. Even today, I feel at times that these buddies are right next to me guiding me along the most difficult of cases. The student-teacher relationships graduated into close friendships & even today I ask them for advice in complex situations or for trouble-shooting. Today, the relationship is on a more even keel and they turn to me for guidance on Medical Tourism & third party reproduction issues.