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”.
Tuesday, June 26, 2007
Monday, June 25, 2007
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.
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.
Sunday, June 24, 2007
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.
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.
Saturday, June 23, 2007
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!
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!
Friday, June 22, 2007
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.
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.
Thursday, June 21, 2007
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!
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!
Wednesday, June 20, 2007
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"
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"
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