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!
Thursday, June 21, 2007
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"
Tuesday, June 19, 2007
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.
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.
Monday, June 18, 2007
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.
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