Thursday, March 30, 2023

Up in Smoke !


The Statesman, March 28, 2023

Whilst travelling recently, I noticed booths selling cigarettes at two well-known international airports in India. This, even though smoking is officially banned in public places. I recalled an incident of a few months ago. That day, while driving to work, I happened to pass by a young girl in a car who was being fined by two policemen for smoking in a supposedly public place - the confines of her own car! She looked terrified so I stopped to enquire if all was well. A crowd quickly collected around us and there ensued a lively debate about whether someone’s car constituted a public space. My learning that day was that a personal car when driven out of the home and especially with its windows open was deemed a public space. It was jarring to note how young college students who are not even earning must pay fines for lighting a cigarette whereas tobacco companies can openly indulge in tobacco sales in public places right under everyone’s noses with no adverse consequences.

On yet another journey, I noticed a special smoking room for passengers in the transit lounge of an overseas airport. I wondered about the necessity of pampering adults like this. Could grown-ups not be asked to desist from smoking for just a couple of hours? Contrast this with the strict enforcement of austerity for widows in India some years ago for example – where they were expected to suddenly change their entire lifestyle forever.

 The powerful tobacco lobby has created an enormous market for itself. Millions spent on advertising helped generate the aura that (the addictive) smoking was somehow cool and smart. As a youngster, though I did not smoke, my list of favourite advertisements included the cowboy in a checked shirt welcoming people to ‘Marlboro country’ and one glorifying the special thin cigarettes for women – Virginia Slims – which had the tag line ‘you’ve come a long way, baby.’ People lit up to feel smart, and to attract a potential mate. Today, about an eighth of the world’s population -1.3 billion people-use tobacco and an overwhelming number of these (80%) live in medium to low-income countries. As the sales of cigarettes went up phenomenally - about 6 trillion cigarettes are currently manufactured every year -; on the medical front, the rates of lung cancer, a truly rare occurrence in the beginning of the 20th century, increased concomitantly.

The lungs, heart, and blood vessels are very vulnerable to the effects of inhaled tobacco smoke which contains harmful chemicals like nicotine, tar, etc. The spectrum of lung problems is vast:  irritation of the airways causes a smoker’s cough (bronchitis); acute lung infections (pneumonia) as well as chronic structural lung changes (emphysema, chronic obstructive pulmonary disease) can occur; and of course, there is the dreaded lung cancer. Changes in the blood and vessel linings increase the chances of heart attacks, strokes, and peripheral circulatory problems. Smoking impacts other organs like the eyes, causes cancers in multiple organs other than the lungs too, and increases the propensity to develop diabetes. About 8 million deaths a year are attributed to Tobacco. For a country like India which is reeling from a spurt in cancers in the North West (a likely fallout of pesticides and crop modifications used to bring about the ‘green revolution’), and is also known as the diabetic capital of the world with 77 million or so diabetics, we can ill afford the smoking addiction. India currently is the second largest consumer of tobacco products, after China, with 267 million adults using various forms of tobacco.

Along with vigorously promoting the sale of cigarettes, tobacco companies in the mid-twentieth century actively suppressed information emerging out of scientific research that showed the link between lung cancer and smoking. This evidence had been painstakingly collected from diverse sources: large population studies; live animal experiments; cell pathology studies. Scientific scrutiny of the composition of cigarette smoke revealed that it contained numerous carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines, among others.

Realizing that their star product, tobacco, might well go out of fashion, even sworn rivals in the tobacco world colluded to protect their common source of profit. These companies created a deliberate smokescreen around the compelling scientific research showing that tobacco was harmful to health. They poured in money to induce other scientists to question these studies to ensure that the public remained in doubt. Their actions were clearly unconscionable, as they subtly promoted an addictive substance through behind-the-scenes manipulation. Criminal groups that openly and illegally peddled drugs were labelled cartels but these companies deliberately propagating an addictive item with full knowledge of its destructive potential got away with the less pejorative collective epithet of ‘lobbies’.

The stranglehold that the tobacco industry has on the decision-makers ensures that the product is still sold freely albeit with a warning printed that smoking is injurious to health. The so-called ‘safer’ alternatives to conventional smoking such as E-cigarettes are also harmful as their vapour contains nicotine and other toxic chemicals and they can be as addictive as regular cigarettes.

The ill effects of smoking reverberate far and wide, affecting not only the smoker but those in the vicinity as well. Formal scientific studies have highlighted the perils of ‘passive smoking’ which refers to the smoke inhaled by a bystander close to a smoker. Passive smoke has been found to have a 2-4 times more toxic effect since it is inhaled into the lungs without going through any filter (as is found on the end of a cigarette). Though malnutrition, the early age of marriage of women, inadequate healthcare facilities and not enough health education are some of the factors blamed for the huge number of low-birth-weight babies in India, the contribution of passive smoking has not been highlighted to the extent it deserves. Pregnant women, even when very careful themselves, often have limited influence on the smoking habits of other family members. Inhaled smoke can impact foetal development negatively. According to the National Family Health Survey number 5 (19-21) the prevalence of low-birth-weight babies in India is 18%.

Tobacco deserves far greater attention at climate change discussions for many reasons: it is not a soil-friendly crop; the process of curing tobacco prior to consumption is expensive; the disposal of cigarette butts and packs adds greatly to toxic waste as well as creating plastic micro waste. The fine smoke particles that settle on surfaces around us like clothing, hair, carpets etc form the ‘thirdhand smoke.’ They can persist for a long while and can be acted upon by oxidants in the atmosphere to release carcinogens into the air such as tobacco-specific nitrosamines and toxic aldehydes which pollute our environment.

Today, a significant number of people are suffering from long Covid (estimates put this between 7.5% to 45%). Amongst general symptoms indicative of this like chronic fatigue, memory fog, insomnia etc, lie specific cardiovascular effects such as hypertension, tachycardia, and heart attacks. Many patients who have recovered from severe Covid have highly reduced lung capacities. Thus, people now are even more vulnerable to the ill effects of tobacco smoke than before. Moreover, smoking reduces a person’s general immunity – something one can ill afford in a Pandemic and where millions are being spent on vaccines to boost immunity.

So instead of putting our health and our environment on a slow burn, we can do away with smoking, and by this single impactful act save our civilization from literally going up in smoke! 





Wednesday, December 7, 2022

We, the climate affected....

 The Statesman        7 Dec 2022

As a citizen of Delhi, I am dismayed at the toxic effects of the air pollution on all of us, as also on visitors from neighbouring hilly terrains. People from nearby states travel to Delhi to avail of the well-developed surgical facilities here. Many of these are non-emergency surgeries like cataract, chronic hernia, or joint replacement. However, even before they can undergo the surgery, the patients fall prey to the ill effects of the bad air quality and develop respiratory tract infections and a generalised weakening of immunity. They begin to feel depressed and want to rush back to the cleaner air of their hometowns.

Conversely, many Delhites are buying residential property in the hills nearby, all the better to escape choking for at least a few weeks in the year. In the foreseeable future it seems certain that people will migrate towards the few remaining areas that have breathable air. Like the well-established migrations for better job prospects, for fleeing political persecution, natural disasters and wars, the new waves of migration are likely to be towards places on earth where one’s lungs can still sample a whiff of fresh healthy air. It is truly ironical that the political- industrial nexus that has exploited and dirtied the environment on a mega scale (compared to those with simple sustainable lifestyles like fishermen, farmers, forest dwellers etc) will have the edge in this resettlement, given their ill-gotten resources.

Years ago, as a young student studying at an army medical college, I took part in a photography contest which required us to submit imaginative entries for the caption ‘the young and the old’. I requested a bunch of sweet young urchins playing in the street to come and sit on the low bough of a very old tree with a gnarled bark. For me, trees have always held a certain timelessness. I remember the awe I felt looking all the way up, my neck flung back, gazing at the tops of the giant redwood trees in California and similarly, at the huge horizontal expanse of an old Banyan tree in the botanical gardens of Kolkata. It takes decades, nay centuries, for a tree to acquire such dimensions. I feel deeply disappointed when grand old trees are sacrificed for any reason and replaced with the ugly inert concrete of buildings. I read a recent report about a mega infrastructure development project in Great Nicobar Island that has received initial environmental clearances. A very rich treasure trove of a whopping 8.5 lakhs trees on an idyllic island will be gone. Why would anyone destroy what is the equivalent of gold or rather Fort Knox itself? The justification of ‘military advantage’ does not cut ice.  For if the various wars have taught us anything, it is that these costly, visibly big , power- guzzling edifices are often the first targets of enemy fire. Even though humans may like to take the credit for destructive valour in the many crippling wars, ironically enough, the accidental but great role of nature - the mountain overlooking a valley, the advantage of stealth provided by darkness or forests, the sea transporting navies or the safe belly of mother Earth where soldiers hid in trenches can hardly be discounted. Governments promise ‘compensatory afforestation’ in lieu of hacking down forests -where old  trees cut are replaced with new plantations. How can tiny immature saplings be a substitute for developed trees with dense canopies or rich fruit bearing abilities ? How can one equate a decorated general with years of experience with a new rookie for example? The senseless destruction of priceless forests is as futile as the destruction of humans in the many military mega- wars this planet has witnessed.

Today’s biggest battle, however, is against habits and business models that destroy our planet. The best ‘generals’ for this sophisticated and difficult combat are climate scientists, indigenous tribes and forest dwellers who understand the terrain better (literally and figuratively). They can help set in place practical and genuine climate change policies.  When politicians negotiate in climate conferences, they often do so on behalf of the businesses which have strongly funded their election campaigns. Local people that do not have these vested ‘obligations’ can better focus on the planet’s survival rather than the survival of a political group or ideology.

There are thousands of innovative ways for individuals to join the battle against global warming as foot soldiers. Apart from recycling, composting, greening, gardening, scattering seeds on empty plots en-route to work and so on, we can also incorporate green actions into our professional lives. As a  personal example, we have started distributing green plants along with medicines to beneficiaries attending our holistic eye and general health grassroots medical camps. We explain to the patients the oxygen-producing abilities of the plant and encourage them to nurture it. My routine medical prescriptions also carry a printed message of harmony with nature at the bottom of every page.

If we as a race of consumers are serious about mitigating our personal impact on global warming , the time has come to ensure that each finished product has a biodegradability index printed on it. This should mention how many days it would take for the product to disintegrate completely. Plastics, we know, are largely non-biodegradable (many degrade only after 500 years or so)

and they harm the environment, plant and animal life and cause serious health issues in humans. Currently, almost all food products for sale mention the calorie breakup. This helps us make correct choices to safeguard our internal health. The time has come to purposefully shape our external milieu as well. Reading the biodegradability label could truly help us reduce the purchases of items that are not biodegradable.

In the recent climate conference, number 27, there was a much-hailed agreement reached (after years of painstaking negotiations) that developed nations that have consumed the Earth’s resources at a faster rate will contribute towards funding the countries that are most vulnerable to the effects of climate change (the carbon footprint of these developing countries has been much smaller but they are getting more affected due to global contributions to climate warming). While a broader redressal of grievances may play out at governmental levels, the same disbursement of compensation does not happen with individuals within states and countries. If destruction of forests and displacement of indigenous people continues with impunity within boundaries of states, then having a centralized UN conference has very limited impact.

The deep understanding of and harmony with nature of indigenous people is brought out well in a famous letter attributed to the native Indian Chief Seattle who wrote to the ‘White man’. Excerpts from the letter….. “This we know: the earth does not belong to man, man belongs to the earth’; “We know the sap which courses through the trees as we know the blood that courses through our veins”; reveal the intimate connection with nature experienced daily by them. Now, even city-dwelling citizens keenly feel the importance of a green cover in their lives.  A straightforward pledge by each and every nation to increase its forest cover by 5%  every year for 3 years and then 1% every year may work wonders. It is easy, non-controversial, and urban citizens and indigenous people alike would be delighted to participate with governments in this crucial endeavour to safeguard our collective future.

Since always, Mother nature has been providing us pure air to breathe but in return, we have been spewing noxious chemicals into her atmosphere; where her fertile soils support our crops and gardens, we plough toxic pesticides into the mud; her gift of fresh water to us is repaid by our spilling oil and garbage into her oceans. When the story of Homo Sapiens and Mother Earth is told, it can either be one of unrequited love by Gaia for humans and the certain destruction of our species or an inspiring tale of a deep and abiding love between man and nature that lasts till eternity.







Wednesday, October 19, 2022

On condition of anonymity

 The Statesman  (30 September)

During our school days, handwritten notes were a popular means of communication between students during monitored study periods which required a strict silence and a full focus on the homework for the next day.

Our teachers, who invigilated these periods, seemed to have eyes in the back of their heads, for many such notes being passed around were

deftly intercepted by them.The writer of the note was admonished and often given a mild punishment too. 


Over time, note senders adapted to the risky terrain by omitting to sign their names. They reasoned that anonymity conferred safety. Contrary

to their calculations, the situation worsened. The teachers punished the entire class. They seemed angrier in general, especially about the fact that the notes were unsigned. 


The values the teachers held dear made them deeply uncomfortable about any person not taking responsibility for something they expressed. They reckoned that a person should be able to stand by what they stated. Owning your words forced you to consider carefully what you wanted to say and also, how you wanted to say it.


The only time anonymity was somewhat appreciated, was when someone hesitated to take the credit for something good. Whether for an elegant poem, an impactful quote or a kind donation. In fact, true philanthropy in those days was supposed to be done discreetly so as not to cause any embarrassment to the beneficiary. Like white lies, 'white anonymity' could thus sometimes be acceptable.


Our teachers of old, would however, be dismayed at the high level of anonymity, accompanied by a lack of transparency that pervades every aspect of our lives today, ranging from everyday social media communications to economics to politics. 


In the cyber world, people hide behind false identities, and artificial intelligence bots are programmed to masquerade as humans.

This anonymity is very unwelcome as regular social media users can be bullied with few consequences for the culprit. Much of the trolling on social media happens via anonymous handles. Hiding behind a veil makes people reckless. Should all social media users be forced to identify themselves customarily, incidences of harassment would reduce substantially. The tremendous resources that are currently utilised in investigating  unwelcome speech would be cut down. Tracing identities of trouble makers would not be necessary as it would be plain for everyone to see who is at fault.  


Apart from bullying, the cyber user is open to manipulation as well. This is on account of the non transparency to the public of the company’s algorithmic designs and principles.The manipulation is insidious and here is how it plays out : users of several popular SM platforms choose topics and handles to follow. However, non-transparent algorithms regulate the content that comes on view. So, if for example, a user ‘likes’ a couple of photos of cuisine, their feed will be flooded with images and content related to delectable delicacies, even though they are not following any chefs or have not selected food as a chosen topic of interest. The critical issue here is, explicit permission has not been given to anybody, leave alone an anonymous bot, to ‘curate’ our lists for us. This curation is across sites e.g. the ‘percentage matches’ of movie viewing sites.  Nowadays, the ‘word of mouth’ of family and friends is increasingly getting replaced by ‘word of bot’. All this targeted meddling discourages deeper deliberation, making users mentally lazy. They are ready to go with the manipulated ‘flow’ and become statistics for money generation apart from getting more deeply hooked to their screens.


Also, certain types of conversations get amplified by these programmed algorithms and others not. They are designed to pick out 'leanings' (such as right or left leaning) rather than meaningful conversations (such as climate change or gender equality for instance). So instead of the popular mediums of communication being used to bring about impactful change, they accidentally or deliberately end up increasing the polarisation of thought and bring more divisions in society. 



Were it widely known what instructions computer algorithms for social media have been programmed with and under whose direction, checks and balances could be put in place.

Currently, there are few truly effective external checks. Whistleblowers from social media companies have highlighted how some company bosses take cyber safety feedback from in- house as well as outsourced professional experts poorly; their main focus being on hooking followers and garnering profits through selling user information. It is ironical that there are 'weapons inspectors' to stall the build up of arms and ammunition in countries but no such stringent safety checks for algorithm creation. Whereas creation of new platforms of communications among people can be conducive to inclusion and social cohesiveness, manipulation of people’s minds can inculcate addiction and lead to mental breakdowns. Behind the scenes manipulation of content can give an unfair advantage to businesses and political parties.

In fact, the alarming negative power of anonymity was demonstrated  recently, when a prominent journalist in India was arrested on the basis of an FIR lodged by an unknown handle. It could well have been a bot. It was indeed sobering to think that artificial intelligence could actually get a human into jail, no questions asked. It took the police several months to identify some face behind the handle, retrospectively, long after the journalist was released on bail.


In case no anonymity was allowed on any platform, enormous resources would be saved. Cyber police could free up a large proportion of the hours spent in uncovering hidden identities. Like the traffic rules which prevent owners from driving cars with blackened windows, similar rules of transparency would work wonders for cyber traffic!


Beyond anonymous words, lie anonymous transactions. In a country  where representatives are elected on manifesto promises of transparency, the electoral bonds - donations to political parties - are opaque. This has been challenged long back by an NGO but the case still languishes in court. Hidden political donations encourage corruption at the highest level as rich businessmen can influence policy and pull strings in the govt. through these 'gifts'. Scientists and professionals are obliged to make financial disclosures before giving their medical or technical opinions.This helps others decide for themselves whether there could be a personal bias in the professional’s recommendation of a particular drug or technology. For example, such a suspicion (albeit fairly unfounded) of bias by pharmaceutical companies also happens to be one of the reasons for a huge pushback against Covid vaccinations in some countries. Strangely enough, although govt decisions impact lives and livelihoods on a large scale, the elected representatives have not seen fit to similarly disclose to the public as to who or what is influencing their actions. 


At the level of the state, the veil of non transparency has traditionally  surrounded the working of the intelligence services of any state. Thus there is limited recourse to justice when there is lack of skill and planning leading to substantial ‘collateral damage’. It is not uncommon for hundreds of civilians to lose their lives as a result of botched up operations with little accountability of the state.

Contrast this with officials who have to wear their badges when dispensing their state duties. In the sad case of George Floyd who lost his life unnecessarily and wrongfully in a police encounter, justice could be dispensed as the officer's identity was known. 


It is clear that non- anonymity in speech and social media and transparent processes in social life enhances responsibility and accountability, saves resources and money and reinforces the good value systems of old. Our teachers sure knew what they were talking about!


Regulating Doctors


The Statesman (8 July 2022)

A comprehensive bill by the National Medical Commission that provides renewed guidelines for the expected professional conduct of medical practitioners and some standardization of healthcare is under consideration now. Suggestions have been invited on the draft of recommendations.

Previously, what has been followed are the medical conduct and ethics guidelines notified by the Medical Council of India in 2002. For dissatisfied patients there are robust grievance redressal mechanisms. Perceived gross negligence by medical practitioners attracts criminal lawsuits. Lesser medical malpractices by doctors attract fines in civil consumer courts. Quacks, i.e., conmen masquerading as doctors, are dealt with strongly and have no connection with the medical world.

The new bill draft suggests five levels of disciplinary action which can be taken by state and central medical commissions against erring doctors. The first level termed ‘reformation’ includes counselling for minor administrative or procedural lapses and advisories can be issued to doctors to attend generalized or specialized workshops on medicine/ethics/other. The second level of punitive action allows suspension of a medical practitioner up to one month. It is to be employed in those instances where there is no evidence of direct harm by the doctor.

To my mind level one and two are completely superfluous and should be done away with. They vitiate the enabling atmosphere and peace of mind doctors need in order to give their very best to the patient. Officially rapping doctors on their knuckles for minor transgressions makes them feel they never transitioned from school to responsible adulthood. It would also unnecessarily add to the work of the officials of various medical commissions, distracting them from bigger issues.

There is much self-correction built into the medical profession. Teachers and mentors keep tabs on those working with them and regularly point out the finer aspects of the profession to their junior colleagues. Almost all doctors belong to professional bodies or work at hospitals/registered clinics that follow prescribed norms (without which they don’t get a licence) so there are regular audits, reminders and well-worn guidelines.

As far as level two is concerned, even the country’s judicial system at large finds a person innocent until proven guilty. It is worrisome that even when the examining officials are sloppy or unsure about the doctor’s attributability, they will still be able to penalize this cohort of sought - after professionals.

Level three and four prescribe longer suspensions from work -up to 3 months and 3 years respectively. In this case there has to be evidence of direct harm caused by the doctor’s actions. Level 5 seeks to debar medical professionals permanently for grave negligence. The last three categories make sense. For actions of the doctor that result in direct grave harm to the patient there should definitely be thorough investigations and full accountability. This is already being ensured through judicial recourse.

Overall, there plenty of reassuring checks and balances in the medical profession. Difficult entrance exams cull out people with fine brains and the ability to work hard. Long arduous years of study, tough competitive exams for getting into a speciality and doctors’ inherent desire to be cutting-edge ensures they remain abreast of developments in their field. Many institutions have doctors working in units or teams and hence collective decisions are made after thorough discussions. A doctor’s reputation is closely linked to the patient getting healed successfully and there is heavy competition in the private sector.

No doubt, medicine is a vocation where quality of life and prevention of death are at stake, so it is always under scrutiny. However, the actions of many other professionals have a deep impact on our lives and therefore this umbrella of accountability has to be widened to include them. Doing this would ensure standardization of care in a holistic manner across professions and not just single out the medical community for having to labour under a plethora of rules.

For example, wrong conclusions arrived at in courts of law have sent many an innocent person to jail. We read about influential rapists who are given bail and then hurt and threaten their victims. Many illiterate people are not able to understand the court proceedings but this doesn’t translate into a reprimand for their lawyer. The court enjoys many honorific titles and can penalize someone who is deemed to have held the court in contempt. Judges have the freedom to ‘interpret’ the laws according to their own understanding. Their judgements cannot be scrutinized on merits per se. There is no judicial ombudsman or grievance cell where the public can ask for review by senior judiciary/ legal peers when an occasional judgement seems illogical or absurd. Citizens can certainly appeal a lower courts’ judgement in a higher court. However even if a judgement is overturned the lower court is not held accountable. Despite laws being well defined, their interpretation is rather ‘fluid’. Imagine the outcomes if doctors were allowed their own ‘interpretations’ of medical textbooks!

Similarly, police reforms are long overdue. A recent report in the paper described how eight people were wrongly arrested by the police for fomenting trouble in a crowd. They were released after their families submitted categorical video evidence of their absence from the scene. It is sobering to think that the police can round up anyone they suspect without due process or accountability and the individual then has to run from pillar to post to free themselves. Of late the police seem to have become a weapon for politicians to bully the public with. Policemen deviate further day by day from their friendly ideal of ‘with the public, for the public always’. The tragic death a few years ago of a dentist’s daughter in Noida, made headlines for long. Despite police thronging the house that day for the express purpose of discovering clues, they failed to pick up an enormous clue – another lifeless human body in the same house! The body being discovered only the next day -the blundering nature of the investigation became equally sensational. Citizens have to live with the spectre of tardy arrests, delayed FIRs, poorly written chargesheets and faulty evidence collection. However, there are no well laid out procedures for police officers to be held directly accountable to the public for poor quality of services rendered.

Politicians imagine they are special and above reproach. From broken manifesto promises, horse trading and jumping parties after elections to hogging all the resources and security, the list of misdemeanours is endless. Political decisions that decimate the environment (for short term ‘development’ gains for a few businessmen) are contributing to global warming and sending our planet hurtling towards a collapse. Poverty, prices and unemployment are surging everywhere. Yet there is no provision to change the representative for non- performance and even the most unpopular ones are allowed to complete their full term.

Doctors are probably the only professionals today that agree to double work shifts - OPD during the day and emergency night duty – in rotation with colleagues. The fact that the world has been through a pandemic where doctors have worked overtime, suffered great emotional and physical burnout and risked their lives for others must never be forgotten. The population is still reeling from ill-health, emotional, financial and mental stress brought on by this pandemic. Patients do need the strong reassurance that doctors provide.

However, doctors can function well as pillars of support if their worth is well recognised and they get appreciation rather than overzealous regulation. Also, rather than the national focus being selectively sustained on doctors’ conduct, it should be holistically broadened to include accountability from all professions. This is the most sustainable way forward.


Wednesday, May 11, 2022

There is much at stake in the US abortion debate

 The Statesman, 11th May

The Roe versus Wade 1973 judgement, which helped legalize abortion in the United States, is in danger of being overturned by their Supreme Court justices. This is rightfully causing great consternation. If reversed, it would deprive women of the right over their own bodies, thereby infringing their constitutional right to liberty. It also impinges on their right to life; pregnancy-induced physiological changes render a woman more vulnerable to morbidity and death; therefore, the choice to be a mother must be hers. Criminalizing abortion forces women who seek it (for a multitude of compelling social and personal reasons) to get it done quietly in unsafe conditions thus putting their lives in danger (4.7% - 13.2% of the maternal mortality which currently stands at 152/100000 live births internationally is due to unsafe abortions). As per WHO research, 45% of the overall abortions performed are unsafe as they are carried out surreptitiously, in countries that have officially made it illegal. This cohort of women therefore unfairly gets excluded from the excellent advances in medical science that all other citizens enjoy. The right to an abortion (medical termination of pregnancy) on demand is available in only about 27% countries though many do allow it on various medical and social grounds and almost all countries allow it as a life-saving measure. In Ireland, the right to abortion was introduced only in 2018, after the public outcry following the preventable death of Savita Halappanavar who was not allowed even a life-saving abortion. The upper time limit of legal abortion ranges from 12 till 24 weeks (these decisions are based on age of viability of the foetus and maternal safety). In India it is thankfully allowed till 28 weeks (with some caveats).

Rescinding any hard-won welfare measure for women is grossly unjust as it forces women to keep going in circles, while men progress forward linearly. Once born, a human is protected under several human rights laws. Insistence on special rights for a foetus before its birth creates unnecessary judicial tension and confusion. For example, no such ‘rights’ are accorded to the artificially fertilized eggs in petri dishes in medical establishments (which are thrown away/ used for medical research after one amongst them is implanted in the woman) for childless couples availing of in-vitro fertilization. Also, a law aided coercion of women to carry pregnancies resulting from rape or incest, totally ignores them as being a victim of a heinous crime. The Geneva convention unequivocally categorizes sexual assault and rape as war crimes. Today there is conflict (and assaults by army soldiers/guerrillas/terror groups on native women) everywhere. Is it ethical to force women to give birth to the children of enemy soldiers?

There is blatant gender inequality in not having any legal binding on fathers (who are at liberty to abandon their pregnant girlfriends or the idea of fatherhood), yet not allowing a woman to change her mind about a lifelong commitment such as motherhood. The anti-abortion lobby must not ignore the enhanced risk of teenage pregnancies (a Lancet meta-analysis highlights that those mothers in the 15-19 age group have a 28% increased risk of dying as compared with those in the 20-24 age group and this is even higher for mothers aged below 15 years). Also,the courts are silent on the critical issue of the foetus’s rights on its biological father. It is imperative to put a legal onus on the father for lifelong parenting and fiscal responsibility when talking about the ‘rights’ of the unborn child.

The anti–abortion lobby focuses on the ‘right to life’ of the foetus. It is noteworthy that the earliest age that a foetus can survive independently is after 28 weeks when the lungs are somewhat capable of gas exchange (modern medicine can accelerate this somewhat). The lobby however wants a total full stop on abortion at any stage. Some believe that a ‘soul’ inhabits the foetus even when it is not physically viable. This is highly presumptuous given that no human can claim to be aware of what happens in the realm beyond life.

 Pro-lifers ignore the human right of women to choose what happens to their body and do not take into account situations where women may be mentally and financially ill-suited to raise a child. The quality of life of a woman changes with conception. Even before that, the overwhelming burden of contraception in most societies falls on the woman. Few men use the simple and widely available condoms with responsibility. Oral contraceptive pills for women can have side effects ranging from relatively milder nausea, weight gain and mood swings to the more serious susceptibility to blood clots (and the effects of embolism).

When a woman does conceive, there is a risk of morbidity and death before, during and just after her delivery. Pregnancy-induced nausea and vomiting, and gestational hypertension and diabetes are fairly common. Peripartum complications can have a lifelong impact such as Sheehan’s syndrome where many endocrine functions may be lost due to the blood supply to the master endocrine gland, the pituitary, being cut off. The mental anguish of those mothers that fall prey to severe post-partum depression is terrifying to behold. When women’s bodies and lives undergo such major changes after conception, is it fair or reasonable to deprive them of agency over their own bodies?

12-24% of all pregnancies end in spontaneous abortions, a majority of which are due to genetic malformations of the foetus. The parental contribution to this genetic pool is equal. Another factor is active and passive inhalation of tobacco smoke. How many family members give up smoking when their wives are pregnant? Some other factors are the mother’s ill health and lesser education levels, poor access to medical care and lack of proper rest. How many pregnant women are encouraged to stop tilling their fields or have the water from the well carried for them by men? When spontaneous abortions can be brought on by the actions of others or prevalent social mores, then why deny just the woman the right to safe abortion when she herself needs it?

Female foeticide is a flourishing evil and our country accounts for 40% of the females that go missing out of 1.2 million per year (China is ahead at 50%). It is no secret that women are sometimes subjected to clumsy abortion attempts by their own relatives. A patient I once attended to in the army MI room gave me a graphic account of how her mother-in-law tried to abort her pregnancy using the thorn studded stem of a rose plant. Relatives who indulge in such barbaric practices have hardly ever been arrested but if a woman legally seeks abortion herself, she falls foul of the law. Is that just?

These biased rulings denying women control over their bodies stem from patriarchal thinking. They are neither conducive to gender just order nor are they rooted in logic. They also are in total contravention to two of the four pillars of medical ethics -namely autonomy of the patient and beneficence. Why should pregnant women be excluded from receiving the benefit of two central tenets of medicine as well as its advances at a most vulnerable stage of their lives?

I sincerely hope the justices will acknowledge the risks a woman goes through to bring forth life, and support her wholeheartedly in her pregnancy-related choices. Most importantly, she cannot be forced to spend her entire life dealing with the outcomes of sexual assault on her body rather than realizing her own potential and dreams. 

Thursday, January 13, 2022

Shrinking spaces and expanding horizons

 The Statesman, 

January 13, 2022

Some years ago, I saw a mesmerizing dance show at the Purana Quila in Delhi where the accomplished dancer Astad Deboo, straining every nerve and sinew, slowly contorted his body into a tight ball – he was simulating an embryo. Today I am reminded of that contortion as I look around. The Pandemic and man-made factors have relentlessly compacted our lives to fit into the shrinking spaces around us.

Concerns around disease transmission have restricted our physical space. Humans that once roamed free on Earth are not able to do so now. Students do not have the pleasure of attending schools, gym enthusiasts have to lift weights at home and increasingly, access to public places is being determined by vaccination or RTPCR status. Humans are experiencing the same uncomfortable reality of depleted common territory that so many magnificent creatures of the wild have been subject to for several years.

Almost 68% of wildlife has declined due to the large-scale attrition of forest cover which now stands at a mere 31% or so of the total land area. Commercially driven takeovers of their habitats have forced animals into close proximity with humans. Despite now understanding first- hand what being hemmed in feels like, many humans remain unempathetic. For example, several resident welfare associations are deeply divided on the issue of the need to provide shelter and food for stray dogs. This is a far cry from the days where we grew up watching our older relatives regularly feeding birds and kind-heartedly throwing a morsel to dogs and cows that wandered close. Displacement regularly affects humans as well, now. Human conflict, ethnic cleansings and calamitous natural phenomena brought on by global warming have created homeless refugees. Such people often face hostility and have a poor quality of life in the countries they flee to.

Women have had it a tougher since the Pandemic has kept people confined to their homes. Domestic violence has risen – even by as much as 30% in some countries. With the entire family being at home, their space for quiet reflection has been lost in the interminable swirl of increased household chores.

Authentic, fun-filled online social media exchanges are getting swallowed up by the superficial quest for ‘likes’.The fulfilling and joyous banter amongst private groups of friends, college and school mates, or neighbours is corrupted by having to designate one (or a few) as the overall administrator - responsible for the ‘conduct’ of the group. Surely the responsibility of not hurting others with our speech rests with each adult human. There are well established laws against hate and incendiary speech. The deliberate creation of such a post strongly places the entire group at the mercy of the administrator’s own personal and political biases.

In the more public platforms, interesting conversations leading to a build- up of consensus among groups or the emergence of sustainable solutions on diverse issues are quickly thwarted by trolls who instead flood the platform with politically motivated, sensational, and fake news. They stalk and abuse women online. We recently witnessed an extremely depraved attempt to auction Indian women on cyberspace. Not surprisingly, the online places where women feel safe and welcome are reducing.

The space to love someone of our choice and even to pray to a deity of one’s choice- two integral aspects of life- is dwindling. Even in this modern era, we hear of young lives being sacrificed to caste related ‘honour killing’. Some state laws make religious conversion punishable. Hoodlums masquerading as moral keepers of society tyrannize young couples in interfaith marriages. Many such young couples facing harassment are compelled to seek judicial intervention.

The space for seeking the truth and telling it is contracting. People are subtly manipulated or outright coerced into following a particular political ideology. Dissenters are treated shamefully. Genuine investigations of crimes or scams are thwarted and instead a lot of money is spent on covering up or whitewashing the incident. There have been instances where journalists out to uncover the truth have been harassed, bullied, jailed and outright killed. Whistleblowers, usually people of rare courage, are made to feel as if they have done something wrong in exposing the truth. Powerful lobbies accused of fraud swing into damage control mode and save their own skins while making whistleblowers look like fools and liars.

The scope for fun and laughter is lessening. Jokes which made us laugh because they were funny and irreverent, now can elicit punishment rather than laughter for the teller. This is because many disgruntled authorities lack a sense of humour and can be childishly vengeful. The regular umbrage-taking by those in authority creates an atmosphere of all-pervading seriousness, vastly different from yesteryears where the wonderfully satirical cartoons of RK Laxman brought a smile to the face of even the crustiest official!

The chance to get a proper education is reducing. Extremely high entrance cut-offs make securing a university seat a nightmarish struggle. For those who are lucky enough to gain admission, there are frequent disruptions in their studies – usually due to some ruckus created by the student wings of political parties. Even the choice of thesis topics has become limited. Rather than subject experts being allowed to design such studies as will address gaps in the current knowledge in that field, they are unethically pressurized to allot research topics of ‘national interest’.

The space for thinking critically and heartily examining controversial topics through debate or discussion is shrinking. There is a sustained attempt by those in power to introduce a conformity of thought and ideas, forcing even the imagination to shrink.

Mirroring the ever-expanding universe, a human’s imagination is limitless, and a stifling of this deep resonance between a human and the stars above is to shrink the very essence of being a human. In astrophysics, black holes in space are bordered by a line called the event horizon. Cross this threshold, and you are sucked into the infinitesimally dense void of the black hole where even light cannot enter. Similarly, if the room for expanding one’s thoughts and expressing one’s views gets compressed further and further, it is going to be impossible for the light of knowledge and discovery to enter. 

Meanwhile, a few things grow rapidly, out of tandem with the world around them. The virus is unfettered and continues to multiply its presence exponentially by making neat alterations to its spike proteins. Several billionaires’ financial net worth is still growing by leaps and bounds in a world with a decidedly inequitable distribution of wealth. Some powerful leaders across the world expend their energies in lengthening their own personal ruling tenures, fairly dismissive of environmental and citizens’ concerns, even as our planet sinks deeper and deeper into peril.

In a world that seems continually programmed by irresponsible leaders and a relentless disease to cave in upon us, we can regain valuable space by expanding our own consciousness, broadening our thinking and enlarging our heart’s capacity to give and receive love. The greatest gift in these times of paucity is to just allow a fellow being a little more space to live, laugh or learn. A little more space to breathe. And watch Astad Deboo’s ‘embryo’ blossom gracefully into a contented and complete being.


Sunday, July 4, 2021

Will a better human strain emerge after the pandemic ?


The Statesman 5 May

The Indian public is trying to cope with the gravest medical crisis in recent history. There is an acute shortage of hospital beds and oxygen, leading to a high fatality rate among Covid patients. Everywhere, people are grieving over the loss of loved ones and there is palpable anger at the lack of preparedness. These shortages which hinder treatment and cost lives make even doctors feel very helpless. Over and above their medical duties, doctors find themselves being pulled in different directions. They are having to get involved in chores such as sourcing scarce oxygen supplies and to get multiple forms signed from relatives. These protect them from liability not related to medicine – such as medicine stocks running out or ICU beds not being available.

Where they were once able to offer comfort and reassurance to most people, they themselves are at their wits’ end. They feel very uncomfortable at having to ask prospective patients to come for admission with their own medicines and cylinders. Outside, at the hospital gates, people wait expectantly, hoping a miracle will happen and an empty ICU bed will surface. Such miracles are rare.

Many people don’t make it to the inside of a hospital and breathe their last on the roadside. Even crematoriums are overburdened and have run out of space. The new mutated virus strain in this wave is causing a lot more medical uncertainty as it is not easily detected anymore. Because the Rt-Pcr tests were designed on the genome of the original strain, they are often not able to detect the presence of the new virus.

Could the virus be having a dormant form like the Varicella Zoster virus (Chicken pox, – which rests in various nerve ganglia and gets active producing shingles years later), when the host immunity is lower or the environment conducive? Maybe this form erupts suddenly once its gestation cycle is complete. Who knows? In India, this massive outbreak has occurred just when the beautiful flowers of spring were blossoming everywhere.

Echoing Darwin’s theory, the virus is trying to survive, by evolving. Whereas evolution in contemporary species is slow, this virus seems to be doing so at supersonic speeds. It also now seems to be taking a faster route to its target organ of choice, the lungs, bypassing the nose and throat areas. And it has cast its net over a much wider area.

We see so many younger people getting infected with Covid compared to the ancestral strain which largely spared the young and healthy.  Matching this uncertainty are various man-made ones. There is uncertainty about the availability of vaccines and their efficacy against newer strains. The data on the disease is not fully reliable or transparent. It does not seem to accurately reflect ground realities.

For example, in many instances, the official death toll has been starkly different from the crematorium records by a factor of 20-25 on some days. Due to this patchy data, it becomes difficult to formulate and test various medical hypotheses.Yet, in the midst of this absolute pandemonium caused by the stealthy attack of the virus, there is a group of people carrying on with their lives with an enviable certainty as if nothing of import has happened.

We have an international cricket league tournament going on towards which already meagre resources are being diverted. People fly off on exotic holidays and post vacation snaps even as journalists post pictures of a profusion of pyres and lines of waiting ambulances.

We have seen elected representatives host crowded public religious events and address large election rallies, totally unmindful of the fact that this can help propagate the virus and spread sickness and death countrywide. This indifference is strange, coming as it does after a severe round of suffering caused by the first wave of the pandemic last year.

Can we really live in a bubble, impervious to what is happening around us? We have suggestions from people to stay happy even as the world around us collapses. Of these, some sensitive souls are truly well meaning. Some others do not want to face reality, and want to bury their heads in the sand. A third group wants to hide reality and diffuse public anger. It may be most healthy to allow feelings and moods to play out in people in their own natural way.

Hiding rage and grief beneath an artificial veneer of inappropriate cheerfulness may adversely impact minds already traumatized with worry and sorrow. A false sense of security may also cause people to lower their guard. Accepting harsh reality may render us better placed to deal with it. Far worse than callousness, are those trying to profiteer from the grim situation.

We have medical vendors who are building up their personal fortunes by selling oxygen cylinders and medicines at highly inflated prices, while people desperately fight to save their loved ones. We even have priests who have hiked rates fourfold for performing the last rites of the deceased. For immediate redressal of the black marketing in medical commodities, the answer is likely very straightforward – the products should be made freely available.

A simple regulation can be made for suppliers and chemists to not sell more than a limited amount to an individual buyer to ensure a more equitable distribution and pre-empt hoarding. The huge amounts of foreign aid in the form of medical supplies coming into India from countries all over the world needs to be transparently documented by customs and distributed to the most vulnerable. The public will feel very reassured if they can track the life-saving goods directly.

Not everything, however, can be painted black. We are also witnessing models of selflessness. People rallying round to help others. There is a sea of concerned humanity, people sharing resources with each other- literally saving lives and stepping in wherever the need arises. Gurdwaras have been at the forefront of providing free oxygen to the community and NGOs are back in action distributing free meals.

Despite having faced severe scrutiny and an acute depletion of funds due to complex regulatory laws, NGOs have still bounced back. Even in an extremely weakened state they are standing tall and inspiring everyone with their work ethic and abundant social responsibility. In fact, in his public address on combating Covid, a prominent leader appealed chiefly to civil society groups and NGOs to help turn the tide. What would undoubtedly add punch to this effort would be for the leaders to themselves lead by example – in terms of wearing masks and ensuring distancing when addressing the public.

The pandemic has brought out both the generous as well as the selfish sides of humans – ‘the good, the bad and the ugly’ as the title of a popular Western movie goes. In this macabre dance for survival, hope springs eternal that it is the human species that survives. That it can mutate into a superior species after its literal trial by fire. Our fervent hope is that the new human variant can live in a responsible manner and in greater harmony with each other and with nature. Apart from healthcare resources, what human behaviour patterns prevail may well decide the fate of mankind during and after this pandemic.

(The writer is a Delhi-based medical practitioner)