A traveller's view

 The Statesman May 2025

An increasing number of people use public transport for economic reasons, environmental concerns and so on. The recent collapse of a valuable customer service, Blusmart, robbed the traveller community of one robust travel option. Some of Blusmart’s likeable features included a homogeneity of cars, speed limit monitoring, good cooling, and assured rides. Being a frequent user of several app-based cab services, I have benefitted from the comfort of having such a facility yet also reflected on some gaps that if addressed, can truly enhance the experience for the user. 

Currently, luck appears to play a big part in the sort of vehicle one gets when one books a cab. There do not appear to be any standards laid down to ensure basic quality of the interiors or exteriors of the cars in the fleet.Even dirty, dented, or dilapidated cars have on occasion been given the tag of a ‘prime sedan.’ Whereas, the proud owner of such a sedan may be as pleased as punch, the customer is most certainly not! The air you inhale during the ride hinges a lot on the habits of the driver. If the driver smokes, you may well be imbibing the stale aroma of cigarette smoke, and if the driver uses a purifier, there are pleasant smells wafting about. Also, the tools you get at your disposal, to beat the heat and humidity vary from mini fans to air conditioners to just handles to slide down the windows. Perhaps a quick glance at your horoscope may well alert you as to what to anticipate during the ride that day! 

So too with drivers. Most drive reasonably well but their habits and personalities can impact your day.Sometimes, passengers who have just booked a cab may be deluged with unnecessary calls from the drivers. For commuters using the precious morning time to finish off their breakfast or complete their dressing, it is an unwelcome intrusion. Many cab drivers hail from states other than Delhi and are unfamiliar with Delhi roads. This puts them completely at the mercy of Google maps, a whimsical navigation tool. Often enough, a flyover or two turns placed close to each other can throw the driver off route with adverse time consequences for the passenger. Since passengers make phone calls during the journey and responses are clearly heard in the close confines of the car, a few drivers eavesdrop and then join in the conversation as if it is the most natural thing in the world.For example, if I give any medicine related instructions to patients or staff, I find that the driver who has guessed my profession, will suddenly begin telling me about various ailments in his body without any preamble and without even inquiring what my speciality is!

Many of these micro level issues can be easily addressed if the cab services are held accountable for monitoring the basic cleanliness level of cars, and providing hired drivers orientation workshops on Delhi routes, and some tips on customer interaction.

At a macro level, these app based services are given special facilities by the regulators. They are allowed ‘dynamic pricing’ which allows them to charge different rates for the same distance. Thus, the business fluctuations are transferred to the commuters who must absorb the problems of short supply of drivers. In fact, now there is an explicit choice to tip the driver and get available cabs quicker. This does not seem right. If people were to ‘tip’ doctors in the emergency room or judges for jumping the queue or getting faster services, it would amount to corruption.Yet in this essential service, this feature is allowed which then favours those with extra funds to spare. 

Since the app-based cars take customers from their homes to workplaces and shopping malls etc., they have very precise data on customers – where they live, where they work, where they like to shop and travel etc. We have no way of knowing whether this information is sold and to whom. It makes customers vulnerable. The app service also uses clients to get feedback on the car and driver; things they themselves should vet in the first place. My own experiences of using these cab services range from the downright scary to the truly pleasant. An unnerving journey one night was with a driver who doubled up as a music jockey during the journey. He commenced by playing songs with vulgar lyrics which were assiduously ignored by me. Not feeling satisfied he tur – ned around and specifically asked me whether I was enjoying the (cheap) music. I politely de c li n ed and said our generation preferred slow ghazals. I hoped that the reference to an older generation might make him disinterested in the passenger. However, he instead started playing different ghazals and after each one would turn round to stare at me, repeatedly asking whether I had liked it. Apart from his constant turning around in his seat being risky for our collective safety, it made me truly uncomfortable. I did not really know what I could to do to change the situation at that late hour. I felt utter relief when I reached home. Another regrettable incident was when I was dumped unceremoniously on a dark road in front of a long boundary wall (the end of which was nowhere in sight) in the late evening wearing a sari, adorned with jewellery and carrying a heavy gift. The driver insisted that the journey map showed ‘done’ so I must exit from the car. I tried to appeal to his logic that the journey’s end should coincide with an entry gate or building at least but the driver was adamant that his responsibility to me had ended so I must disembark straightaway. No amount of reasoning or persuasion worked.Finally, I was forced to walk about 3/4ths of a kilometre on the dark stretch carrying a heavy load and looking nervously over my shoulder till I finally reached the entrance which was on the other side of the compound. 

There are also many instances when the ride has been a truly joyful one. Some drivers are very courteous, wish you politely, keep to themselves, and will be good Samaritans when it matters, such as patiently waiting for you when you buy an urgent drug from a chemist en route. One elderly driver I happened to be journeying with swerved left a little sharply which resulted in a collision with two motorcyclists, one of whom got a few superficial injuries. I expected a fight to break out and feared for the old driver.The driver got out of his cab and offered to take the injured biker to any nearby hospital for wound dressing. I was very pleasantly surprised when the affected motorcyclists as well as the collected bystanders exhibited kindness to the aging driver and assured him that they would manage everything themselves, asking him to resume his journey. Clearly, Delhi at its best.

To conclude, app owner business teams can make the journey a most satisfying experience for the public should they put in a few more value-added services. The regulator should ensure that the overall average driver rating (across all drivers) is made publicly available. This will indirectly ensure a more thorough selection process. Travellers will stand to benefit.

The curse of Capitalism

 The Statesman March 25

Capitalism, the ‘saviour of the free world,’ was touted as an economic paradigm that incentivised effort, encouraged barter and most crucially, brought power back into the deserving hands of the masses of regular, hard-working people. Sadly, many of these objectives have not been achieved. Moreover, capitalism has generated some popular narratives and engendered ways of living and thinking that bear significant reexamination.

Power has once again become concentrated in fewer hands than ever before. A handful of corporate megaliths use their economic clout to stifle competition, effectively discouraging diversity. Additionally, the non level playing field thus created even blunts the pace of their own research, turning innovators into mere mass producers. For example, a well-known chip manufacturer, once ad mired for dynamically improving computer processing speeds, lazily plateaued into monotonously releasing slightly better versions of the same chip every year once they gained a sizable monopoly. Some tech mega brands that dominate the market coast comfortably every quarter more on the class consciousness of their loyal users rather than genuine upgrades of their products over time. Even revolutionary technology like the large language models of AI was deeply influenced by market forces.

A small cartel controlled the research which was as expensive as it was exclusive. It took a small start-up from China to shake things up. By providing a version that was a fraction of the cost and freely available to everyone, they totally changed the narrative. Capitalism justifies its own ideas and actions, while blaming others: The key ingredient to a fruitful business idea, as many executives will say, is ‘solving a common problem.’ Capitalism some times can create a problem, partially solve it to feign progress, and generate a new problem along the way. We notice how big firms in developed nations outsource production to third world countries, availing cheap labour rates and thus increasing their profits. They are welcomed by the officialdom in these countries on the premise that jobs are being created locally. However, these jobs are quite basic and often exploitative (underage workers, unsatisfactory working conditions etc.). Ironically, these profit hungry megaliths are not accused of taking away valuable jobs from their own country by outsourcing. Rather, the spotlight falls on foreign immigrants to their country ~ these are blamed for usurping local jobs. In fact, much of the employment taken up by these immigrants is that which local people shy away from doing. The lenses and metrics capitalism chooses to view overall economic progress ignores imp – ortant nuances.

One would think, rationally, that the indicator of a strong economy is the ability of the common man to sustain himself financially. When we look at India’s economic prosperity through the lens of GDP growth, it is easy to think that we are doing extremely well ~ due to the huge turnover of corporate powerhouses. However, this measuring tool masks the pitiable living circumstances for the myriad poor and thus is not very reliable. Capitalism has somehow normalised the discrepancy between senior managers of companies on business trips being put up at five-star hotels after journeying by business class and masons and bricklayers not getting even a decent dormitory to sleep in when they cross state boundaries to work. The narratives spawned by the big fish portray themselves in glowing terms while being a little derogatory about the smaller players. Robust small size enterprises are pejoratively termed ‘mom and pop’ shops. On the other hand, big conglomerates confer on themselves epithets like ‘unicorns,’ when they could well be labelled ‘King Kong’ enterprises (that destroy others in their path) for example. Likewise, NGOs sourcing funds (to help others) are dismissively deemed to be ‘begging’ for funds yet regular business companies pitching for funds (for their personal growth and profits) are painted as brave warriors who tamed the ‘sharks.’ Capitalism weaves itself into processes and subverts healthy trends: Capitalism is slowly seeping into various professional ecosystems and modifying them in ways that could be unsuitable. Take the world of medicine for example.

Rather than concentrating mainly on professional excellence and service with a smile, corporate hospitals are increasingly focusing on going deluxe. The outcome of hospitals simulating destination res or – ts comes at the cost of raised tariffs, out of the reach of many. The content of medical literature is also changing, with the incorporation of heavy amounts of (to my mind) unnecessary economic data. When we were young medical students, the articles written focused chiefly on the disease entity itself. Now a days, there seems to be a requirement to write about the economic implications of diseases and interventions. Is this necessary? Is the impact on the GDP an appropriate focus for students reading journals to learn the medical nuances of diseases? Similarly, nowadays, discussions in corporate hospital monthly meetings are as much about the revenues generated by various specialities such as cardiac, orthopaedic etc. as they are about hospital policies. Where once senior doctors on grand rounds held up patient charts for groups of students to scrutinize and learn from; we now have hospital administrative staff holding up excel sheets with graphs depicting departmental earnings and ‘educating’ doctors, nudging them to not ignore fiscal responsibilities to the hospital even while dealing with responsibilities to patients. Medical insurance companies in some countries have found a way to skim profit at every stage of a patient’s interaction, creating a new angle to medical care that denies access to many who severely need it simply because their life-threatening disease is not on a list of preap proved conditions. Doctors who take conservative approaches to diseases or choose gentler cures that take longer may well be blacklisted by insurance companies who prefer a quick solution or surgery. When did society agree that black suits should hold more power over healthcare decisions than white lab coats? Capitalism insists that the financial net worth of an individual overrides everything else: Well-wishers and professional psychologists alike tell us of the overriding importance of investing time and effort in no – urishing our souls, minds, bodies and becoming self-aware. Then along comes capitalism and persuades you that your bank balance overrides everything else. Many companies have a ruthless professional ethos that dictates employees must first and foremost be robust cogs in the professional wheel ~ and family, life, health, and liberty are lower on the rung of importance, firmly below corporate targets.

Clearly, capitalism has managed to trick us into believing that a rich slave is somehow freer than a poor one. Gullible executives grossly neglect their personal life and family chasing higher packages and designations in the corporate world. This often does not end well; the executives discover they are professionally dispensable when the company happens to downsize and the people who they have neglected at home for years are not exactly waiting for them with open arms. Capitalism persuades you that you must keep putting the details of your life out there on social media, to build your personal brand. The bigger the ‘influencer’ you become, the more wealth you could attract.

Slowly and surely, rather than products, it is humans who have become the advertisement. We have been persuaded to change our perspective from ‘I think, therefore I am’ (cogito ergo sum) ~ to ‘I influence therefore I am.’ Focus on money/profits contributes to severe lapses of judgement: Recent news carried stories of immigrants from third world countries deported back from the US. Amongst these were fellow Indians who sold valuable land, gave staggering sums of money to unscrupulous agents, got into debt, risked getting arrested or killed ~ all in the belief that it would improve their monetary prospects in the future in the US. Such is the illusion of success created by capitalism that it makes people leave the priceless comfort of home, family, and friends, and take a difficult gamble on making it big in a foreign land ~ likely after years of more sacrifice and struggle.

What is not clearly thought out, is that if the same vast sums of money were invested in the home country itself, the immigrant would have a likely chance of economic success here itself, in some form or another, while simultaneously being on more predictable and familiar territory along with the benefit of familial support. It is a similar desperation for profit that has often brought out the inhumane side of supervisors in charge of factory or agricultural workers. In Beed, Maharashtra, for example, you may have read of the harrowing tales of women workers forced by their contractors to undergo hysterectomies (often in unhygienic, unsafe conditions) just so that they do not have to take a day or two off from work during their periods. Rather than promote true merit as envisioned, capitalism has instead somehow spawned an environment where the act of generating profits (by hook or by crook) is itself deemed excellence. There seems to be no end goal with capitalism.

Considering the failings of capitalism, it is important to question some of its entrenched narratives. At an individual level, we can surely try and lead our lives on a much broader scale than that envisioned through the narrow pecuniary confines of Capitalism. As far as governments are concerned, they must put humans before banknotes. Much like the land ceilings which got rid of the Zamindari system, regulatory adjustments can put healthy limits on mega capitalism (e.g. no single entity can own more than 10 per cent market share) to encourage other players and strictly monitor monopolies and restrictive trade practices. Not getting unduly influenced by the profit-oriented outlook of capitalism is what will truly enrich mankind.

 

An Ageda for G 20 meet

 The Statesman, Sept 7 2023

 

There is much excitement about the G20 summit to be held in Delhi this week. The city is looking beautiful. We have Ashoka lions placed at regular intervals and cut-outs of Langurs to keep away the common monkey. For animal lovers like me, this gives an earthy feel. The G20 slogan ‘One Earth. One Family. One Future’ is very positive. This summit is a wonderful opportunity for world leaders to follow the spirit of the slogan and set a new narrative wherein ordinary citizens’ concerns are treated as paramount.

When we think of a country, we think foremost of its people and culture. When we travel to a country, we are enticed by its natural beauty, wildlife, and heritage monuments. Travellers are not attracted to a country for its GDP, armoury, or foreign relations. Yet, often, when our elected leaders return from international visits, newspapers are filled with headlines outlining the intricacies of negotiated arms deals, lauding them as milestone achievements for our country. Unfortunately, there is rarely any mention of shared concerns regarding the environment, gender, race, or citizens’ rights. These issues are systematically swept under the carpet by categorizing them as ‘internal problems.’ This is reminiscent of when domestic violence used to be considered a ‘personal, family issue’ until it reached a point where almost one in three women became affected.

A wiser triaging of topics that must be given importance is necessary. Considering that the most serious challenges citizens face today are environmental issues, mass migrations and human rights violations, it makes sense to keep them centre stage in global, political discussions.

Here are some of the issues many citizens would appreciate seeing addressed by the heads of state in the G20 summit. Resolutely putting true wealth forests, above superficial wealth, machine-generated banknotes: Today, most countries face significant environmental problems, such as the raging wildfires in Canada and Hawaii or the fast-sinking townships in our Himalayan foothills caused by unrestricted construction.

Despite this, serious discussions about a green future are relegated to the annual conference of parties (COP). The complex financial arrangements countries draft at the COP with respect to compensation for past carbon footprints are time-consuming. Nor have COPs achieved consensus on putting a hard stop to coal mining. Relying on a single annual global climate summit for dealing with a pandemic of daily natural catastrophes is incredibly inadequate. It may be wiser to take small steps towards environmental collaboration at each intergovernmental meet, starting with G20.

For example, India could build on its ancient culture of revering trees, including the Peepul, Ashok, Neem, Coconut, and Bodhi tree (where Gautam Buddha is said to have found enlightenment). This would resonate with many other cultures such as Japan and Madagascar for example (with their love for Cedar and Baobab trees respectively).

A joint declaration by a handful of nations to protect our common natural, green heritage of ancient trees and prevent even one tree above 25 years old from being cut, as well as rebuilding our lost forest cover, is important. A concrete target of increasing mixed species forest cover by 5 per cent annually for three years, followed by 1 per cent annually thereafter, is easily achievable and will preserve our most precious universal commodity – natural carbon sinks.

Cutting trees or clearing forests under the pretext of ‘development’ must now be declared a crime against mankind. It is ironic that large business houses are allowed licences to destroy the creations of God – pristine forests, while climate activists who destroy man-made paintings to raise awareness about the need for environmental protection are sentenced to years in prison.

Leaders also need to talk about rogue governments that thwart international aid to citizens for political reasons when extreme weather phenomena wipe out lives, houses, and livelihoods. A grave collective threat to mankind’s existence is nonbiodegradable plastic, which harms the environment greatly. Insidious micro-plastic creates several health hazards in our bodies, affecting many systems such as the endocrine and nervous systems and exacerbates cancer development. Leaders, while sipping tea in sustainable earthen ‘Kulhads,’ a lovely Indian lifestyle accompaniment, can work out modalities of banning plastic altogether, rather than allowing its mere tweaking to the still hugely damaging ‘bio-plastics’ Capitalism as a failing model: Though political coffers benefit greatly from capitalism, it is time to acknowledge that unchecked capitalism has proved to be a failure.

According to a recent Oxfam report, the top 1 per cent richest humans garnered 63 per cent of the total increase in wealth during the last 2-3 Covid years. At the other end of the financial spectrum, we find 47 per cent below the poverty line and 8 per cent of the world living in extreme poverty. Three billion people (out of a total of 8 billion) cannot afford a healthy diet. That millions remain entrenched in poverty indicates that this economic model is spectacularly inefficient on a larger scale. In other fields, ineffective models are quickly replaced. In medicine, for example, before any drug is licensed for actual use, it must surpass the efficacy of pre-existing drugs. For any surgical technique to be widely adopted it should have a high success rate across patients.

Given that only a small fraction of humanity has benefitted from it, capitalism needs huge overhauls or replacement. It is also truly concerning that a significant part of the economy of the world over is based on war, smoking, and illicit drugs sales. For example, the sales of U.S. military equipment to foreign governments rose 49 per cent in 2022. A joint resolution on implementing curbs on market shares of any one company to a maximum of 10-15 per cent will discourage monopolies, facilitate diversity, and spread economic prosperity among more citizens. Independent India abolished the Zamindari system, and put in place the land ceiling act (which sadly has been diluted in many states in more recent times) to curb excessive land ownership by individuals.

This experience and equitable thought make India ideally suited to usher in meaningful change for a more just distribution of market resources as well. Common justification for capitalism centres on the idea that without financial incentive, people would lose their desire to excel. This is debunked by the existence of several creative geniuses, who lived and died in penury, including Gauguin, Modigliani, De Kooning and Mirza Ghalib. Chore-burdened housewives are not paid, yet they create delicious food and decorate their houses stylishly.

The present model of capitalism does not suit today’s environmental needs. For an idea to be implemented or even researched, it must first prove its market viability (profitability). Due to this, we are losing out on scientific progress that could assist with the worsening climate change crisis. For example, fuel-driven cars are being replaced with electric ones but why not more research on faster versions of simple, light frame, human pedalled ones that would cut down on all external energy and keep human beings fitter too?

Human rights issues: Human rights discussions are frequently brushed under the carpet at important summits. Poorly executed military operations and botched up intelligence reports have often resulted in an unacceptable loss of civilian lives, conveniently glossed over as ‘collateral damage.’ The recently made movie ‘Oppenheimer’ reminded us of the most devastating face of collateral damage when entire cities full of civilians were blown up in Japan, in total contravention of wartime conventions (such as the Geneva convention). Some states in India have suffered unusually prolonged internet shutdowns due to ‘security reasons,’ due to which decent, innocent citizens have lost jobs, students have been unable to study and medical assistance has been difficult to find. There is no redressal or compensation for the loss of productivity, happiness, or destroyed futures.

Apart from the bugbear of unemployment, even citizens in secure jobs find it difficult to flourish. Academicians cannot publish research or direct theses that are unapproved by politicians, journalists are troubled and often jailed for speaking candidly. Artists and singers invited to a public event to perform, suddenly find their shows cancelled if their political leanings upset some official in charge. All these factors lead to a very poor quality of life for the average citizen. Citizens cannot speak freely in many countries specially when their ideology does not match that of the ruling party. In India, for example, elected representatives can freely expound their views on any topic as per their convenience from any forum at any time, with security forces helping with the arrangements for such ‘political rallies.’

On the other hand, citizens who want to express their views, or raise legitimate concerns are only allowed to do so in small designated areas and often treated very shabbily by uniformed policemen. When our Constitution unequivocally confirms the equality of all citizens, these differential rules are jarring. The lovely rural Indian ethos of village elders deliberating every evening on village issues under a large canopied tree (likely in several other countries too), can be magnified to a bigger stage with inclusive spaces for wise elder citizens to openly contribute their wisdom to leaders, with more women members and fewer Hookahs of course! It is unfortunate that when elected representatives of people meet, they prefer to talk more about arms sales, military alliances, and strategic relations rather than share concerns and ideas for the wellbeing of their citizens.

India can make a bold positive contribution at G20 by pulling out the world from the rut of discussing stale agendas to invigorating the hopes of citizens by discussing vital human topics on priority. For as Ellen Glasgow once said ‘The only difference between a rut and a grave are the dimensions.’

(The writer is a Delhi-based medical practitioner.)

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 20^th 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! 

 

 

 

 

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.

 

 

 

 

 

 

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.