Thousansds gather at Meherabad for 50th Amartithi

Meherabad: The two-day Amartithi celebrations got underway at Meherabad at the stroke of 12 noon today. Hundreds and thousands of Meher Baba lovers gathered at the forecourt of the tomb shrine of the Silent Master atop a low lying hill. Song and dance will continue uninterrupted till 12 noon tomorrow, Jan 31. The congregation will become silent at 12 noon amidst full throated chants of Meher Baba ki jai. Silence ends fifteen minutes later commemorating Meher Baba dropping his physical body at 12.15 pm on the 31st of January fifty years ago.

Marking the 50th Amartithi, Baba’s museum, located close to the tomb shrine has put on display new artefacts that tell stories from Meher Baba and his divine mission. which has been given a makeover with new collections on display. The museum is in the very room Baba had used for his extensive seclusions.


The collections include never-before-displayed crowns given to Baba. His woman disciple, Mehera made the crown with colored sequins. There are several photos of Baba in frames made by Mehera and the women mandali in the early days at Meherabad. Typically, Mehera designed the objects, and together the women worked on them. One exhibit is a garland of numerous strands of cut cotton lace which was given to Baba during a Sahavas programme in the 1950s.

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Fake News Monster is Devouring Democracy

By Tushar Charan

With heads of various social media platforms visiting and meeting Indian leaders in recent days, the focus seems to have shifted to the need to tame the monster called Fake News. The mission looks impossible when Fake News has become a major content of political discourses in the country and the politicians who lend direct or indirect support to it pretend to be oblivious to the danger it poses to the survival of healthy democracy in the country.

Narendra Modi is reported to have said that the 2019 polls will be fought with the help of social media. He probably said so because till very recently, his Bharatiya Janata Party faced virtually no challenge from the rivals. The reach of the social media supporting the BJP was several times greater than that of the Congress.

It is disturbing to note that the prime minister ardently follows social media messages that are clearly objectionable. It is an indication of his support to the message as well as those who circulate them. It also makes it hard to believe that Narendra Modi or his government wants to make sincere efforts to end the menace that emanates from the misuse of social media. The CEOs and proprietors of social media networks cannot force the prime minister to follow or not follow any media outlet.

The Opposition Congress woke up to the potential of social media after 2015, after the BJP had already established itself over a much larger territory. It is to be seen how much of this territory the BJP is made to cede in coming months and what role social media plays in the outcome of the next Lok Sabha polls. Some observers have said that the BJP may be unwise, unlike 2014, to depend too much on social media with the help of its formidable IT cell.

The spread of Fake News over the social media in India and its consequences have been brought out by a BBC documentary which cannot be dismissed as Opposition propaganda. It makes it clear that the ‘right’ in India is far ahead of its rivals in using—rather, misusing—the social media platforms to propagate falsehood in pursuance of its ‘nationalist’ agenda.

Politics is perhaps the more popular subject of displaying the dubious FN talents but instances of social media networks being used for attacking non-political persons—mostly celebrities and lately journalists too– are not lacking. Politicians revel in hitting out at their rivals in objectionable ways but in most cases they have a clear idea of who is hiding behind the attack when the contestants are face to face. The social media attacker may not be known and, in any case, is physically at a safe distance.

Film and sport stars and journalists are trolled mercilessly and in case of journalists, abuses are sometimes accompanied by threats to life and limb when what they have written is considered unflattering to a leader or his or her ideology.

Not just India, much of the world is said to be lunging towards the ‘right’ with its emphasis on ‘nationalism’. Intolerance of criticism is negation of democratic principles, more so when it is mixed with threats and intimidation. It is, of course, not surprising that the BBC survey has found that the ‘right’ in India with its ‘nationalist’ agenda is more active on the social media than the rival ‘left’ leaning groups and organisations.

It may be an old timer’s whine, but it does appear that the negative part of the social media has gained salience after the media–newspapers to be precise– virtually decided to provide lesser and lesser space for expressing divergent views. That is to say, the readers’ forum in newspapers, identified as the Letters to the Editor column, has become a casualty in most newspapers. Some have done away with it and some publish not more than a handful of letters from the readers, mostly in appreciation of what has been published. This form of flattery has replaced the old practice of publishing letters expressing divergent views, often challenging the contents of an article or an editorial.

There can be no justification for denying the readers their ‘right’ to express their views. But perhaps the newspapers will argue that the social media provides more than ample space for the readers to comment on what they have read in a publication—or heard over the airwaves and the idiot box. It may also be true that far more people are willing to express their views on the social media than taking recourse to writing letters to the Editor.

But that is where the problem begins. Social media comments may be filtered on paper; in reality there is a free-for- all atmosphere for expressing views on the social media. You can use abusive language and circulate manufactured news through the social media without much to worry about consequences.

The letters column in newspapers uses readers’ comments after judiciously editing the letter; not by basically changing their tone but to ensure that there is nothing obscene or patently defamatory in them. This kept the dialogue between the reader and the writer at a civilised level. Civility in expressing opinions has by and large become a casualty with the advent of the social media—and the mushrooming television ‘news’ channels.

Fake News accelerates through Twitter, Facebook or WhatsApp groups and is also lapped up by TV channels. There is apparently nothing much that is being done, or can be done, to stop the pernicious trend which is eroding the basic intelligence and good sense of ordinary citizens because of the overflowing hate contents.
It is relatively easy to send distorted texts with a view to malign someone or organisation. But the FN crowd is equally proficient in morphing photographs for reprehensible ends.

Ordinary men and women cannot distinguish between the real and fake photographs which are circulated with ulterior motives—to divide society and incite violence. In their zeal to incite hatred and polarise society, social media platforms have been used to circulate provocative photographs and, what is more, it succeeded in obtaining the objective.

Judging the veracity of text messages is also not easy for the ordinary citizens. The problem, however, becomes complex when the false messages are circulated within a close-knit groups where nobody bothers to check the source of information. Perhaps the best way to meet the challenge will be for the politicians to inspire people to respect differences in opinion and understand the value of dignified discourses.

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Fish team up for more food!

By NEERAJ BAJPAI

Cooperative behaviour to acquire food resources has been observed in hunting carnivores and web-building social spiders.

Now researchers have found comparable behaviours in a fish species. A tiny striped fish called Neolamprologus obscurus only found in Lake Tanganyika in Zambia excavates stones to create shelter and increase the abundance of food for all fish in the group.

Led by Hirokazu Tanaka of the University of Bern in Switzerland and the Osaka City University in Japan, this study is the first to document how team work in fish helps them to acquire more food. The research is published in Springer’s journal Behavioral Ecology and Sociobiology.

Neolamprologus obscurus is a highly sociable species of cichlid found only in the southern reaches of Lake Tanyanika. These zebra-striped fish feed mainly on shrimp and other invertebrates found along the bottom of the lake. At night, shrimp move into the water column, but by dawn they sink back to the lake bottom to hide in crevices and holes, including the shelters that the fish have dug out under stones. Such excavation work is always done as a group, as is subsequent maintenance efforts. Breeding fish seldom leave these safe havens and are supported by up to ten helpers from their family group. The helpers protect the brood, and constantly remove sand and debris that fall into the cavities.

“The function of these excavated cavities is much like that of the webs of social spiders, which live in groups and share the trapped prey among group members,” explains Tanaka.

In this study, Tanaka and his colleagues wanted to find out if the size of the cavities at the bottom of the lake relate to the abundance of food available in the area, and if the presence of helpers influences the size. Through hours of scuba diving in Lake Tanyanika, the researchers created artificial cavities and examined the stomach contents of some of the fish. In another experiment, the researchers removed helpers that were assisting breeding fish. Within a week, enough sand had fallen into the cavities to decidedly shrink these spaces. This effect was augmented when the helpers removed were big.

One of the key findings was that the size of an excavated crevice had an influence on the amount of shrimps that subsequently gathered in it. When there were more helpers around, the space that could be created was bigger and more shrimps could be gathered.

“Helpers in Neolamprologus obscurus extend and maintain the excavated cavities, and by doing so, contribute to an increase in food abundance inside the territory of breeding females,” explains Tanaka.

“Fish living in groups may be able to increase and maintain considerably larger excavated cavities per capita compared to solitary living fish. Consequently, group living enables Neolamprologus obscurus to efficiently increase the prey abundance in their territory. This increases the body condition and future reproductive success of breeders and/or helpers,” adds Tanaka, who suggests that there is a clear benefit to group living for this species of fish.

GROUND REALITY
1.3 MILLION PEOPLE LOSE LIVES GLOBALLY EVERY YEAR IN ROAD ACCIDENTS; DISRUPTIVE TRAUMA CARE NEEDED: INDIAN AMERICAN SURGEON DINESH VYAS

Far away from immaculate and cutting edge technology equipped operation theaters in the United States, a lanky missionary and eminent surgeon Dinesh Vyas is running around Institutions in India to sensitize people for prehospital trauma care to save millions of human lives.

Fired by missionary zeal, Dr Vyas, during his brief sojourn in India recently, engaged with those who can change the trauma care narrative and envisioned that a high tech training program could bring the desired change.

“We can transform the trauma centers into survival sites rather than hopeless units.it needs slight but structured training to those who handle trauma victims on daily basis like security persons.

It is not exaggeration but unpalatable reality that over 1.3 million traffic related deaths occur per year globally. This is apart from 20-50 million people sustaining permanent injuries or disabilities”, Says Dr. Vyas, Program Director Surgery Residency, Associate Professor, California North State University.

Quoting reports ,Dr Vyas told this writer that the Association for Safe International Road Travel predicts road traffic injuries to become the fifth leading cause of death globally by 2030 if corrective measures were not taken immediately.

Glancing through his lap top screen in a corner of Gurugram club (India)where he was interacting, a determined Dr Vyas asserted that besides being a major strain and drain on health care system and the system’s meager resources, road trauma and mortality inflict massive emotional liability.A countless lives can be saved with preventive measures. He carries with him a 202 pages manual –First Resonder’s Manual of Prehospital Trauma Care , And shows how human lives can be saved with advanced training.

According to him, Mission Million Life Fighters is panacea for the scaring scenario and “it needs support from all stake holders to turn tables”.
With over 10,000 first responders trained, these fighters is one of the fastest growing dynamic educational platforms that will help address today’s trauma crisis.

Elaborating the ambitious plan, he says the Vyas Global Pre-hospital care Education initiative is one such initiative, and with the training in 2015 of over 10,000 True first responders –policemen, fire fighters, workers at industrial sites, teachers and common persons – this platform better known as MMLF is a fastest growing, dynamic educational program .They can and already has helped this crisis in India, Texas (USA), Costa Rica and other nations. Number of trained hands are increasing every year but it needs urgent attention of stake holders.

The plan has effectively transcended the barriers of conventional training. His team has established multiple, self-sustainable training centers throughout India by the concept of ” training the trainers”, thereby generating capable first responders from both medical and non-medical backgrounds; these responders stabilize the injured and possibly allow some type of additional medical to be instituted immediately to allow eventual transport to the healthcare facility.

According to him, Trauma epidemic in fast growing economies and rural USA needs a unique and disruptive approach. Dr Vyas and his team of mass communication experts and animators are pushing the project relentlessly.

Experts say their pedagogical approach will save millions of trauma victims and other patients in desperate need of emergency care across the globe in next ten years. He observes status of trauma care is quite bad in rural swathes of US, and unfortunately, same situation is prevalent in urban belts of India.

According to observers, the cost involved in such training is quite meager vis-à-vis saving of lives who can be productive assets of the nation.

For example, ever since inauguration of the Yamuna express highway connecting Delhi with Agra, six years ago, a total of 7.65 crore drivers used the Expressway till last year.A total of 626 people lost their lives in 4,848 road accidents on the 196-kilometer-long Yamuna Expressway ever since it was thrown open to public in August 2012, an RTI had revealed.


Between August 2012 and June 30, 2017, a total of 4,848 road accidents were registered by police on the stretch, in which 626 casualties were reported, with 2016 reporting the highest number of accidents in a year.

Experts say a number of these lives could have been saved, had there been perfect handling of the victims.So for such reasons, both government and private players in close rapport with common people, must come forward to lend support for training programs.

Unfazed by bumps on road to his uphill task,this Indian American surgeon, hopes to raise requisite funds to train scores of first
responders – who are the first rescuers to arrive at the accident sites. It will save about 50 bn Dollars annually.

He has already trained scores of first responders in India using simulator dummies. For last few years, he is trying to enlist support from the country’s IT, Auto and healthcare industry through their CSR (Corporate Social Responsibility) Programs. His team is making presentations to foundations and various bodies to win support for the program that will save millions of lives every year.

With many first to his name and more than 20 years of experience in advancing surgery, research, innovation, education,technology integration and global health, Dr Vyas, a Rajasthan born specialist,has successfully turned around 3 surgery residency programs; Authored 3 surgery books, authoring 2 novels and approx. 100 chapters and SCIENTIFIC peer reviewed articles.He has innovative self-sustaining Global Health programs has exponentially grown in last 15 years. In 2009 he developed first MOOC program in medicine and is highly successful.

Dr. Vyas is editor-in-chief of Surgery and GI journals and on editorial board of more than 10 journals including NATURE group and 3 textbooks. He is the pioneer in the most advance surgery: imaging guided, robotic and hybrid endoscopic surgery by describing NEW surgical procedures. He is a board member of biomedical start-ups and helps with direction/funds to their success and integration with industry.

STRONG (Save trauma and road navigators) initiative is 17 years now, and has successfully launched many products to save million lives by 2020 . The program centers are focusing on trauma in rural US and globally fast growing economies.

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King of Jungles Lions, too, can be outwitted by Cheetahs

by Neeraj Bajpai

Cheetahs in the Serengeti National Park adopt different strategies while eating to deal with threats from top predators such as lions or hyenas.

Male cheetahs and single females eat their prey as quickly as possible. Mothers with cubs, on the other hand, watch out for possible threats while their young are eating in order to give them enough time to eat their fill.

The research was led by Anne Hilborn of Virginia Tech’s College of Natural Resources and Environment in the US. The new study in Springer’s journal Behavioral Ecology and Sociobiology has shown the interesting findings.

Cheetahs are medium-sized carnivores that live alongside large carnivores such as lions and spotted hyenas. These large carnivores are known to not only attack cheetah cubs, but also steal prey in an act called kleptoparasitism.

Cheetahs do not have the strength to haul their kills up trees to keep them safe from scavengers as a leopard does, nor can they physically defend themselves against a lion. They therefore tend to hunt when larger predators are away or less active.

Hilborn and her colleagues studied 35 years of observations from more than 400 hunts involving 159 cheetahs in the Serengeti in northern Tanzania to find out how cheetah behavior while eating is altered by threats from larger predators.

The researchers established that the tactics cheetahs use depend on which type of threat they face from large carnivores. The primary threat to male cheetahs and single females without cubs is having their kill stolen. They therefore spend little time watching out for attacks, and instead eat their prey as quickly as possible before it can be snatched away from them.

Mothers with cubs must first ensure the safety of their offspring and that they get enough to eat. Cubs can eat quite slowly because of the size of the cubs’ mouths and their tendency to take regular breaks to rest or play.

“Instead of speed, mothers use vigilance to minimize risk,” explains Hilborn. “They spend more time paused before eating, perhaps also to catch their breath, and are more vigilant. This increases the amount of time they spend eating, which in turn increases their overall handling time.”

The research team believes that the behavior of a cheetah after a hunt depends on the territory it finds itself in. Cheetah mothers might, for instance, be less vigilant in the Kgalagadi Transfrontier Park in the Kalahari region of South Africa and Botswana, where lion densities are three times lower and spotted hyena numbers are 100 times lower than in the Serengeti.

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Media Attacks: US and India

by Atul Cowshish
Donald Trump had no difficulty in getting the ‘hard pass’ (accreditation) of a CNN journalist suspended immediately after Jim Acosta had persisted with his ‘aggressive’ questioning of the US President at a Press conference at the White House. It was an unprecedented incident. US Presidents are used to facing ‘aggressive questioning’ by reporters but never before an accredited journalist had to face virtual ban on attending a White House Presser.

The show of a direct attack on Press freedom at the US Presidential Palace did little to salvage the image of Trump as a media baiter. But to be fair to him he appears to be quite happy with this image. He sees himself as a crusader against the ‘fake news’ phenomenon that he thinks dominates the US media scene. He is upfront in declaring the US media—the larger section of it—as his ‘enemy’.

It is very different in India where generally speaking the larger section of the media is happy to suspend its traditional watchdog role to present Narendra Modi a leader who cannot be replaced. His faults are glossed over. Most interestingly, there is willing acceptance of Modi’s dislike for being questioned—neither ‘aggressively’ nor even mildly. That much has been clear from the fact that Modi has refused to meet the Press after taking over as Prime Minister in May 2014.
While Trump has to constantly return media fire with his own brand of aggression, Modi remains in the winning position without having to enter the boxing arena to achieve his goal of keeping the media hounds away. Trump could well be envying Modi’s privilege.

But Modi should not really be happy with the Indian media’s one-sided love affair with him. The advantage that he enjoys from the voluntary submission by the media will one day—may be sooner rather than later– boomerang on him. An obedient media may suppress the problems faced by people brought about by his whimsical handing of affairs of the nation but the anger of the affected people will eventually boil over; it may spill over to the streets.

For the moment it appears that the duo of Narendra Modi and the BJP president, Amit Shah, has a free run and at best can expect no more than a limited scrutiny of the drawbacks in their style of governing the country. It appears like a cry in the wilderness when matters like farmers’ distress or joblessness are raised in some quarters. Demonetisation may have been dubbed a disaster by economists but the louder voice—government propaganda–in its support drowns the contrary view.

How easy it has been for the government to divert attention from the assurances given by Modi on the day he announced ban on circulation of Rs 500 and Rs 1000 notes two years ago. He had talked about demonetisation as a means to end black money, corruption, terror financing and fake currency circulation. A byproduct of all this was supposed to be a body blow to terrorism.

Modi had stated that he would not allow the pain of demonetisation to last long. In fact, he had said in his televised address to the nation while announcing ban on high denomination currency notes that he would be ready to accept any punishment—he offered even his head—if the travails of the common people did not end in ‘fifty days’.

Of course, all that proved to be yet another of example of using ‘jumlas’ (false promises) to drum up support for Modi. The goalposts have been effectively shifted by the media on a cue from the government. It is being said that among the benefits demonitisation brought was a rise in tax revenues; country moving swiftly into cashless society was another.

At best such claims are only partially true. It is amazing that demonetisation was the only way to collect more taxes, just as it is a puzzle how would the Modi government thought of welfare schemes had petrol prices not gone down drastically. The media has not asked what punishment should be given to Modi for not fulfilling the promises he had made on that unfortunate evening in November 2016. The media does not ask Modi to at least express some regret over the 100-plus deaths caused as a result of the endless wait by people outside banks for exchanging old notes for new ones.

That Modi almost invariably makes an ‘election speech’ is understandable, given his burning desire to stay in power for the rest of his life in a virtual one-party state. But he is allowed to get away by making statements not backed by facts, even if the facts are given by his own government! Contrition is not known to Modi, no matter how serious a matter may be, concerning deaths of innocent, defiance of court orders and open resort to hate politics.

Trump may not be very different from Modi in all this but the larger part of the US media that he hates so much does not bestow the kind of adulation that can be noticed among the influential newspapers in India. The leading US newspapers and TV channels have not capitulated to him the way their Indian counterparts have.
The Indian TV channels, barring a few exceptions, do not sound very different from their counterparts in countries like China and North Korea. Those two countries do not have to flaunt democratic credentials but the media in India is supposed to work under a democratic set up.

Modi scores over Trump in media relations because the fourth estate in India has no teeth, having got them extracted at the very beginning of the Modi regime. Trump tries to break the jaws, so to say, of the vast number of ‘unfriendly’ media in his country with perhaps only a limited success.

The recent mid-term polls in the US would seem to suggest that Trump’s ratings have dropped drastically though it must be admitted that the kind of nationalist fervour he generates among White Americans has not diminished much. The racial bigots in the US are the core of Trump’s supporters. But it is open to question if they are in a position to help Trump get another four-year term.

Modi’s followers are not very different from Trump’s in that they can also be called right-wing extremists who are known for their jingoistic nationalism. But in India also it remains to be seen if these followers can help Modi fulfill his ambition of being a life-long ruler.

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Indian Spy Masters Speak

By Malladi Rama Rao

1. Title: Spy Chronicles, Raw, ISI And the Illusion of Peace
Authors: A S Daulat, Asad Durrani & Aditya Sinha
Publisher: Harper Collins
Pages: 312. Price: Rs. 799/-

2. Title: The Unending Game, A Former R&AW chief’s
Insights into Espionage
Author: Vikram Sood
Publisher: Penguin, Viking
Pages; 282 Price: Rs. 599/-

Books by Indian spymasters are very rare. So two books by two retired espionage chiefs in the same calendar year is no more than a bonus for students of contemporary history. Both do not set the Yamuna on fire. There are no damning revelations since A S Daulat and Vikram Sood are not cut in the mode of their CIA counterparts, who take delight in washing dirty linen post-retirement. Nonetheless, both offer good fodder for thought with their insights into a wide range of issues that include Pakistani bomb and the India-Pakistan relations in which Kashmir has come to play a major role.

Sood’s ‘The Unending Game’ is a solo-effort unlike Daulat’s ‘Spy Chronicles: RAW, ISI and the Illusion of Peace’, which was a collaboration with Asad Durrani, a former ISI chief. This book addresses all categories – the believers and the skeptics but is not meant exclusively for intelligence professionals. It is not a personal memoir, nor is it about R&AW for which Sood worked after his transition from the Indian Postal Service. Instead, it seeks to familiarise the reader with the intricacies of espionage and intelligence collection. The reader is transported to the classroom to learn about basics like the definition of intelligence and how spies work. And the book falls by the way-side.

While on ‘The Asian Playing Fields’, Vikram Sood does not tell us beyond the mundane. He writes: “In Pakistan’s case, the ISI is part of the force that drives the country’s foreign policy and determines strategic priorities. In India, the R&AW remains a service provider to the policymakers. The ISI has a high profile in Pakistan than R&AW has in India”.

Indira Gandhi created R&AW in 1968 while Major General Walter Joseph Cawthrone, an Australian with the Pakistan Army helped set up the ISI in 1948. There can be no objective comparison between the ISI and any other intelligence agency operating in a democratic environment, more so after ISI has morphed into a special force that recruits, trains, and equips and sends out jihadis into Afghanistan and Kashmir. As senior CFR fellow Daniel Markey says, ISI is part of Pakistan’s entrenched, unelected and opaque deep state. Some right-wing leaders nurtured by ISI are part of the deep state as the Americans have realized after Raymond Davis episode in 2011.

What about China? First under Deng Xiaoping and now under Xi Jinping, China, in order to keep pace with its global ambitions, has spurred its intelligence activities. This new player on the global scene has drawn lessons from the US strength, which also is its Achilles heel – reliance on technology and information systems in warfare. So it has gone in for systematic ability to hack and steal and to hunt in the US for denied technologies.

What about China vis-à-vis India? Says Sood: “The Chinese have interfered in India’s north-east in the past but this interest has been declining in recent years. Their new found interest in Arunachal Pradesh could, of course, lead to renewed meddling in the region”. In his assessment, India will have to make matching efforts in cyber warfare and cybersecurity and R&AW will have to strengthen HUMINT (field network) capacities in China and use all other non-diplomatic means to collect intelligence. This advisory ignores his own reality check that it is difficult to find agents in China who are of Indian ethnicity. There is hardly any non-diplomatic cover available as there are very few Indian companies operating in China. Moreover, the Chinese ensure that Indians have no access to the Tibetans in Tibet.

Sood has devoted a long chapter on ‘State of Surveillance’. In another chapter, he elaborated on the triangle between the terrorist, the criminal, and the spy. Both chapters are a must read. The book deals with the dilemma the debate about privacy and freedom has generated in these days of heightened security concerns and stepped up surveillance since “terrorism has become cheap and unremittingly lethal”. It also examines in detail the new dangers the social media has thrown up in the wake of the exposure of Cambridge Analytica’s tryst with the American Presidential election.

Today we are living in a world where the buzz word is instant. Information is exchanged in microseconds. And it increases security risks as India has learned the hard way. Jammat-ud- Dawa (JuD) and its ideological mentor, Lashkar-e-Toiba (LeT) have a huge presence on the Internet and social media and have ushered in the age of Digital Jihad. Even the ISI is said to be spreading its network into India’s cities beyond Kashmir for recruitment of spies and jihadi outfits. This naturally makes the task of Indian counter-intelligence not merely difficult but very difficult indeed.

Chandraswamy pops up suddenly in the Sood narrative, and his games to prop up Rajiv Gandhi, Chandrasekhar and P V Narasimha Rao (in that order) make interesting reading. Surprisingly, the author throws up no new light and what he says is mostly in the public domain. There can be no denying his assessment however that Chandraswami died mostly unsung and possibly unmourned. Also, his lament that the R&AW did not get the attention it deserved during Rajiv Gandhi, VP Singh, and the Rao regimes. It was a lost decade for the R&AW which had as many as nine heads in succession. Amarjit Singh Dulat headed the outfit for two years after this decade. His stint 1999-2000 coincided with the Vajpayee years.

Dulat’s book with Durrani is devised in the form of extensive dialogues on relations between India and Pakistan with journalist Aditya Sinha acting as a moderator. When Dulat mooted the idea of writing a joint book, Durrani laughed it off saying, “Nobody will believe it even if it was written as fiction.” The project finally took off in 2016 thanks to the trust the two men had developed in each other in their post-retirement years, and the joint papers they had written on a couple of Track IIs, on intelligence cooperation and Kashmir.

They met in Istanbul, Bangkok, and Kathmandu and discussed topics like Kashmir and a missed opportunity for peace, Hafiz Saeed and 26/11, Kulbhushan Jadhav, “surgical strikes”, and how violence undermines the attempts of the two countries at negotiations, besides the “deal” for Osama bin Laden and US -Russia factor in the India-Pakistan relations. Their 312-page book is the first of its kind wherein the spymasters of the rival agencies worked together on the same assignment.

Daulat and Durrani have spoken quite frankly, without spelling any secrets, of course, on leading public figures, military personalities, as well as the spy service personnel on both sides. Expectedly, Vajpayee comes in for very positive appraisal while Modi, the Bhuttos, Zardari, and Sharif get a negative rating.

On the September 9 surgical strikes, Durrani’s take reflects the establishment view. He dubbed the surgical strike as “a modified hot pursuit”. And went on to bluntly puncture the Indian balloon thus: “In military terms, a surgical strike would normally be something like dropping special services 200 km behind enemy lines to carry out a spectacular attack against a sensitive target: a nuclear installation, a GHQ; or Osama bin Laden. Shelling across the LoC, and a raid a couple of hundred meters inside enemy territory to kill a few goats would not exactly meet the criteria. But then the bigger purpose – a political one – could be fulfilled. That is why for some it’s a genuine surgical strike, for others a political surgical strike, and for yet others a fake surgical strike”.

Durrani’s take on yet another subject is no less interesting. When Daulat said, “I would love to meet Maharaja Amarinder Singh in Lahore. He would think he’s following Maharaja Ranjit Singh,” he asked tongue in cheek: “Who will accompany him as Maharani?”

The short point is that Durrani remained true to his moorings in his interaction with his Indian counterpart. Yet he has been hauled up by the Pakistani media and political class and has been barred from leaving the country till the GHQ completes an inquiry into the charge that he had violated the army code of conduct with the comments he had made in the book.

From what is in public domain, Durrani can be said to have already invited the wrath of the Deep State by his comments on a host of issues that matter for the establishment. He angered the powers that be with his confession that he had spent as the ISI chief millions of military dollars to influence the outcome of 1990 elections. The book controversy offered the opening for proceeding against the 77-year old, who was known as FireFox during his army days.

(This review first appeared in Power Politics magazine)

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National center for aging coming in New Delhi

By Neeraj Bajpai

Ahead of international day of old people on October 1, a foundation stone of the National Centre for Ageing had been laid recently at AIIMS in the national capital and now, sources say, work gets underway, cutting red tape.

The National Centre for Ageing will provide state of art clinical care to the elderly population and shall play a key role in guiding research in the field of geriatric medicine and related specialties.

The Centre will also be a key training facility for under graduate and post graduate courses. The Centre will provide multi-specialty health care and will have 200 general ward beds, which will include 20 medical ICU beds.

The center will be developed at a cost of Rs 330 crores and shall be completed by February, 2020. On the occasion, Prime Minister Narendra Modi also dedicated the underground connecting tunnel between AIIMS and JNPA Trauma Centre, and Power Grid Vishram Sadan at AIIMS along with the 500 bedded New Emergency Block and 807 bedded Super Specialty Block at the Safdarjung Hospital to the nation.

Informatively, on the 70th anniversary of the Universal Declaration of Human Rights (UDHR), the United Nations International Day for Older Persons (UNIDOP) celebrates the importance of this Declaration, and reaffirms the commitment to promoting the full and equal enjoyment of all human rights and fundamental freedoms by older persons.

Growing older does not diminish a person’s inherent dignity and fundamental rights.

( On 14 December 1990, the United Nations General Assembly designated October 1 as the International Day of Older Persons. This was preceded by initiatives such as the Vienna International Plan of Action on Ageing – which was adopted by the 1982 World Assembly on Ageing – and endorsed later that year by the UN General Assembly.
In 1991, the General Assembly adopted the United Nations Principles for Older Persons.
In 2002, the Second World Assembly on Ageing adopted the Madrid International Plan of Action on Ageing, to respond to the opportunities and challenges of population ageing in the 21st century and to promote the development of a society for all ages.
Almost 700 million people are now over the age of 60. By 2050, 2 billion people, over 20 per cent of the world’s population, will be 60 or older. The increase in the number of older people will be the greatest and the most rapid in the developing world, with Asia as the region with the largest number of older persons, and Africa facing the largest proportionate growth)

The interdependence between older persons’ social integration and the full enjoyment of their human rights cannot be ignored, as the degree to which older persons are socially integrated will directly affect their dignity and quality of life.

The 2018 theme of UNIDOP is “Celebrating Older Human Rights Champions“. What better way to celebrate this Day than by celebrating the older people around the world who dedicate their lives to championing human rights?

Older human rights champions today were born around the time of the adoption of the UDHR in 1948.

They are as diverse as the society in which they live: from older people advocating for human rights at the grass root and community level to high profile figures on the international stage. Each and every one demands equal respect and acknowledgement for their dedication and commitment to contributing to a world free from fear and free from want.

The 2018 theme aims to:

Promote the rights enshrined in the Declaration and what it means in the daily lives of older persons;
• Raise the visibility of older people as participating members of society committed to improving the enjoyment of human rights in many areas of life and not just those that affect them immediately;
• Reflect on progress and challenges in ensuring full and equal enjoyment of human rights and fundamental freedoms by older persons; and
• Engage broad audiences across the world and mobilize people for human rights at all stages of

On the day of laying of foundation stone for aging persons,Mr J P Nadda, Union Minister of Health and Family Welfare,Mr. Ashwini Kumar Choubey and Smt Anupriya Patel, Ministers of State for Health and Family Welfare were also present at the event.

Addressing the participants, the Prime Minister said that our government has been successful in taking healthcare out of the ambit of the Health Ministry and today we have Rural Development Ministry, Water and Sanitation Ministry, Women and Child Development Ministry and Ayush Ministry with our vision of healthcare.
He further added that our vision is not limited to hospitals, diseases, medicines and super specialty care but also with the idea that affordable and equitable healthcare should be ensured for every citizen.

Mr Modi said that the Government is equipping existing hospitals with the all the modern facilities and at the same time it is also making sure that the healthcare facilities reach to the remotest areas of the countries. He added that 58 district hospitals are being upgraded to medical colleges and the government has also sanctioned budgets for 24 new medical colleges.

The Prime Minister said that the global target for eliminating TB is 2030, but we have set 2025 as our target for India to eliminate TB, five years before the global target. He further stated that the Government is providing Rs 500 to the TB patients towards nutritional support.

The Prime Minister also mentioned about the Ayushman Bharat programme. He said that under the National Health Protection Mission, 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) will be provided a coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government funded health care programme, he stated.

Mr Nadda said that there has been a visible change in the tertiary healthcare in the country and assured that the Government is committed to ensuring that the new AIIMS will meet the same standards of service as AIIMS, New Delhi. No effort will be spared to make them the very best, he added.

He said that that the new AIIMS will have the same work culture and the government is taking all the steps to ensure that. He further stated that the Ministry in the past 4 years has not left any stone unturned – from monitoring the clean and effective implementation of national programmes to establishing 13 new AIIMS like institutes across the country.

Reiterating the commitment of the Government, he said under Ayushman Bharat, 150,000 sub-centres will be converted into Health and Wellness Centres (HWCs) that will deliver comprehensive primary health care.

“The H&WC would provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc. He further stated that the Government has initiated universal screening of common NCDs such as diabetes, hypertension and common cancers along with Tuberculosis and Leprosy and everybody above the age of 30 years will be screened for these diseases and as such this will eventually help in reducing the disease burden of the country. “We will implement the vision of the Prime Minister in letter and spirit,” he added.

The underground tunnel is providing connecting facility between AIIMS and JPNA Trauma Centre and will reduce the commute time between the two centers. The completed length connectivity between two centers is approximately 1 km and has been completed at a cost of Rs 44 crores.

The Powergrid Vishram Sadan has a 300 bedded night shelter facility meant for the patients and their relatives visiting AIIMS main hospital and JPNA Trauma centre at AIIMS. The 11 floor facility has been constructed at a cost of Rs 32.67 crores and funded by the Power Grid Corporation.

New emergency Block at Safdarjung Hospital will house 64 triage beds, red zone for children and adults and 90 ICU beds for victims of road traffic accidents, acute trauma suffered by individuals at home or work, acute poisoning and severe medical and surgical emergencies. The Block has been developed at a cost of Rs 346 crores.

Super Specialty Block at Safdarjung Hospital holds tertiary care facilities in the areas of cardiovascular sciences, neurosciences, pulmonary medicine, nephrology and endocrinology and shall be offering the facility of a heart Command Centre, respiratory care facility, sleep labs, 24×7 dialysis unit, MRI guided Braine Suite, etc. It also has a 228-bedded private ward. The super specialty block has been developed at a cost of Rs 920 crores.

Also present at the event were Smt. Preeti Sudan, Secretary (Health), Prof. Randeep Guleria, Director, AIIMS New Delhi, Dr. Rajendra Sharma, Medical Superintendent, VMMC & Safdarjung Hospital, New Delhi and Mr I S Jha, CMD, Powergrid Corporation along with the senior officers from the Health Ministry and faculty of AIIMS.

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AI engraving foot prints on health care

By Neeraj Bajpai

SIR ALEXANDER FLEMING, the discoverer of penicillin, shared the NOBEL PRIZE for Medicine in 1945.but when he arrived in Stockholm to receive the award he had a bad cold. Throughout the ceremony he used his handkerchief repeatedly. Later when he was leaving, his eyes were still watery, and he was still sniffing.

One of the officials shook his head sympathetically and said, “No good for colds”.
.
But, it was a stunning discovery that changed the course of history. The active ingredient, which Fleming named penicillin, turned out to be an infection-fighting agent of enormous potency.
When it was finally recognized for what it was, the most efficacious life-saving drug in the world, penicillin altered forever the treatment of bacterial infections.

Now, it is turn of AI that is making fast forays in a broad-spectrum of disciplines, and Medical diagnostics and treatment field is paving way for intrusion of AI (artificial intelligence).

Across the world, race is underway to exploit AI for good of patients. Many say it is not much away from tipping point: Those who will take timely advantage of it or those who are set to miss the opportunity at the initial moments.

In INDIA, AI ball has started rolling in the wake of huge potential of healthcare network and ever burgeoning population of 130 crore people.

A discussion paper on National strategy for Artificial Intelligence prepared by NITI –Ayog team which included , Arnab Kumar, Punit Shukla, Aalekh Sharan and Tanay Mahindru ,came up for discussions recently and moves are afoot to move further.

The paper delved at length on various dimensions of AI .It said NITI Aayog is working with Microsoft and Forus Health to roll out a technology for early detection of diabetic retinopathy as a pilot project. 3Nethra, developed by Forus Health, is a portable device that can screen for common eye problem.

Integrating AI capabilities to this device using Microsoft’s retinal imaging APIs enables operators of 3Nethra device to get AI-powered insights even when they are working at eye checkup camps in remote areas with nil or intermittent connectivity to the cloud.

The resultant technology solution also solves for quality issues with image capture and systems checks in place to evaluate the usability of the image captured.

AI based healthcare solutions can also help in making healthcare services more proactive – moving from “sick” care to true “health” care, with emphasis on preventive techniques.

AI solutions can augment the scarce personnel and lab facilities; help overcome the barriers to access and solve the accessibility problem; through early detection, diagnostic, decision making and treatment, cater to a large part of India.

Cancer screening and treatment, the paper says, is an area where AI provides tremendous scope for targeted large scale interventions. India sees an incidence of more than 1 million new cases of cancer every year, and early detection and management can be crucial in an optimum cancer treatment regimen across the country.

NITI Aayog is in an advanced stage for launching a programme to develop a national repository of annotated and curated despite the obvious economic potential, the healthcare sector in India remains multi-layered and complex, and is ripe for disruption from emerging technologies at multiple levels.

It is probably the most intuitive and obvious use case primed for intervention by AI driven solutions, as evidenced by the increasing activity from large corporates and startups alike in developing AI focused healthcare solutions.

Researchers said Adoption of AI for healthcare applications is expected to see an exponential increase in next few years. The increased advances in technology, and interest and activity from innovators, provides opportunity for India to solve some of its long existing challenges in providing appropriate healthcare to a large section of its population. AI combined with robotics and Internet of Medical Things (IoMT) could potentially be the new nervous system for healthcare, presenting solutions to address healthcare problems and helping the government in meeting the above objective pathology images. Another related project under discussions is an Imaging Biobank for Cancer.

In US, Viz.ai, Inc., an applied artificial intelligence healthcare company a few months back announced that the U.S. Food and Drug Administration (FDA) has granted a De Novo request for the first-ever Computer-Aided Triage and Notification Platform to identify Large Vessel Occlusion (LVO) strokes in CTA imaging. This regulatory clearance compliments Viz.ai’s recent European CE Mark for the product in January 2018.

“The Viz.ai LVO Stroke Platform is the first example of applied artificial intelligence software that seeks to augment the diagnostic and treatment pathway of critically unwell stroke patients,” said Dr. Chris Mansi, neurosurgeon and Chief Executive Officer. “We are thrilled to bring artificial intelligence to healthcare in a way that works alongside physicians and helps get the right patient, to the right doctor at the right Time.”

Stroke is a serious and time-sensitive medical condition that requires emergency care and can cause lasting brain damage, long-term disability and death. A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. When this happens 2 million brain cells die every minute. “This software device could benefit patients by notifying a specialist earlier thereby decreasing the time to treatment. Faster treatment may lessen the extent or progression of a stroke,” said Robert Ochs, Ph.D., acting deputy director for radiological health, Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health.

The Viz.ai LVO Stroke Platform was developed using deep learning, a revolutionary technique where algorithms learn how to identify patterns in data from millions of prior examples. The Viz.ai system connects to a hospital CT scanner and alerts the stroke specialist that a suspected LVO stroke has been identified, sending the radiological images directly to their smart phone.

In a 300-patient performance study, the Viz.ai LVO Stroke Platform obtained an AUC of 0.91, identifying LVOs and alerting the relevant specialist with 90% sensitivity and specificity and a median scan to notification time of under 6 minutes. In over 95% of cases, the automatic notifications demonstrated faster notification of the specialist, saving between 6 and 206 minutes, with an average time saving of 52 minutes.

“Timely LVO stroke identification and transfer to a specialist hospital that can perform mechanical thrombectomy is the top priority for LVO stroke patients,” said Dr. Raul Nogueira, Professor of Neurology, Neurosurgery and Radiology at Emory University and the Immediate-Past President, Society of Vascular & Interventional Neurology. “This software is designed to help identify appropriate patients earlier and more often, and enable faster transfer and treatment, which, ultimately may result in improved patient outcomes.

Noted cardiologist ERC topol,who is professor of genomics and holds the Scripps endowed chair in innovative medicine, has now written a book that calls for the “creative destruction” of the current medical paradigm, which he believes has failed to keep up with the digitized world of interactivity, social media, computers, apps, and advanced engineering and electronics.

In his book, he lambasts current-day medicine as being archaic and wasteful, making his case with a compelling blend of statistics, anecdotes. He talks about how destruction and rebooting. Topol believes that consumers teaming up with innovators in the med-digital world are the key to forcing change, which is certainly true. But how exactly will this work? He is the director of the Scripps Translational Science Institute in La Jolla, California. Previously, he led the Cleveland Clinic to its #1 ranking in heart care, started a new medical school, and led key discoveries in heart disease. He lives with his family in La Jolla, California.

The NITI-Aayog discussion paper says AI is a constellation of technologies that enable machines to act with higher levels of intelligence and emulate the human capabilities of sense, comprehend and act. Thus, computer vision and audio processing can actively perceive the world around them by acquiring and processing images, sound and speech.

The natural language processing and inference engines can enable AI systems to analyse and understand the information collected. An AI system can also take action through technologies such as expert systems and inference engines or undertake actions in the physical world. These human capabilities are augmented by the ability to learn from experience and keep adapting over time. AI systems are finding ever-wider application to supplement these capabilities across enterprises as they grow in sophistication.

The paper says Healthcare is one of the most dynamic, yet challenging, sectors in India, and is expected to grow to USD280 billion by 2020, at a CAGR of upwards of 16%, from the current ~USD100 billion. Adoption of AI for healthcare applications is expected to see an exponential increase in next few years. Technology disruptions like AI are once-in-generation phenomenon, and hence large-scale adoption strategies, especially national strategies, need to strike a balance between narrow definitions of financial impact and the greater good.

NITI Aayog has decided to focus on five sectors that are envisioned to benefit the most from AI in solving societal needs: a) Healthcare: increased access and affordability of quality healthcare, b) Agriculture: enhanced farmers’ income, increased farm productivity and reduction of wastage, c) Education: improved access and quality of education, d) Smart Cities and Infrastructure: efficient and connectivity for the burgeoning urban population, and e) Smart Mobility and Transportation: smarter and safer modes of transportation and better traffic and congestion problems.

AI combined with robotics and Internet of Medical Things (IoMT) could potentially be the new nervous system for healthcare, presenting solutions to address healthcare problems and helping the government in meeting the above objectives.

AI solutions can augment the scarce personnel and lab facilities; help overcome the barriers to access and solve the accessibility problem; through early detection, diagnostic, decision making and treatment, cater to a large part of India.

Cancer screening and treatment is an area where AI provides tremendous scope for targeted large scale interventions. India sees an incidence of more than 1 million new cases of cancer every year, and early detection and management can be crucial in an optimum cancer treatment regimen across the country. Despite the obvious economic potential, the healthcare sector in India remains multi-layered and complex, and is ripe for disruption from emerging technologies at multiple levels. It is probably the most intuitive and obvious use case primed for intervention by AI driven solutions, as evidenced by the increasing activity from large corporates and startups alike in developing AI focused healthcare solutions.

Adoption of AI for healthcare applications is expected to see an exponential increase in next few years. The healthcare market globally driven by AI is expected to register an explosive CAGR of 40% through 2021, and what was a USD600 million market in 2014 is expected to reach USD6.6 billion by 202112.

The increased advances in technology, and interest and activity from innovators, provides opportunity for India to solve some of its long existing challenges in providing appropriate healthcare to a large section of its population. AI combined with robotics and Internet of Medical Things (IoMT) could potentially be the new nervous system for healthcare, presenting solutions to address healthcare problems and helping the government in meeting the above objectives.

AI solutions can augment the scarce personnel and lab facilities; help overcome the barriers to access and solve the accessibility problem; through early detection, diagnostic, decision making and treatment, cater to a large part of India.

Healthcare is one of the most dynamic, yet challenging, sectors in India, and is expected to grow to USD280 billion by 2020, at a CAGR (Compound Annual Growth Rate) of upwards of 16%, from the current ~USD 100 billion .

Yet, it faces major challenges of quality, accessibility and affordability for a large section of the population:

A: Shortage of qualified healthcare professionals and services like qualified doctors, nurses, technicians and infrastructure: as evidenced in 0.76 doctors and 2.09 nurses per 1,000 population (as compared to WHO recommendations of 1 doctor and 2.5 nurses per 1,000 population respectively) and 1.3 hospital beds per 1,000 population as compared to WHO recommended 3.5 hospital beds per 1,000 population.

B: Non-uniform accessibility to healthcare across the country with physical access continuing to be the major barrier to both preventive and curative health services, and glaring disparity between rural and urban India. With most of the private facilities concentrated in and around tier 1 and tier 2 cities, patients have to travel substantial distances for basic and advanced healthcare services.

The problem is further accentuated by lack of consistent quality in healthcare across India, most of the services provided is individual driven rather than institution driven, and less than 2% of hospitals in India are accredited.

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Medical devices in India witness churning, Price war escalates

By NEERAJ BAJPAI

“We are moving into a bold era, defined by advanced medical technologies and artificial intelligence. But healthcare will always remain a human business”. For Dominic Asquith, British High Commissioner to India that is the crux of current situation, but a razor sharp competitive business in Medical devices across the world has a different narrative because of market compulsions Vis-a Vis human business.

India’s strong position on heart stents’ price regime triggered debate and the price war snowballed into tough positions and international players gaped with a bewilderment.

Many institutions and professional bodies flew into action and debated price structures while the country’s federal government unveiled its world’s largest health coverage scheme for millions, virtually creating a colossal potential in the health sector. If the Government extends healthcare services to its 1.25 billion population as part of India’s Universal Health Coverage (UHC) agenda, it will be a challenge to devise ways to reduce catastrophic Out Of Pocket (OOP) expenditure on healthcare and ensure affordable access to essential health care for the entire population with the limited resource envelope.

Amid ongoing trading tussle between US and CHINA, many apprehend ar that ripple effect will also percolate down in India as the latter is going ahead with its price regimes and its moves to bring down stent and knee implants devices had raised many eyebrows.

A section of media has reported that AdvaMed (Advanced Medical Technology Association) in its briefing memo for US commerce secretary and US trade representative last year had conveyed that “Made in India “scheme has been used by parts if the Indian government to justify protectionist measures such as import tariff hikes and preferential market access policies.

The US Economist newspaper,recently carried a write up which quoted china Digital times , a California based website that Chinese media had been advised to play down China’s global dominance in various technological sectors ,known as “Made in China 2025’”.Such developments indicate that should India also dial down the hype on “Made in India “.

The 2014 World Bank Report estimated the OOP spending on healthcare in India to be as high as 89%. India is the only country out of the major world economies where out-of-pocket expenses are increasing, despite a concurrent increase in public spending. This effectively means that more people are availing private healthcare services due to rising incomes, or are forced to spend due to inadequate public expenditure.

Official sources say big schemes can be ensured with the help of Health Technology Assessment (HTA), which is a widely used methodology internationally for optimization of resource allocation in health. HTA is a method of evidence synthesis that considers aspects pertaining to clinical effectiveness, cost- effectiveness, social, ethical and legal implications of the use of “health technology” for healthcare intervention
The Indian healthcare industry was valued at over USD 100 billion in 2016 and is expected to reach more than USD 175 billion by 2020, resulting in a CAGR (Compound annual growth rate) of 20%. The medical device industry is valued at USD 6 billion. The medical device industry was accorded the status of an independent industry in 2014 the medical device sector today is clearly small and indicates low penetration in the country.

“The path to realizing healthcare goals is complex, and various fundamental issues and challenges need to be addressed and solved holistically. Long-term plans need periodic policy and regulatory interventions to ensure fair conduct within the industry while providing the support needed for pro?table and sustainable growth. These activities will enable the medical device industry to accelerate rapidly and play a key role in making India healthier and stronger.“

Mr Guljit Singh, Executive Chairman of SKP BUSINESS and Consulting Vice President Global Strategy and Analysis AdvaMed (Advanced Medical Technology Association) Abby Pratt tatt said in their foreword of the study. AdvaMED had partnered last year with SKP to publish the study entitled – Medical Device Industry in India –the evolving landscape, opportunities and challenges.

The study also examined various policies and regulations impacting the industry and attempts to make recommendations on the way forward from the perspective of different take holders.

The Study made a slew of recommendations like cap trade Margins and not Price to the dealers, should be capped after detailed evaluation of each Medical Device segment and the role of trade. Trade margins should be ?xed deferentially for different categories of devices, based on service requirements and role of distributors.

It says allow the dealers to compete with each other and provide a fair price to the hospitals based on the terms and conditions of services and payments. There is a need to work towards bundled payment models as used in many other countries to better align incentives for hospitals and their business models. Increase government healthcare spending as a percentage of GDP. India lags behind the other BRICS in this regard.

Adequate utilization of government infrastructure to reduce the cost to Private players – PPP model could be an attractive alternative to explore. Specify certain quantities/proportions of supply of different stents at lower prices to speci?ed government agencies for use with underprivileged sections. It advocated to empower the Medical Technology Assessment Board (MTAB) to Evaluate the model of tiered pricing as observed in the French healthcare ecosystem, wherein the NPPA cap the generic products and leave the latest generation products with incremental value out of the ‘essentiality purview’.

The incremental value could be on account of e?cacy, material used, ease of delivery and shortened recovery time. Various combinations are possible here such as: an increase in the number of tiers, allowing new introductions to be free of price Intervention for a certain number of years. Identify priority medical devices and procedures that demonstrates the greatest need stemming from disease burden. MTAB along with other regulators for medical devices should ensure that there are minimum

Quality parameters—in terms of safety, clinical e?cacy, and cost-effectiveness—for medical devices that get used in the public and private health system, such that long-term costs are lowered over a patient’s lifespan, with need for fewer hospital readmissions, lowered need for medication, and overall better health outcomes.

The report said factors such as changing demographics, rising life expectancy, growing incomes and public awareness have contributed to a higher demand for medical care. A more focused approach from the government, with increased public expenditure on health, greater utilization of technology, vibrant private sector participation, and continued innovation can transform the sector and move India closer to its goal of providing quality universal healthcare.

Some of the key issues faced by the Indian healthcare industry are evident: With India’s disease burden shifting from acute to chronic diseases, large numbers of the population continue to not have access to basic healthcare services. Public health infrastructures poorly equipped to deal with this shift toward NCDs.

The report said it is essential that healthcare professionals are appropriately trained and adequate in numbers. However, the Indian healthcare system continues to lag behind both developed and other developing countries in terms awareness, availability, affordability, and access to quality health services.

While the government and value chain participants are undertaking several steps to address these issues, they have been executed in silos. Medical service providers are not only inadequate but are also not evenly distributed across rural and urban areas.

This shortfall occurs despite an increase in the number of medical colleges from 23 in 1947 to 398 in2014. The quality and availability of healthcare deteriorates as one moves away from large urban centers to lower-tier towns and rural area.The Indian medical device industry, the report found, is highly fragmented. Currently, this sectors dominated by MNCs with 70–75% of the demand being met through imports.

Approximately 30% of the domestically manufactured devices are exported, in which the consumables and disposables segment has the largest share.

On a mix of technologies such as engineering, electronics, material sciences and information technology. Innovation, capital and technology drive the industry. However, India has not been able to bridge the gap between investments, skilled resources and innovation to fully capitalize on these opportunities. Numerous factors underlie the prevalence of higher imports in the country.

Some of these are: There is no clear comparative cost advantage in comparison to other emerging markets and policy issues like inverted duty structured not help in creating a positive environment. Lack of favorable policy and regulatory framework, the report, compiled last year said.

On Segments, the study said, hearing aids and pacemakers form major part of patient aid segment and constitute 70% f e segment collectively. Most of the products are sourced from Ireland, USA, Australia, Singapore, China, and South Korea.

The medical disposable and consumables sector consists of products such as plastic syringes, blood bags and many others. This segments dominated by domestic players in India due to its low technology requirements.

Needles and syringes constitute majority of the sales. However, wound management products and medical apparels are the fastest growing products in this segment. The Indian implants segment has witnessed an encouraging growth rate of CAGR25%.

With a healthy mix of both domestic companies and MNCs, this segment has witnessed intense competition between players due to strong pricing pressure. The domestic players have realized the market potential which demands customization and differentiated product quality. The equipment and instruments section is the largest segment of the medical device industry constituting nearly 54% of the segment and is dependent on imports.

MRI machines, CT scanners, ultrasound machines, dental drills, dental chairs, dental x-ray machines. Are some of the key products of this segment? It is dominated by MNCs like GE Healthcare, Philips Healthcare, Schiller Healthcare, Danaher Corporation, and Roche

Drug-eluting stents and bare metal stents form a major part of the stents segment and constitute more than 70% of the segment collectively. Most products are sourced from the USA and Europe.
While domestic companies are manufacturing cost competitive products, they still face competition from international players on account of quality. Diagnostics segment is growing due to advanced technology being increasingly applied in medical procedures.

The report had said government initiatives control regulation and the new Public Procurement Policy .the preferential Market Access do not fully re?ect this and has alarmed many industry participants.

A clear long term vision and roadmap for the industry and predictability of policy would excite the industry. The government needs to provide policy support for both the supply and demand side of the medical device industry to successfully accelerate growth. Industry and government need to work together to improve awareness, access, has made rapid progress in the last decade, but Signi?cantly lags behind other nations in availability and quality of equitable medical care and services for citizens.

This in turn presents an enormous opportunity given the large population, growing economic prosperity, and the disease burden. Major issues such as availability of adequate infrastructure, trained human resources, geographic spread, rapidly changing disease burden, and high/often catastrophic out of pocket expenditures are challenges that the government is keen to address, the report said.

The Indian government is committed to raise public expenditure on health to 2.5% of the GDP. Public and private sectors need to play equally important but different roles in bringing rapid change to the healthcare scenario in the coming decade.

Around opening up FDI and infrastructure development are welcome initiatives that will enhance the ecosystem for investment. The Indian medical device industry appreciates government’s efforts to remove bureaucratic hurdles and improve the ease of doing business, but believes that additional steps can be taken to strengthen its approach.

The study identified challenges and said growth in the healthcare industry has been attractive. However, much more needs to be done. Despite the Advent of private players and better government spending, most Indians can only afford and/or have access to basic healthcare. Hence, the path to universal healthcare coverage is challenging.

Some of the obstacles faced are —Real estate prices and high capital costs limit the growth of delivery infrastructure. Insu?cient attention by policymakers and a complex tax regime are also responsible for the sector’s underdevelopment. The lack of a comprehensive policy and focus to develop the healthcare eco-system. Low Penetration – The per capital medical device spending of USD 3,compared to USD 7 in China and USD 42 in Russia is signi?cantly low. The limited attractiveness of India as a destination for medical devices, the study said, is due to uncertain regulations and pricing environment, unavailability of skilled resources, and ease of doing business compared to other comparable destinations in Asia. It said the Indian healthcare system is inadequate, ine?cient, and evenly distributed.69% of the Indian population lives in rural areas, while 73% of quali?ed consulting doctors reside in urban areas.

Eight percent of quali?ed doctors are in rural areas, and the remaining 19% are in semi-rural areas.it highlighted that Lack of innovation and Customization resulting in fewer options available to the patients. Inadequate regulatory systems: Non-alignment with global Standards and the lack of quality product testing infrastructure are issues that hinder sectoral progress. The Indian Medical Device sector is undergoing signi?cant changes for the better and will continue to do so in the foreseeable future.

From both the regulatory and domestic innovations perspective, recent changes in this sector, especially with the government’s focus on the Make in India campaign, will cause a shift in the industry’s structure, conduct, and performance. Manufacturing will get more organized and international companies will assess plans to manufacture in India in selected product segments due to harmonized global standards. The increase in testing labs, clinical trials and certi?cations will increase R&D in India and eventually more customized products for the Indian market will emerge.

It called for a conducive environment for technological Companies who demonstrate quality innovations standards together with cost sciences to thrive ;Focus on manufacturing and research in More International companies to manufacture in India and expand their presence across segments; Focus on technology and innovation to drive down cost and improve margins with better and differentiated products Patients to bene?t from competitive costs and better quality products from both domestic and international companies

The report highlighted that International companies will look at domestic innovation opportunities; domestic companies should focus on raising quality standards and technological upgradation ;International and domestic companies to customize products for Indian needs International and domestic companies to collaborate with each other through joint ventures or associations.

Another study early this year -Medical devices in India- an agenda to effective healthcare delivery” said to attract world’s top medtech players to establish their research and development (R&D) operations in the country and to establish a firm footing in the global market, the Government needs to adopt a robust policy and regulatory framework. India can replicate some of the models being adopted by other nations that have succeeded in attracting leading medical players. The contents of this report are based on a study commissioned by AdvaMed and conducted by IQVIA on behalf of ADVAMed.

It said the Government can provide financial incentives in form of extended tax holidays or weighted tax reduction for R&D investments; Boost local demand for medical devices by stepping up public healthcare spending which in-turn could catalyse investments in this sector Further, Government should focus on creating an enabling regulatory landscape by creating a separate legislation system for medical devices.

The report said While, Medical Devices Rules, 2017 is a welcome step towards regulating the medical devices sector, the setting up separate notified body and distinct legislation system for devices with a focus on the following could further boost growth of the industry like Grant product approvals; Instituting quality standards; Setting up monitoring mechanisms for devices; Expedite patent approval process for medical devices.

Medical devices form a more than $200-billion global industry, which develops and manufactures essential healthcare equipment. The Indian industry is currently valued at US$ 4.4 billion With about 700 medical device makers, India’s medical device market is currently the fourth-largest in Asia (after Japan, China and South Korea) and ranks among the world’s top 20.

Imports constitute a substantial part of the medical device market in India. An estimated 80% of India’s demand for medical devices is currently met by imports, nearly 30% of which are supplied by the United States. Imported medical devices are often those that are critical, innovative and high-risk in nature – either life-saving or life-enabling – and therefore undergo rigorous testing. These complex, innovative devices are designed to address the growing expectations of India’s population in the country’s rapidly evolving healthcare system, this report said.

The medical device industry has been very encouraged by the Prime Minister’s recognition of the critical role of medical devices in addressing India’s healthcare challenges. The AdvaMED website says In general, we have a received a strong message from the government that they are interested in promoting the medical devices sector and creating an environment that fosters innovation. This is great news not only for manufacturers of medical devices but more importantly for patients who desperately need access to high quality yet affordable lifesaving and life enhancing medical technologies.

The PM’s call to medical device manufacturers is a welcome recognition of this separate and important part of the healthcare system. Several of AdvaMed’s member companies have already established manufacturing units in India, and India is being increasingly viewed as an R&D base.

The website says the medical device industry in India has grappled with challenges for several years around recognition and regulation. While the Global Medical Device Nomenclature (GMDN) lists more than 14,000 different product types, the current regime only regulates a relatively modest portion of these products. Moreover, these devices/products are regulated as “drugs” under the Drugs and Cosmetics Act of 1940. This is problematic because medical devices are very different from drugs in terms of diversity, product development, patent structures, types of failures, scientific disciplines involved in assessing performance/efficacy.

In addition to the arbitrary application of the rules for drugs to medical devices, which hinders the development, quality of and access to medical devices, there is also a lack of predictability in the regulatory system. The industry is also concerned about the lack of standardization in line with global best practices.

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Unfolding NRC Scenario

By Malladi Rama Rao

Opposition parties, notably, Rahul Congress and Mamata Congress, are happy at the new talking point – National Register of Citizens, NRC- they have got in Assam. And they are going to the town to beat Narendra Modi and his Sancho Panza, Amit Shah in the forthcoming electoral game. Will they succeed? Assam and Bengal hold the key. Assam is BJP turf. Mamata may stand to benefit on her home soil, Bengal, Neither here nor there syndrome will spoil the party for Rahul Congress with or without Maha Ghatabandan.

Illegal migrants from Bangladesh are a reality in Assam, adjoining North-east, and Bengal. Their infiltration has been taking place since partition. It acquired exodus proportions in 1965 – during the India-Pak war, and in 1971- the Bangladesh Liberation War. Not all of them are Muslims. A large number of them are Hindus and Buddhist Chakmas. Delhi had officially tried to settle the Chakmas in Arunachal Pradesh during the Indira regime. But the locals had not taken kindly to the move. The issue remains a political football. And it is a clear unmistakable signal that other states will not be favourably inclined to take in Assam’s disfranchised Bangladeshis even as they are compelled to let the Bangladeshis and Rohingyas due to scarce labour mostly in low wage bracket.

Rahul Congress, Mamata Congress and Yechury Communists are acutely aware of the distinct advantage that the BJP has acquired, well, by default, in an election year. Neither rhetoric nor dubbing the BJP as communal is an answer to checkmate the saffron party’s surge.

In today’s globalised world, no country -whether it is Trump’s America, Merkel’ Germany or Le Pen’s France is willing to take asylum seekers. National interest – not religion or race issues are the consideration. That is why Saudi Arabia has thrown out illegal Bangladeshi and Pakistani migrants. India cannot be an exception to the trend. Problem has become severe in Assam and other north-eastern states because the region had seen several waves of immigrants since Partition in 1947 unlike Punjab, Delhi and Rajasthan where it was a one-off affair.

The Grand Old Party deserves a good word and bad word in equal measure. Once foreign nationals issue brought the Assamese to the streets, it woke up to ground reality, and made 1971 as the cut-off year for Assam while it is 1951 for the rest of India. Its undoing was the Illegal Migrant Determination by Tribunal (IMDT) Act, 1983, which was struck down by the Supreme Court in 2005 as “the main impediment in the identification and deportation of illegal migrants”.

All religious faiths who had entered Assam before 1971 are accepted but after 1971, the entry was limited to persecuted minorities – the euphemism for Hindus from Bangladesh, Pakistan and Afghanistan. The Modi government is following the same policy. Yet it is facing flak. Reason: its credentials as the Hindutva champion, and the track record of Hindutva outfits since 2014.

Assam’s draft NRC has left out some 40 lakh residents. Some of them will surely find their way back into the register after proving their citizenship “beyond a reasonable doubt”. Given the reality of India, this is bound to be a very cumbersome exercise, and has the potential of making the victims pawns in the hands of local power brokers, and lower bureaucracy. The only silver lining is that the bureaucracy is answerable to the Apex Court, which is monitoring their work under a strict timeline.

The final NRC should be ready by December end, a period that would coincide with the sounding of the electoral bugle. “After the final NRC, we’ll begin disenfranchising illegal migrants (in Assam)”, BJP’s pointsman for Northeast, Ram Madhav, said in a recent interview and indicated that NRCs would be prepared in other states as well. Advantage slipping into BJP lap? Yes.

The question – what next after disenfranchisement – has no answers. Deporting them to Bangladesh? It is not possible with or without a friendly regime in Dhaka. Existence as a stateless citizen? Well, it will give rise to a fear syndrome amongst the disenfranchised Muslim as also the Hindu expecting Indian citizenship. A new industry of protectors will take roots. Advantage firmly with the BJP! Yes, in Assam to begin with!

Work cut out for Rahuls, Mamatas, and Yechuris? Yes, undoubtedly!

(* This article appeared in Power Politics, Sept 2018)

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Message from Chinese Army drill in Tibet

By Malladi Rama Rao

People’s Liberation Army, PLA, has just tested its “logistics, armament support capabilities” and “military-civilian” integration by carrying out a drill in the Tibet. Held on 26 June, it was the first such exercise since the Doklam stand-off, and second since the 13-hour-long drill also in Tibet held two years ago. It fits in well with President Xi’s strategy of building a strong military in the new era.

There are two messages.

One for India, obviously.

And the other for a domestic audience as well as the outside world

The first signal is that unlike in 1962, the Chinese PLA is now in greater control of the Tibetan Autonomous Region (TAR), which will enable it to launch operations against India as and when required with adequate logistic support.
The sec0nd signal is that PLA has been able to enlist the support of the local Tibetans to its military exercise. “A local petroleum company supplied fuel when the armored unit ‘ran’ out of fuel and the city government of Lhasa delivered a steady flow of food to soldiers after a day of mock battle, as a part of ‘actual integration on the ground’, Xinhua reported. It is no more than simulating a war-like situation in which civilian authorities rush with aid to the military. Well, this is the civil-military integration that the PLA is talking about – living off the land, as it puts.

Zhang Wenlong, head of the Command Logistics Support department, has an interesting take. The PLA has adopted a military-civilian integration strategy and constantly advanced logistics support capabilities to solve difficulties in “personnel survival, delivery, material supply, rescue, emergency maintenance, and road safety,” he told Xinhua (Global Times, 28 June 2018).

For the PLA, the drill is a very significant milestone, according to the Chinese media which has gone to the town to say that the PLA has achieved what it had failed to accomplish in the 1962 Sino-Indian conflict – namely integrating local resources with Army units. “In the 1962 China-India border conflict, China failed to protect its fruits of victory due to poor logistics support. Although local Tibetan residents provided soldiers with temporary support, it was not sustainable,” military commentator Song Zhongping, told Global Times.

Why the Chinese media has raked up this so-called failure? About it a little while later.

As pointed out at the outset, the Tibet Military Command conducted a 13-hour drill at an elevation of 4,600 meters in August 2016. It was targeted at specific issues that came to the front in a high-altitude drill conducted a month earlier. Again in July last year, the PLA had carried out a live-fire assault exercise also on the Qinghai-Tibet Plateau. A ground combat brigade of the PLA Tibet Regional Command took part in the drill that featured rapid deployment, multi-unit joint strike, and anti-aircraft defense.

What are the implications of the present exercise? Reports in the Chinese are understandably sketchy. Only the location of the exercise has been indicated. There is no mention of the kind of troops or the Theatre Command that had carried out the drill. It is most likely a show of the Western Theatre Command headed by Lt. Gen. Zhao Zongqi.
The objectives of the exercise, namely improving the logistics from the time of 1962, Sino-Indian war, require a careful look at where the Chinese are today. True in 1962, one of the factors which kept the Chinese from advancing fully into India was logistic difficulties.

But there can be no gain in saying that PLA has had a long march since then. Ever since Xi Jinping took over as President, the PLA has focused on improving, integrating and reducing the teeth-to-tail ratio in the forces.
The first signs that the PLA was reorganizing its logistics came in late 2015 and early 2016 when President Xi brought all military elements under the Central Military Commission, (CMC). The process led to the creation of a Logistic Support Department. A natural corollary by September 2016, was the setting up of Joint Logistic Support Force (JLSF) of the CMC to support the five new Joint Theater Commands. Under its domain are civil-military integration related to logistics, including outsourcing of logistics and promoting research and development of dual-use technologies.

What prompted Xi to set up JSLF? Well, rampant corruption. Many PLA officers accused of corruption were from the logistics department. It was obviously a weak spot in PLA’s capabilities with embezzlement of funds from the purchase of supplies, logistics equipment and maintenance of stocks in depots. President Xi and his egg-heads expect greater central control over logistics to reduce corruption.

Civil-military integration is not a new weapon in the PLA armory. For over a decade, the Chinese army has been working to integrate and improve its mobility across varied terrain. It has conducted exercises across Tibet to improve the delivery of man and material and to respond to different contingencies. And faced the harsh reality – access to many areas in the West and the Qinghai-Tibet Plateau remains limited particularly in terms of logistics and support to troops on the ground. This increases the importance and dependence of ground troops on military and civilian fixed wing and rotary-wing transport capabilities.

Today, Chinese control over Tibet is complete, and there is little worry about local Tibetans not supporting PLA troops should the need ever arise. It is, therefore, strange, that Chinese media should hark back to 1962 and to say that in 1962, “although local Tibetan residents provided soldiers with temporary support, it was not sustainable.”
This makes no sense unless it is a signal to India that it had better be prepared for another short conflict? Of course, the Chinese are past masters at using their historical examples to justify their actions and Doklam was no exception.

Frankly, it is necessary for India to monitor such exercises closely and focus on its own logistics as we have a much greater logistic challenge while confronting China. It is not to say that things have not changed over the past five decades. Road network has improved vastly though not substantially as yet. Our forces have also increased access to air and missile power. All this may be reason enough to not worry about the Chinese.

Nonetheless, the Chinese model of civil-military integration in Tibet is relevant to India. Reason? It is being done in a territory, which China assumes never to be in its absolute control. That is the lesson for India as its military prepares for any eventual conflict with China.

New Dragon Signals

In July, PLA has held a new round of military drill in Tibet. It simulated behind – the enemy –lines infiltration mission and trained helicopter pilots in the potential military confrontation. Like the June drill, this also has an Indian angle, according to Global Times which broke the ‘news’ on 19th July.

“It’s normal for any military training to have an imaginary opposing force. In this case, it’s obvious who the target is, given the fact that training was conducted on the plateau in Tibet”, Song Zhongping, a military expert, told the daily. And went on to add: “The training prepared participants for a potential military confrontation with India”.
The drill should offer good food for thought for the Indian strategic community on Dragon’s signals. Because China has just opened an unmanned automatic weather observation station in Tibet near the border with India. Data from the weather station will assist aircraft take-off and landing and the launch of missiles.

(* This commentary appeared first in the August issue of Power Politics, a monthly magazine from New Delhi)

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