LETTERS
The Agra Summit
Pakistan President General Pervez Musharraf came to India with an "open mind" but failed to rise to the level of a statesman. Under intense pressure from hardliners in Pakistan, he refused to show any flexibility at the Agra Summit ("Deadlock at Agra,"
August 3).
Musharraf harped on Kashmir, ignoring other important issues such as poverty, health and education. And he engaged in doublespeak. Even as the talks were on, the Kashmir Valley was reverberating with the sound of gunfire.
India played the role of a host in a dignified manner, by conducting the talks in a cordial, responsible and mature manner. Prime Minister A.B. Vajpayee has emerged a stronger leader in the eyes of the international community. He firmly but politely
conveyed to Musharraf India's stand on Kashmir and indicated to the international community that India really wants peace and stability in the region.
The Congress(I) should be lauded for its support to Vajpayee in the matter of the Summit and for the role of a responsible Opposition it played, keeping the national interest above political considerations. The Summit was not a failure. It has paved the
way for further talks.
There seems to be light at the end of the tunnel because the people of India and Pakistan yearn for peace.
S. Balakrishnan
Jamshedpur
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The failure of the Summit shows that Pakistan is in no mood to work for peace. The Indian government committed some mistakes, the major one being that it went into the Summit without doing its homework. The media created unreasonably high expectations
of a positive outcome.
Although India did not gain anything from the Summit, Pervez Musharraf did. By denying the charge of cross-border terrorism and talking about Kashmir's "freedom struggle", he might have strengthened his political base in Pakistan.
Bhalinder Singh
Meerut
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The Summit was not a failure. It was only the starting point of the great road to peace. Although it did not lead to a joint declaration, the statements made by the two sides in Agra show that efforts were indeed made to resolve disputes and bring about
peace.
The decades-long enmity between the two countries cannot be settled with merely two hours of talks between two leaders. There is a wide gap between the respective stances of India and Pakistan on many issues, the major one being Kashmir.
Lack of preparation was a major reason for the Summit's failure to produce a joint declaration. Still Prime Minister Vajpayee is hopeful. He has asserted that the efforts to arrive at peace will continue. The people of India and Pakistan want a
resumption of the dialogue.
K.A. Solaman
Alappuzha, Kerala
Lawless acts
The police seemed less disposed to use their wits than their fists, as the arrest episode in Tamil Nadu demonstrated ("Tamil Nadu's shame", July 20). The pain suffered by M. Karunanidhi, Murasoli Maran and T.R. Baalu might have satisfied the sadists,
but how can these leaders be compensated? This act of political villainy is without a parallel in India. The government's attempts to justify its actions through concocted stories and doctored video-clippings will carry little conviction with the
masses.
R. Soundararajan
Nagapattinam
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Political vendetta has become part and parcel of Indian politics. But the drama in Tamil Nadu in the early hours of June 30 crossed all limits. Chief Minister Jayalalithaa's tit-for-tat policy has only vitiated the political atmosphere in the State.
Sankar Patnaik
Hazinagar, West Bengal
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One of your readers has correctly pointed out that the police personnel who arrested Karunanidhi acted no better than common criminals. They flouted the right of private defence conferred by the Indian Penal Code. The IPC lays down that nothing is an
offence which is done in the exercise of the right of private defence and that every Indian citizen has the right to defend his own body and the body of any other person against any offence affecting the human body. It also empowers any Indian citizen
by way of exercising the right of private defence even voluntarily to cause the death of illegal assailants who act in conscious and blatant violation of the law of the land.
B. Sivaraman
Chennai
Cancer Institute
This has reference to the article on the Cancer Institute in Chennai ("Surviving cancer", July 20). My aunt was a patient of Stage 3 cancer. She was cured and has not had a relapse for the last seven years.
I wish to place on record the extremely good care bestowed by the institute on my aunt during and after the illness. What really touched me during my frequent trips to the hospital accompanying her was the kindness and attention shown to patients,
irrespective of their economic status.
At one stage, when my aunt's condition worsened after her discharge, one of the senior doctors came home rushing to provide care and arrange to transfer her to the hospital. Of course, the high level of professionalism of all the doctors at the
institute is a well- known fact.
We can be rightfully proud of Dr. V. Shanta and her colleagues.
Subramanyam Sridharan
Jeddah
Books
K. Satchidanandan concludes his review of Paul Zacharia's two novellas by stating that Zacharia and N.S. Madhavan have few peers among their Indian contemporaries ("Retrieving the narrative art", July 20). One cannot disagree with him because very few
of us are familiar with writings and writers in other Indian languages. Being the Secretary of the Sahitya Akademi, Satchidanandan has been associated with writers of and writings in most of the Indian languages. Moreover, he has been writing in English
about comparative Indian literature for a long time. But Satchidanandan's observation, in the course of narrating the plot of "Praise the Lord...", that Zacharia portrays his female characters as being stronger and wiser than his male characters is a
conscious effort to paint Zacharia as a feminist co-traveller. This is not true.
Until a couple of years ago Paul Zacharia was not concerned with issues such as gender equality. He is an intelligent writer with all the strengths and weaknesses of a middle-class Christian from Kerala. Zacharia is very sensitive to his surroundings;
his humanness and narrative style are commendable. But to describe him as pro-feminist would be far-fetched.
There is a visible effort in certain quarters to portray Zacharia as a supporter of feminism. Zacharia too is a part of this. He has recently published a collection (Zachariayayude Penkathakal) of short stories which are supposedly written with a
feminist tilt. With the arrival of Sara Joseph, Ashitha, Dr. P. Geetha, Gracy, Priya A.S., Chandramathi and so on, feminist writing in Malayalam has come of age. These writers have found their own niche in the literary world and become assertive too.
Satchidanandan played a role in this transformation. He coined the Malayalam word pennezhuthu, which denotes feminist writing, and he is considered an authority on it. Zacharia wants to be seen in the same bandwagon for reasons known to him. But why
should a writer of Satchidanandan's repute trumpet for him?
P.J.J. Antony
Jubail, Saudi Arabia
Medicines
The article on the pharmaceuticals industry placed the issue of patents in perspective ("For affordable medicines", July 6) by explaining how the regime of Trade Related Intellectual Property Rights (TRIPS) has led to denial and deprivation rather than
meet the health needs of populations that are confronted with pandemics like Acquired Immune Deficiency Syndrome and tuberculosis and tropical diseases like malaria. Obviously there is a need to save the respective governments and their health laws from
the stranglehold of imperialist designs.
The Patents Act, 1970, has been the cornerstone of India's self-reliance in drug manufacturing. It helped take drug companies like Cipla to global heights on the AIDS front. Cipla's antiretroviral drugs are the most affordable.
The New Delhi symposium cited in the article was conducted by the Janswasth Abhijam, a Delhi-based non-governmental organisation, together with the Federation of Medical and Sales Representatives Associations of India (FMRAI). The FMRAI has a record of
conducting struggles in the 1970, against the unhealthy marketing techniques of the baby food industry in which their products were projected as substitutes for breast milk, and in the 1980s against the sale in India of formulations banned abroad. It
conducted campaigns and strikes against the proposed amendment to the Patent Act in the 1990, on the ground that the amendment would have led to the monopolisation of the drug industry. It organised a week-long strike in January 2001 on the issue of
patent protection and against the blackmarketing and sale of spurious drugs. The FMRAI was an important constituent of the Health Assembly held in Dhaka.
M.G. Prakasam
Kollam, Kerala
Medical education
This refers to the article "Mixing medicines" (July 6) which says that Dr. C.P. Thakur, Union Minister of Health and Family Welfare, wishes to introduce a course in Ayurveda, Siddha and Unani in the MBBS curriculum. This move, according to the article,
flouts medical ethics and a Supreme Court order which prohibits simultaneous practice of two systems of medicine. The article also refers to a Ministry of Health and Family Welfare letter dated November 30, 2000, to the Medical Council of India,
advising it to take necessary action to include the basic principles and concepts of Ayurveda, Siddha, Unani and Homoeopathy in the course content for MBBS students. The article gives the impression that the directive of the Ministry would amount to
mixing the two streams of medicine and the approach, being time-consuming and beyond the capacity of the student, would be impractical.
The correct position is that Ayurveda, Siddha, Unani and Homoeopathy are age-old systems of medicine with proven strengths in certain areas, which is nationally recognised. The medicines are plant-based and extensively relied upon by people,
particularly in rural areas. The interest in and use of alternative and complementary systems of medicine is growing worldwide and the market for plant-based drugs has peaked in the last decade. The inclusion of the basic concepts and principles of
different Indian systems of medicine in the MBBS curriculum will broaden the knowledge of students of allopathy and give them an opportunity to have a general outline of these systems to be able to understand their principles, concepts, practices and
philosophy. The approach is primarily intended to make the practitioners of modern medicine aware of the areas of strength of Ayurveda, Unani and Homoeopathy. They also voluntarily seek treatment under these systems, sometimes side by side with
allopathic treatment, to mitigate symptoms and prevent the onset of certain diseases.
The decision to expose students of modern medicine to the basic concepts and principles of Indian systems of medicine is intended to sensitise them to these systems and it is not part of any effort to equip them to practise Indian medicine. There is no
attempt whatsoever to mix the two systems as each system is regulated by independent, elected, autonomous regulatory councils set up under separate Acts of Parliament in regard to education, course content, registration of practitioners and practice of
medicine of the system concerned. You may also note that several medical schools in the United States have set up departments of alternative and complementary medicine. Several foreign institutions have evinced interest in the modules of Ayurveda being
imparted to their students.
L. Prasad
Joint Secretary,
Ministry of Health and Family Welfare
New Delhi
Scrap collectors
The thousands of scrap collectors in Mumbai and Pune need assistance to lead decent lives ("On the scrap heap", August 3). As in the case of workers, they need an organisational network that would secure their legitimate rights. Group insurance, welfare
funds, pension schemes and so on can go a long way in alleviating their misery. By regularising their service through licences, garbage collectors can be protected against any harassment by the police or securitymen.
A. Jacob Sahayam
Karigiri, Tamil Nadu
Correction: In "The Supreme Court norms" (July 20), the judgment in which the court laid down certain norms that should be followed by an arresting/detaining authority is inaccurately mentioned as having been delivered in D.K. Basu vs. the State
of Rajasthan. The original litigants in the case cited were D.K. Basu and the State of West Bengal. Many States, including Rajasthan, impleaded themselves in the case later.
A case for integrated medicine
C.P. THAKUR
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A response from Dr. C.P. Thakur, Union Minister of Health and Family Welfare, to the article "Mixing medicines", published in the July 6, 2001 issue of Frontline
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THE word integrative medicine has been coined by the Americans (it is integrated medicine in the United Kingdom) to refer to a system in which conventional (allopathic) medicine and the good elements of complementary medicine (such as Indian systems of
medicine) are integrated. In the past, the practitioners of the two systems have remained bitter critics of each other. Now the wind is blowing in favour of integration. If we examine three editorials published in the British Medical Journal, which is
of international repute, the attitudinal change becomes apparent.
The first editorial published in 1980 on complementary medicine titled, "The Flight From Science", suggested that some aspects of chiropractic ought to be as extinct as divination of the future by the examination of birds' entrails; acupuncturists'
beliefs were described as irrational. In contrast, the second editorial, published in 1999 alongside a specially commissioned series of articles on complementary medicine, entitled "A New Dawn", stated that complementary medicine is not unproved. The
article continued: "Increasing evidence shows the effectiveness of some treatments in some conditions."
The third editorial, published in 2000 with a front-page legend "Integrated Medicine - orthodox meets alternative", defines integrative or integrated medicine as a system of medicine that is practised in a way that selectively integrates elements of
complementary and alternative medical systems into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment. It aims to combine the advantages of the conventional and the complementary systems.
It has been increasingly recognised that allopathic medicine has become more disease-specific and ignores the person as a whole. As for complementary medicine, it deals with health and healing. It views a patient as a whole person with mind and spirit
as well as body and includes these dimensions into treatment. How has this attitudinal change been brought about? Is it because of the rising cost of conventional medicine that people are opting more and more for complementary medicine?
There has been a phenomenal increase in the demand for complementary medicine in recent years. In the United States, expenditure on complementary medicine rose between 1990 and 1997 from $13 billion to $38 billion a year and twice as many consultations
were with the practitioners of complementary medicine as with mainstream family doctors.
This trend was also apparent in Australia. Within the U.K. a recent survey showed that in Southampton (population 2,00,000) around œ4 million was spent in a year on complementary medicine outside the National Health Service (NHS). The World Health
Organisation (WHO) estimates that in the coming two decades the world market for complementary medicine will reach $5 trillion. Who can ignore such a tremendous increase in public demand for complementary medicine?
In the U.S., the National Institutes of Health (NIH) established a National Centre for Complementary and Alternative Medicine (NCCAM). The centre's mission is "to explore complementary and alternative healing practices in the context of rigorous
science; to educate and train CAM (complementary and alternative medicine) researchers; and to disseminate authoritative information to the public and professionals. This centre had funds of $68.3 million for the fiscal year 2000.
In England, there was a combined meeting of the NCCAM and the Royal College of Physicians to formulate integration between the two systems. The Select Committee of the House of Lords on Science and Technology not only acknowledged that 40 per cent of
general practice in U.K. provided some complementary medicine services but also evolved guidelines for its improvement. It categorised complementary medicine as follows:
Group 1: Professionally organised alternative therapies: acupuncture, chiropractic, herbal medicine, homoeopathy and osteopathy
Group 2: Complementary therapies: Alexander Technique, aromatherapy, Bach and other flower extracts, body work therapies including massage, counselling, stress therapy, hypnotherapy, meditation, reflexology, shiatsu, healing, Maharishi ayurvedic
medicine, nutritional medicine and yoga
Group 3: Alternative disciplines
3 (a) Long-established and traditional systems of health care: anthroposophical medicine, ayurvedic medicine, Chinese herbal medicine, eastern medicine (Tibb), naturopathy and traditional Chinese medicine
3 (b) Other alternative disciplines: crystal therapy, dowsing, iridology, kinesiology and radionics.
The Government of India objected to this categorisation and sent a team of ayurvedic experts to seek to have ayurvedic medicine included in the first category. To educate medical practitioners and medical students about complementary medicine, a
conference was organised in 1995 by the NIH, which recommended that complementary and alternative medicine should be included in nursing and medical education.
Two years later, a survey of all 125 U.S. medical schools found that 75 of them offered some form of education on complementary and alternative therapy. Teaching includes elective modules, core curriculum lectures and problem-based learning at the
undergraduate and residency level. Reputed universities such as Harvard and Stanford offer continuing post-graduate education courses, and the Universities of Maryland and Arizona offer research and clinical fellowships. The Association of American
Medical Colleges has issued guidelines on including alternative and complementary therapies in the curriculum for residents.
The NIH recently issued a funding initiative in order to support the development of teaching on complementary and alternative therapies in medical, dental and nursing education. It also supports career development and training programmes at several of
its research centres in the U.S. In the U.K., two centres - Southampton and Glasgow - have emerged as advance centres for teaching complementary medicine and they have prepared teaching modules for undergraduate students. The aim of these teaching
modules is to sensitise medical graduates regarding complementary medicine.
In the field of research, many good trials have been completed. Specific examples of such reviews include the use of Hypericum Perforatum (St. John's Wort) in depression. It has been found equal to any allopathic anti-depressant. Gingko biloba has been
found to delay cognitive decline in patients with Alzheimer's disease; Serenoa repens (saw palmetto) relieves symptoms associated with benign prostatic hyperplasia; and glucosamine and chondroitin sulphate help in osteoarthritis. The NCCAM now supports
randomised controlled trials on many dietary supplements. More and more research trials have been initiated in recent years.
The integration of complementary medicine with conventional medicine was started mostly in China in the early 1950s in order to deal with a massive health problem. A survey in Thailand showed that 60 per cent of the people use multiple healing systems,
including modern Western medicine, Chinese medicine and religious healing. A survey in two village clinics in China's Zheijang province showed that children with upper respiratory tract infections were being prescribed an average of four separate drugs,
always a combination of Western and Chinese medicine. The Department of Traditional Chinese Medicine treats 20 per cent of the outpatients. Integration is seen also in South Korea.
In India the two systems have been developed in a parallel model. They are governed by the Indian Medicine Central Council Act, 1970. In most of the Central Government Health Scheme (CGHS) dispensaries there exists a counter for complementary medicine.
This department is no doubt under the Health Ministry but is looked after by an officer at the level of Secretary to the Government of India. In recent years great stress has been laid on improving education, standardising drugs, enhancing the
availability of raw materials, research and development, information, education, communication and larger involvement of this type of medicine in the national system for delivering health care. The Central Council of Indian Systems of Medicine oversees
research institutes, which evaluate treatment. The government is adding 10 traditional medicines into its family welfare programmes, funded by the World Bank and the Central government. These medicines relate to anaemia, oedema during pregnancy,
postpartum problems such as pains, uterine and abdominal complications, difficulties with lactation, nutritional deficiencies, and childhood diarrhoea.
We live in an era of evidence-based medicine. In complementary medicine also, evidence is being established through good scientific trials. The number of randomised trials of complementary medicine has approximately doubled every five years.
St. John's Wort has been found to be as effective as any allopathic tricyclic antidepressant but has fewer side effects. Twenty-seven drug trials have been published on this drug. Another drug, Sawpalmetto (Serenoa repens), has been found in 18 trials
to relieve symptoms of benign prostate hyperplasia. Acupuncture has been found to be effective for pain and nausea but not in helping smokers to quit. The British Medical Journal has published a report supporting the use of acupuncture for pain and
nausea. In the U.S., the NIH has issued a consensus statement supporting the use of hypnosis for pain related to cancer and the use of acupuncture for pain and nausea. Acupuncture, hypnosis and relaxation techniques have been included in guidelines on
the management of pain associated with cancer that have been published in the U.S. National Comprehen-sive Cancer Network.
Gingko biloba has been found to delay mental deterioration in Alzheimer's disease and is now being tried for prevention of dementia in elderly people. More and more clinical trials have been initiated in complementary medicine.
In Germany, a centre for research into complementary medicine has provided a series of important systemic reviews on complementary medicine. In the U.S., research units have been established in the University of Maryland, Columbia University in New
York, Harvard University in Massachusetts and Memorial Sloan-Kettering Cancer Centre in New York. All these centres are not any less renowned than the All India Institute of Medical Sciences (AIIMS). Regulations for the proper use of complementary
medicine have been prepared in these countries.
India has a rich heritage of indigenous systems of medicine. Ancient Hindu texts speak of many a medical marvel. Shusruta, for instance, is credited with having done brain and plastic surgeries 3,000 years ago. With such a background, we should not feel
shy of talking of the integration of Indian systems of medicine with the conventional system. The world is moving faster in this direction and we should not be left behind.
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