Fitness Mantra

STRESSED OUT: They have businesses to run, deadlines to meet and power-packed meetings to attend. Four career women straddled the sometimes uneven balance between their hectic work and an equally busy home life that left them with little time for themselves. But the need to not just look but also feel good about themselves saw them carving out some me-time.
Each had their own special fitness mantra. Like 31-year-old Avisha Goswamy who hits the road in her running shoes every day or 34-year-old Neha Lidder Ganju who turns to Pilates.

Follow a portable diet when hard-pressed for time “Spending long hours at work and neglecting meals is a sign of trouble. I munch on fruits and drink a lot of juice at regular intervals when I am travelling. It’s important to keep the body fuelled at all times,” says Goswami.Pick an exercise that works for you

TIP: It’s very easy to have a rum and coke or smoke to ease the stress. But following a regular regime instead is beneficial.“I am used to being on my toes 24X7 and being hyperactive is second nature to me. An exercise that gives an instant adrenaline rush keeps me going, whereas forms like yoga, personally don’t work for me, as opposed to others,” adds Goswami, who believes that one shouldn’t forcefully take up a regime. Passion for wellness should be the key.

Following a regulated diet and regime became inherent,” adds Ganju, who does Pilates and strength-building exercises at a gym, four times a week for two hours. “I don’t depend on a trainer. I pick up moves from different forms of exercise and add it my routine to make things interesting,” she adds. She isn’t one to hit the treadmill only after putting on weight, “I think strength and stamina are built over the years,”

Know your stress points “Everyone has different stress points like the lower back and shoulders. Don’t strain them to the level that they give away,” says Ganju, who concentrates on exercises like stretches, shoulder rotations to release the pressure.

Go the Arnold way “My husband and I treat Arnold Schwarzenegger’s book on body building like the Bible. It explains everything one needs to know about fitness. I pick out exercises that I find suitable for my body type and create a regime for myself,” says Ganju, who doesn’t believe in following a trainer blindly. “It’s imperative to understand the importance and focus of each exercise, and change is good to kill the monotony,” she adds.

Dieting is emotionally starving “Constantly stopping yourself from eating or mentally debating the kilo and calorie ratio will leave you exhausted. Rather than punishing yourself, eat everything in moderation,” says Ganju.TIP: Can’t get yourself to eat green vegetables all the time? Just pick up a carton of juice instead. It’s healthy and refreshing during summer.With two businesses to run, clients to meet and battling Delhi's traffic, Bhavna Jasra’s day is tightly packed. But despite the demands of her work, she chalks out time, thrice a week, to stay in shape. “I’ve always been on the slim side, but after my pregnancy, I put on seven kilos. I thought I’d lose the weight, but I got comfortable with it,” says the mother of six-yearold Tia. But it was while flipping through old photographs that Jasra decided she wanted to get back in shape. This was also the time when her business was getting off the ground and pressures were high. Jasra started going to the gym, but the monotony saw her switching first to swimming and later, Pilates. When the business began to franchise out of Mumbai, her stress levels hit a high and she decided to try Tai Chi. “Its holistic approach to well-being helped put my mind and body in sync and did wonders for my concentration,” she says. And it’s helped her go beyond just getting the right muscle tone to feeling good. She shares her tips on staying fit.Tuck into a big breakfast “A healthy breakfast that’s high on the nutrition count keeps energy levels running high,” says Jasra, who keeps it interesting with an omelette made of egg white, sprouts, cereal or a whole grain sandwich.Don’t deny a hunger pang, just keep it healthy “A fruit goes a long way in tackling a hunger pang and is low on the calorie count,” says Jasra, who carries fruit to work. She also warns against exercising on an empty stomach, suggesting a glass of juice or milk.Don’t do anything you’re forced to but not comfortable with “A sure fire way to feel let-down is on a diet that has you craving for that square of chocolate,” she says. Jasra allows herself the occasional indulgence, but keeps a mental track of what she’s eating without being obsessive.TIP: Take breaks from work for a long weekend or to spend time with the family. It’s the best way to rejuvenate and will reflect on your productivity.Nandini Sawhny has always been conscious of her weight. “I’ve been on the heavy side all my life and it’s made me keep tabs on the weighing scale,” she says. After her pregnancy, it became more of a challenge, when she put on 12 kg and was bordering on being overweight. Choosing yoga to shed the wobbly bits, she avoided the usual gym routines that she felt were hard on the knees and back. “I lost five inches and it’s also helped my sinusitis, allowing me to go off medication completely,” says Sawhny, who does yoga five times a week, for an hour every morning.She is also particular about what is cooked at home, additionally so because her father-in-law is a heart patient and her elder son is a few kilos too heavy. “I am a foodie but while I don’t obsess over what I eat, I know I have to work at staying a certain size and it helps me stay disciplined,” she says.Focus on the internal as much as surface good looks “Being able to cut off from everyday pressures and clear my head is more valuable than losing inches,” says Sawhny, who does a combination of breathing exercises and cardio to stay on her toes. And there’s the additional psychological boost of being able to fit into clothes she couldn’t earlier.Eat healthy and you don’t need to crash diet Sawhny doesn’t frequent dieticians or deny herself the odd cookie or ice cream. “I’ve swapped white rice for brown, rotis are made of bajra or jowar and fried foods are a treat for the children when we go the movies, but not lying around at home,” says the mother of Advaye, 10, and Arush, 8.

MAN HEALTH TIPS

Yet it’s obviously important that men of all ages become more proactive about their health. And an easy way to start is to follow these 10 basic steps to maintaining health and vitality.

1. Eliminate "White Foods" from Your Diet. White flour, white sugar and other processed foods are not only devoid of vitamins and minerals, but they’ve also been stripped of their natural fibre. As a result, they rapidly drive up blood sugar levels, which contributes to weight gain, diabetes and a host of other health problems. Avoid breads and baked goods made with white flour, sugar-laden sodas and snack foods. Instead, focus on eating fibre-rich fruits, vegetables, legumes and whole grains.

2. Stay Away from Dangerous Trans Fats. While it’s important to reduce your overall fat intake, it’s even more important to watch the types of fat you eat. Deep-fried foods and anything made with hydrogenated oils (margarine, peanut butter, shortening, store-bought pastries and cookies) contain trans fats that raise your risk of heart disease. Eat only healthful fats, such as olive oil and the omega-3 oils found in salmon and other cold-water fish, which actually protect against heart disease.

3. Take a Potent Daily Multivitamin and Mineral Supplement. Although there is no substitute for a good diet, I am convinced that for optimal nutrition, you need to take a high-potency multivitamin and mineral supplement. Even if you are eating right, it’s unlikely that your food contains all the nutrients you need. Poor soil quality, storage, processing and cooking deplete our food of vitamins and minerals. Taking a high quality daily supplement is "health insurance" against possible deficiencies.

4. Include Weight Training in Your Exercise Routine. Aerobic exercise is great for cardiovascular conditioning, but it’s vastly inferior to weight training in attacking the "flab factor." Recent research has shown that as little as once-weekly resistance exercise can improve muscle strength. Even the busiest or laziest among us can find the time and energy for that. Join a gym, consult a personal trainer or ask an experienced friend to show you the ropes.

5. Maintain Your Optimal Weight. Current statistics suggest that half of us are losing the battle of the bulge, but maintaining a healthy weight is one of the best things you can do for yourself. You’ll look better, feel better and reduce your risk of heart disease, diabetes, hypertension and other major killers. I know this is easier said than done, but if you just follow the four steps above, you’ll be well on your way.

6. Drink Alcohol Only in Moderation. You’ve probably heard of the "French Paradox," and that drinking wine protects against heart disease. Repeated studies have shown that drinking moderate amounts of alcohol (all kinds) protects not only against heart disease, but also lowers risk of death from all causes. Remember that moderation is key. While one to two drinks a day are protective, excess alcohol consumption is devastating to health. And for some, one drink is too many.

7. Protect Your Prostate. Around the age of 40, the prostate gland begins a growth spurt that results in symptoms such as frequent nighttime urination. The good news is that this condition, known as benign prostatic hyperplasia, can be prevented or reversed by taking extracts of two herbs: saw palmetto (Serenoa repens) and pygeum (Pygeum africanum). Dozens of studies have shown that these herbs work in improving urinary flow without adverse side-effects. Suggested doses are 160 to 320 milligrams of saw palmetto and 40 to 80 mg of pygeum daily.

8. Reduce Your Risk of Prostate Cancer. Experts estimate that 80 per cent of all cancers can be prevented by making healthy lifestyle choices. Avoid saturated and trans fats, which may fuel prostate cancer growth, and incorporate protective foods, such as soy, green tea and tomatoes, into your diet. Soy contains isoflavones with specific anti-cancer activity. Green tea is rich in polyphenols that inhibit the formation of cancer-causing compounds and block the growth of prostate cancer cells. And tomatoes, particularly cooked tomato products, are an excellent source of lycopene, which is linked to a reduced risk of prostate cancer. In addition, make sure your daily nutritional supplement contains high doses of the antioxidant selenium (200 micrograms) and vitamin E (800 IU), which have been shown to dramatically lower the risk of prostate cancer.

9. Maintain Vigorous Sexual Function. Most cases of erectile dysfunction (impotence) have a physical cause: You’re just not getting enough blood to the area in question. To improve overall circulation, follow the diet, exercise and supplement recommendations above. If you’re taking drugs, review them with your doctor, as many can worsen erectile function and impair libido. Smoking also significantly impairs erectile function. Several herbs have been shown to improve sexual function. Ginkgo biloba increases blood flow to the penis, and Panax ginseng, oats, horny goat weed, maca and seroctin improve libido.

10. Maintain Close Relationships. Another thing women seem to do better than men is maintain close relationships. Make a point to strengthen ties with your family and friends. Volunteer work, religious ties, even pets–anything that keeps you involved with others–reduces stress and enhances health. Take charge of your health by incorporating these 10 steps into your life. The rewards of optimal health and well-being will be well worth your efforts.

FOR WOMAN

When you are eating well and exercising daily, one of the last things you want to do is feel as though you are depriving yourself of some of your favorite treats. So, be sure to treat yourself. You may wish to have a small indulgence each day if you wish or a slice of cake as a reward once a week as an example. A small piece of chocolate has about 50 calories. If you choose dark chocolate, it is rich in flavonoids (just like red wine) and they are actually good for you! Cadbury has a 100 calorie thin chocolate bar that is also great. If you choose a once a week treat, then adjust your calories accordingly throughout the day and you should be just fine. Even if you eat more in one sitting such as at a restaurant on Saturday night, this can actually work to your benefit.

When your body is kept guessing each day on the amount of calories you are consuming, it actually tends to burn more fat over the course of the week.I know organic produce, dairy and meat is generally more expensive and harder to find in many cases, however the sooner you start budgeting for this, the better. There are a lot of toxins in our food chain that are making us progressively sicker as a society.

Do a little research and you'll see that this is indeed true. In addition, the moment you try some of the produce for example, you'll start to notice a real difference in quality. Standards vary, so be sure to read labels and become a more educated consumer. The whole foods industry is growing and we will soon see decreases in pricing as demand for these wonderful products increases.Eat berries and more berries. Berries are rich in antioxidants, high in fiber and low in calories. Foods that are rich in antioxidants are highly recommended.

According to Wikipedia.com: "an antioxidant is a molecule capable of slowing or preventing the oxidation of other molecules. Oxidation is a chemical reaction that transfers electrons from a substance to an oxidizing agent. Oxidation reactions can produce free radicals, which start chain reactions that damage cells". Free radicals can lead to cancer.

Try putting those berries in your oatmeal, and not only are you helping ward off cancer but you are also lowering your blood cholesterol levels too!Meditate for the sake of your heart and circulatory system, as well as your overall sense of well-being. Meditation in its simplest form involves closing your eyes and focusing on your breath. When a distraction enters your mind, you simply re-focus on your breath. After a few sessions, you'll find that you are able to go longer and longer without interference. The benefits of meditation have been documented over the past 25 years in leading research studies.

In a nutshell, meditation can: reduce stress, increase energy, increase creativity and intelligence, increase inner calm, promote a younger biological age, improve memory and learning ability, reduce anxiety and depression, reduce insomnia, and increase happiness and self-esteem.

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Baring the truth

It’s perhaps appropriate. In the age of universal meltdown, India seems to be a nation in heat. Take what just happened in Meerut.A young woman, Priyanka Singh a former beauty queen, well-spoken, smart, goes on camera to plead her case after being accused of killing her parents. She and her friend, Anju Singh, hint at a murky saga of sexual exploitation by their relatives and talk of being driven to the edge of a breakdown.Prise the lid off India’s gleaming globalised façade and a welter of images comes forth. There’s a woman in Mumbai chopping her boyfriend into pieces with her former lover.There’s a teenager mysteriously murdered in her Noida home amidst murmurs of her parents’ swinging sexual lifestyle. If social norms are changing, with the touchstones of modern life under siege, then sexual mores are in a state of confusion. What was considered a perversion earlier is a guiltless pleasure now. What was thought of a taboo is now believed to be an all access VIP pass.Even the terminology, loaded with the prudishness of the past, is being reinvented. Is adultery the same as infidelity? Does kinky sex just mean prolonged foreplay? The IT-AC Nielsen-ORG MARG sex survey 2008 of 5,353 men and women between 18 and 40, the sixth consecutive time we are studying the intimate life of urban Indians, seems to suggest all this and more.The seven deadly taboos, kinky sex, homosexuality, adultery, incest, underage sex, prostitution and pornography, are no longer regarded as out of bounds.Approval rates for everything considered censorious are high. Twenty-six per cent (more men at 43 per cent than women at 8 per cent) think sex outside a long-term relationship is acceptable, especially with those close at hand like friends and neighbours.Sixteen per cent are fine with homosexuality. Almost 20 per cent of the male respondents have had sex with prostitutes, some even sharing the experience, while 28 per cent of those surveyed have had sex before 20, a figure that social anthropologist Perveez Mody points out is comparable to the 37 per cent of Britons who lose their virginity before age 16.
Kinky sex is more than a blip on the urban Indian’s radar. Twenty per cent of adulterous couples (that is 1,037 of the total respondents) have tried swapping partners, 18 per cent of all respondents think trying new things in bed helps boost their sex life and anal, bisexual and sado-masochistic sex figure high in the score of sexual experiments they have checked out. Clearly, a bit of rough goes a long way. Much of these fanasties are being fed by the glamour and pornographic industries. Both men and women seem to share a taste for titillation, especially for home-grown and celebrity porn. Technology has freed their bodies, though their minds may still be trapped in a twisted moral universe.

There is a hint or more of repression, of aspirations outstripping actuality. According to our survey, 27 per cent of all the respondents had never had sex, and the percentage was expectedly higher for women (35 per cent) than for men (18 per cent).Does the survey show urban Indians speaking the language of love or of sheer desire, bottled for so many years by a socialist mentality? The fact that they are willing to even speak about their intimate lives is interesting as is the emerging female sexual self, who watches pornography as an extension of foreplay, who is testing the limits of alternative sexuality and who is willing to explore the possibility of paid sex. The urban man’s appetite remains as voracious as ever, no surprises there, even if the reality is often grim, with sex being bought.What is elevating though is that the urban Indian bedroom may not necessarily be an arena of combat between the sexes. Women may not want to confess to their deepest fantasies (a majority coyly says their greatest fantasy lover is their partner, not a celebrity) but as the silent shattering of other myths shows, what is between the sheets is no longer what lies beneath. Women are standing up for their pleasures, role-playing, even trying sex with eunuchs.

Fun, fearless and fierce. Will sex emerge as therapy for a modern society with its attendant anxieties? Will the good Indian girl and boy, restricted as they by society in their choice of monogamous partner, have greater latitude with their sleeping partner? As the silent pushing of the sexual envelop shows, the missionary position stands, but just about.

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Rethinking Medical Ethics

In 2001, an article in 'Commentary' magazine asked, "Who Needs Medical Ethics?" Surely, argued authors Christine Rosen and Sally Satel, the Hippocratic Oath (Do No Harm) offered sufficient guidance to physicians and other health care providers. Weren't philosophers and bio-ethicists merely trying to develop a specialty in order to stay employed?Certainly, ethical dilemmas within medicine have presented themselves frequently. Among the most notable is the US government's 40-year study wherein hundreds of poor, black syphilis-infected sharecroppers in Alabama were left untreated to see what would happen to them. More recently, when doctors in Florida kept Terry Schiavo, 41, alive on a respirator longer than some members of her family wanted, it raised ethical questions that were followed avidly by the general public. But, wrote Rosen and Satel, "It is not at all clear what sort of specialised abilities or knowledge these trained 'experts' bring to the hospital bedside." Now, new knowledge and newly-proposed interventions arising from an increase in sexually transmitted diseases (STDs) - including HIV/AIDS -
are fostering an unprecedented environment in which to contemplate medical ethics.

One proposed action in the US is mandatory vaccination for pre-pubescent girls and young women, not yet sexually active, against the Human-Papilloma Virus (HPV) that is known to be associated with cervical cancer. Another is the wider, if not mandatory, male circumcision, a practice associated with dramatically lower rates of HIV/AIDS in African studies. Opt-out testing for HIV/AIDS - automatic testing unless
patients state explicitly they don't want it - is yet another intervention being debated.

In the past, human rights advocates and staunch defenders of individual autonomy have argued vociferously against such practices. Ethicists have argued specifically against the circumcision of male infants, claiming it constitutes a human rights violation as well as sexual assault (see 'The Bioethics of the Circumcision of Male Children', www.cirp.org/library/ethics).

Those who take a rights-based approach towards opt-out testing caution against the current push by national and international agencies to have as many people tested for HIV as possible. A statement compiled by a consortium of women's health organizations and issued during the International Conference on HIV/AIDS in 2006 states that knowing one's HIV status can have benefits, but goes on to say that "what concerns those who question the speed with which testing initiatives are being expanded is whether this public health measure will be based on respect for individual human rights." The authors cite concerns about the shortage of health care workers, lack of informed consent, and breeches of
confidentiality. Examined from a gender perspective, "testing services often do not address the stigma, discrimination and related violence, and loss of livelihood that many women face if their status becomes known. This makes seeking treatment and care a devastating prospect for many."

Ethicist Margaret McLean, Assistant Director of the Markkula Center for Applied Ethics at Santa Clara University in California, recognises that the field of medical ethics has grown increasingly "messy". The overall role and responsibility of ethicists, she says, is to look at what's at stake and for whom, to explore what values inform policy or action, and to think of what principles may apply. "We have a large plate when it comes to what questions to raise," she says. "Our job is to have a conversation that facilitates responsible decisions and actions."

Dr Larry McCullough, professor of medicine and medical ethics at Baylor College of Medicine in Houston, Texas, and a specialist in the history of medical ethics, takes a somewhat more pragmatic view. "Human rights are not a trump card," he says. "The question is what do we owe each other? We must frame the discussion around obligation, conviction, and constrained rights and then learn to live peacefully with our differences. Ultimately, it is a discourse of moral conviction. But we must keep in mind our duty to others."

McLean agrees that the common good must be well considered. Community needs, she says, can outweigh individual rights. "Human rights protect individuals, but how does that translate to collective cultures? It's a helpful lesson for those of us stuck on autonomy to realise that relationships and community also matter ethically," she says.

Levels of responsibility also change with new knowledge - a particularly sticky point when it comes to intervening within the context of industrialised countries making decisions that will affect people in the so-called Third World. McCullough poses this relevant question: "What are the obligations of immensely wealthy societies?" He points out that the US has the moral and financial resources to address massive public health threats like HIV/AIDS but the political will is lacking.

But the issue becomes even more difficult when one moves beyond such interventions as providing affordable antiretroviral therapy (ART). What happens, for example, if opt-out testing for HIV/AIDS is instituted but there is no counselling or medical service to provide follow-up care? What is our moral responsibility to girls in developing countries who can't access the HPV vaccine but who will never be tested for cervical cancer? "Do no harm is a multicultural concept," says Larry McCullough, "but how do we interpret that in terms of public policy? We must translate trans-cultural moral principles into practice."

That's a pretty tall order. Perhaps in this increasingly complex world, it's time to take another look at who needs medical ethics.

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Shape Up for Your Beauty Sleep

Meeta Vohra's loud snoring had become the butt of family jokes lately. Her kids would imitate the 'funny sounds' mom made while sleeping and then double up with laughter. Initially, even Vohra, 43, would join in the fun, but gradually - when tiredness and grogginess started interfering with the schoolteacher's daily routine - the joke stopped being funny. And Vohra decided to see her physician about it.The physician's diagnosis was disconcerting - Vohra was suffering from obstructive sleep apnea (OSA). Elaborates Dr K.K. Handa, ENT specialist at the All India Institute of Medical Sciences (AIIMS), New Delhi, "It is a common sleeping disorder in which one has one or more pauses in breathing or has shallow breathing during sleep. The pauses can last from a few seconds to a few minutes. They often occur five to 30 times or more in an hour. Typically, normal breathing then starts again, sometimes with a loud snort or sputtering sound." This occurs due to an obstruction or narrowing of the airway in the nose, mouth or throat and can lead to an increased risk of diabetes, high blood pressure, heart attack, stroke and even obesity. According to the International Diabetes Foundation (IDF), which had convened a summit of renowned specialists in Sydney, Australia, last year, sleep apnea - earlier thought to be largely a disease of men - is increasingly afflicting women. Though no official figures were released, the consensus among the participants was that apnea could severely impact human health climaxing in Type 2 diabetes along with a host of other ailments.

This is reiterated by doctors back home who say that more and more Indian women, especially in the 30 to 60 years age bracket, are succumbing to sleep apnea. "I'd say about 10 per cent of Indians would be suffering from sleep apnea, half of which would be women," elaborates Dr Ajay Rastogi, Senior Consultant, Fortis Hospital, New Delhi, who has been counselling scores of patients with sleep disorders lately. Even young girls and boys, says the doctor, are being diagnosed. The condition is found frequently in people who tend to snore or those who are overweight.

Unfortunately, sleep apnea often goes undiagnosed, as it is difficult for doctors to pin down the condition during routine investigation. Moreover, there are no prescribed tests for the condition. Even people who suffer from sleep apnea don't know they have it because it only occurs during sleep. A family member is usually the first to notice the signs of the chronic condition. "I come across many patients who are referred to us by other doctors through a two-three tier process, as physicians often find it tough to detect sleep apnea," says Dr A.S. Srivastav, a Delhi-based ENT specialist.

Dr Rastogi though has a pointer that family members can keep in mind. "If the breathing stops for more than 10 seconds around five times in an hour, it is a case of OSA."For women, especially, sleep apnea can have disastrous consequences. According to Dr Michael S. Nolledo, M.D., University of Medicine and Dentistry of New Jersey at Princeton, USA, sleep apnea raises a woman's risk for gestational diabetes by twofold and pregnancy-induced hypertension four times. Such women may, however, need treatment only during pregnancy, he feels, as apnea during pregnancy usually crops up because of nasal congestion or rhinitis induced by hormonal changes or weight gain.Studies reveal that undiagnosed sleep apnea may also affect women's sexual function by reducing sexual desire, sensation and lubrication, negatively impacting their relationship with their partner. In a study published in the 'Journal of Sexual Medicine' in 2005, researchers evaluated the sexual function of 25 pre- menopausal married women - average age being 48 years - diagnosed with OSA at a university sleep centre in Turkey. The results showed that as the severity of sleep apnea increased, sexual function scores decreased among the women.Snoring among children does not necessarily signify sleep apnea but could be due to enlarged tonsils or adenoids. However, in children, sleep apnea needs to be cured as it leads to mental distress, low school performance, irritability and hyperactivity.

Doctors say that OSA becomes common with advancing age. At least one out of 10 people over the age of 65 has this condition and women are particularly at risk after menopause. Sleep apnea is also genetic. People who have small airways in their noses, throats, or mouths also are more likely to develop the condition.

Currently, there are no medicines or drugs to treat sleep apnea. For mild sleep apnea, doctors recommend lifestyle modifications like avoiding alcohol and shunning sleeping pills, which make it harder for the throat to stay open while one sleeps. Knocking off excess weight also goes a long way in fobbing off this
ailment.In acute cases, however, patients have to wear 'Continuous Positive Airway Pressure' (CPAP) masks over the nose during sleep. This mask delivers air into the airways creating enough pressure during inhalation to keep the airways open. Some people may also benefit from surgery, which is done to widen breathing passages. It usually involves removing, shrinking, or stiffening excess tissue in the mouth and throat or resetting the lower jaw.In some countries, sleep apnea patients are often referred to sleep clinics, which can treat such conditions better. In France, for instance, doctors have been studying sleep disorders seriously since the Sixties. The United States and Australia, too, are very sleep-disorder savvy. However, India woke up to its first sleep clinic at AIIMS as late as 1985. Now, of course, more sleep centres have been set up in cities such as Bangalore, Kolkata, Mumbai, Chennai and Coimbatore."The idea," sums up Dr Srivastav, "should be to create public awareness about this seemingly innocuous ailment, which can have life-threatening consequences. The more informed people get about this ailment, the better it will be treated and it's damage contained."

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Foot Asleep? Wake up to Diabetes!

If your foot often falls asleep and there are cuts or bruises on them that cause no sensation, brace yourself - it may be a case of diabetic foot. With World Diabetes Day falling on Friday, experts have a word of advice. Leading a life of discipline and being cautious with one's feet is the key to living with diabetes and dealing with the potential risk of gangrenous infection is simple, they say."Diabetic patients are often lazy about basic instructions - following a disciplined routine of taking medicines and regular exercises as prescribed. These are essential to keeping the circulation of blood and sugar levels in check," said Ashok Jhingan, diabetologist and chairman, Delhi Diabetes Research Centre, Diabetes is a growing problem on the Indian subcontinent and in the Middle East.

According to the International Diabetes Federation (IDF), there were an estimated 40 million people with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by 2025.

"When a normal person wakes up in the morning, he goes to the mirror to look at his face. But a diabetic needs to look at his feet with the same care," Jhingan said.

This is because the symptoms and signs of a diabetic foot include numbness or tingling in the feet, persistent sensation of cold feet, ulcerations on the foot or the toes.

"One must also be wary of small cuts or burns that can develop into gangrene or deformities on the toes and the foot," Jhingan explained.

A recent study compiled by Kushagra Katariya, CEO Artemis Health Sciences and cardio thoracic surgeon, ahead of World Diabetes Day on Nov 14, found that approximately 5 percent of diabetics develop foot ulcers and 12 percent develop poor leg and foot circulation and every 30 seconds a lower limb is lost to diabetes.

"Unfortunately as a result of these problems, a diabetic is 15 times more likely to have an amputation of the leg than a non-diabetic," Katariya said.

Diabetic foot problems can occur at any age and after any amount of time following someone being diagnosed as a diabetic.

"However, most patients with diabetic foot problems are older, as circulation gets poor with advancing age," he added.

It is important for diabetics to get their feet regularly checked by a healthcare professional that specializes in this field, feel doctors.

"If there is a small infection, it can be controlled before it develops into a gangrene-like threat - the dead skin can be scraped, aspirin like drugs for speeding circulation to wounded areas can be prescribed, but first the diabetic must check his feet and be careful," Jhingan observed.In some cases, the blood circulation in diabetes patients is so bad that it can cause vascular blockages. These can be removed surgically but also through an angioplasty or laser."The doctor may order simple tests such as a vascular ultrasound to check the circulation in the legs. More advanced tests may include a CT-Angio or an MRA to look at the vascular supply," said Katariya.Many diabetic foot problems can be nipped in the bud by raising patient awareness to potential problems - watch your weight, keep blood sugar levels in control and get regular checkups."Diabetics should always buy footwear in the evenings," Jhingan quipped, "not in the mornings as poor blood circulation causes the foot to swell in evenings - the shoes should not be tight or smaller. Comfortable soft soled footwear should be worn."In winters, the diabetic foot is often likely to be regarded as a chill bite."In which case the patient should be doubly cautious - keep warm but avoid prolonged exposure to hot water - this can cause bacterial infections and non-healing ulcers in diabetic patients, as their wounds take longer to heal. Due to loss of sensation in their feet, diabetics often don't come to know about such injury early enough," Jhingan averred.In India almost 40,000 legs are amputated every year due to diabetes alone."Due to a gradual decrease in vision, diabetic patients tend to wound themselves. And due to a simultaneous loss of sensation in the feet, they do not feel the pain and hence the wound is ignored, causing prolonged infection - the limb then has to be amputated," Jhingan said.

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This Children's Day create diabetes awareness

EVERY YEAR November 14, the birthday of independent India’s first prime minister, Pandit Jawaharlal Nehru is celebrated in India as Children’s Day. But this particular day is recognised globally as World Diabetes Day. One of the most dreadful diseases of the world, diabetes is known as a silent killer, that comes silently, grows gradually and finally, kills. This is not the time for Indians to delve into the revelry of Children’s Day. Better, parents and teachers should guide their children regarding diabetes, the reasons behind this disease and the proper remedies. Presently, India has been labelled as the ‘Diabetes Capital’ of the world, as more than eight per cent of its population ie 41 million people are suffering from diabetes. The more frightening is that over 50 per cent of Indian people have diabetes, but they are completely unaware of their condition. Diabetes is referred as the breeding zone of several other diseases like - blindness, kidney failure, nerve disorders, limb amputations and cardiovascular diseases, which grow rapidly if diabetes is not diagnosed properly on time. Eventually, people have to spend thousands of rupees to get cured from these serious physical problems as all of these arise from undiagnosed or poorly treated diabetes.At least 80 per cent of global population are not aware whether they have diabetes or not. In 2007, diabetes caused 3.8 million deaths globally. Record says that a person dies of a diabetes-related disease every ten seconds throughout the world. According to the report of the World Health Organisation (WHO), diabetes is the fourth leading dreadful disease in the world, that takes away numerous lives every year.The growing problem of obesity among urban-children is one of the prime reasons behind this auto immune disorder. Every year, a number of people as well as children in India die of diabetes due to lack of knowledge. Generally, diabetes in a child is often overlooked. Sometimes, it is also misdiagnosed as a common flu.
According to the medical experts, diabetes is considered as one of the most common chronic diseases which affects children. Children, irrespective of any age, even toddlers and babies can be a prey of this deadly disease. Diabetes can to be more fatal if is is not detected early in a child which may result in serious brain damage. Diabetes has two variations. While Type 1 or insulin-dependent diabetes is a clearly localised genetic defect. It is a kind of disorder which damages the insulin-secreting cells of the pancreas, thereby, making the individual incapable of secreting enough insulin to maintain blood sugars at normal levels. Type 2 diabetes is a strongly inherited one. In this case, the defect is not localised. But it has been proven that obese children of diabetic parents develop diabetes after 10 years of age. Diabetes is also caused by different environmental factors and lack of physical exercises. Generally, Type 2 diabetes can be cured by a dose of metformin and insulin shots or oral drugs. But Type 1 diabetes can only be treated with insulin shots. Diabetes occurs when the production and supply of the hormone insulin gets reduced in our body. Insulin helps us to use the energy stored in food. In Type 1 diabetes, the sufferers produce insufficient insulin. But the patients of the Type 2 diabetes cannot use the generated insulin effectively. According to the experts, Type 1 diabetes is an auto-immune disease and cannot be prevented. It is the most common form of diabetes in children. At least five lakh children under the age of fifteen, are suffering from Type 1 diabetes throughout the world. The Type 2 diabetes has also been found in staggering numbers among the obese children due to the trend of sedentary lifestyle. Most of the child specialists accuse the changing lifestyle with less physical activity as the main reason which causes Type 2 diabetes in children. The number of Type 2 diabetic children is alarmingly high in India. Lack of physical exercise prevents the children in developing insulin. Environmental factors and genetic predisposition are the secondary reasons behind this disease.
Most of the children in urban society prefer to spend their free hours in observing cartoon channels or playing computer games. Instead of playing in the field, which would certainly develop their physical and mental strength, the urban children sit idle in front of TV and play computer games. In most cases, parents also prefer to keep their children busy in indoor games. Not surprisingly, the children in rural areas are less affected by Type 2 diabetes due to their active lifestyle. Time has come to rise from slumber and make ourselves aware of diabetes. The World Diabetes Day campaign in 2008 aims to raise awareness of this deadly disease, encourage initiatives to reduce diabetic ketoacidosis and distribute materials to support these initiatives

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AIDS will spread like ‘bushfire’ in India: UN

HIV/AIDS infections will spread like ‘bushfire’ in parts of India if the country fails to check a spike in the number of intravenous drug users, the United Nations AIDS agency said on Thursday. India has the world's third highest caseload with 2.5 million infections. It has an estimated 200,000 intravenous drug users, many of whom are in the remote northeast region which borders the opium-producing Golden Triangle of Myanmar, Thailand and Laos. "If we don't prevent new infections in new emerging populations like injecting drug users, it can go up as bushfires. We may see a major surge in infections," Peter Piot, the Executive Director of UNAIDS, said. He also raised concerns about the spread of drugs in India. "Drug use is moving a bit everywhere, we can see it in Bihar, UP and in Kashmir, it is kind of moving across the northern part of the country," Peter Piot, head of UNAIDS said. "I was really shocked to hear what was going on." Official figures show that more than 10 per cent of intravenous drug users in India are infected with HIV, a higher prevalence than among prostitutes. The country's overall HIV/AIDS prevalence rate is about 0.9 per cent for those aged between 15 and 49.

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Shining protein

THREE scientists, one Japanese and two American, share this year’s Nobel Prize in Chemistry “for the discovery and development of the green fluorescent protein, GFP”. They are Osamu Shimomura, 80, of the Marine Biological Laboratory, Woods Hole in Massachusetts, and Boston University Medical School; Martin Chalfie, 61, of Columbia University, New York; and Roger Y. Tsien, 56, of the University of California, San Diego. Luminescence and fluorescence refer to light emission from cold bodies. The former results from chemical reactions or subatomic motions or stress on a crystal. In particular, it is referred to as bioluminescence when the luminescence occurs in living organisms, say a firefly, owing to chemical reactions within some part of the organism. Another bioluminescent organism is the jellyfish Aequorea victoria whose outer edge glows green when the jellyfish is agitated. Fluorescence is luminescence caused by external light stimuli as an optical phenomenon in which molecular absorption of a photon triggers the emission of another photon, usually of a longer wavelength. In 1955, Osamu Shimomura, after having been devastated by the War and the atomic bombing of Nagasaki where he lived, was employed as an assistant by a professor at Nagoya University. He was given the task of finding out what made the remains of a crushed mollusc, Cypridina, glow when it was moistened with water. This was a problem considered to be difficult even for professional researchers and, apparently, the professor not wishing to spoil the career of a research student over such a problem, put Shimomura on this task. However, in 1956, to the professor’s surprise, Shimomura isolated the glowing material. It was a protein that glowed 37,000 times more brightly than the crushed mollusc. This earned him a valuable gift of a Ph.D. from his professor even though he was not enrolled as a doctoral student. Armed with his results and the doctorate, he joined Princeton University under Frank Johnson, with whom he set about studying another bioluminescent organism, the jellyfish.During the whole of the summer of 1961, Shimomura and Johnson gathered jellyfish at Friday Harbour, Washington. They chopped off the edges of the jellyfish and pressed them through a filter to get what they called a squeezate. Serendipitously, on one occasion, when Shimomura poured some of the squeezate into the sink, he saw a bright blue flash, not green as in the jellyfish. He reckoned that the sea water in the sink, which contained calcium ions, caused the squeezate to luminesce. Johnson and Shimomura collected squeezate from about 10,000 jellyfish and took it to Princeton. It took them a few months to purify just a few milligrams of the blue luminescent material from the liquid. They named this protein aequorin. “There were many difficulties and troubles. But… somehow I found how to extract the protein,” Shimomura says in the post-award interview with the Nobel Foundation’s website. “And after finding that, what we needed to do to study that protein was to get large amounts of that protein. So, we collected huge numbers of jellyfish by going to Friday Harbour every summer, with a schedule of 50,000 per summer, in one or two months,” he adds. They did this apparently for 19 summers and accumulated a total of 850,000 jellyfish. In 1962, when Shimomura and Johnson published their isolation of aequorin, they mentioned that they had also isolated another protein, which was slightly greenish in sunlight, yellowish in the light from an incandescent bulb and green in ultraviolet light. This was a fluorescent protein (as against the luminescent aequorin), which they called the “green protein”, but later it came to be called green fluorescent protein (GFP).

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Young brain at work

With Children’s Day round the corner, SDP decided to get the young minds on board and give them an opportunity to decide on what they want to read. For this, SDP got in touch with some of the reputed schools of the city and short listed some students from these schools. For a day, the students donned the thinking cap and formed a Shadow Editorial Board for SDP. They sat together and brainstormed for hours to decide the content of this SDP’s Children’s Day Special Issue. Smug in the editor’s chair, they conceptualised and executed the entire issue. The result is for all to read. Here’s wishing all kids out there a Happy Children’s Day! Here’s a special issue of the children, by the children and for the children
They are young but not restless. They have ideas that make sense. They are the future of the country, to lead from the front. With Children’s Day round the corner, it made perfect sense to have a bunch of youngsters from different South Delhi schools to voice their opinions in their own way. Working as a Shadow Editorial Board (SEB), these young minds came together, brainstormed and managed to bring out this issue, entirely on their own. In their interaction with the SDP edit team, these young adults showed no inhibition in expressing their thoughts. For our Children’s Day Special issue, they focussed on the life and times of South Delhi. Bad roads and crumbling infrastructure of the city are a sore point for one and all, even for Standard 11 student Mayumi Mohan of Ryan International School, Vasant Kunj who wondered how Delhi can be ready to host Commonwealth Games if it continues to fight problems galore. But when there are problems, there are solutions too. In an effort to help the city come out of those problems, she has suggested solutions as well. While the crumbling infrastructure troubled Mayumi, Yusuf Hassan of Summer Fields School, Kailash Colony thought of something out-of-the-box and wondered what hilarious things would happen if the scientific theories can be applied to everyday life. On one hand there was 10-year-old Shyon Chowdhury of The Shri Ram School, the youngest of the lot who asserted that young people of his age know how to handle things and that adults need not be such control freaks. On the other there was Mayank Vashisht of DPS, RK Puram, who wanted to tell people to be happy with what they have instead of cribbing about what they don’t have. As SEB’s choice, the lead story focuses on the choices that kids today have when it comes to reading books. In other words, this Children’s Day Special issue is of the children, by the children and for the children. Hope you enjoy reading it as much as our SEB loved bringing it to you.

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31-23-32 Equals a Big Zero

Many a time young Indians have been influenced by the unreasonable lifestyle, food habits and crazy fads of the West. The latest to hit them is the size zero body. Boosting the cravings of this group of women, aged between 15 and 35 years, are leading Hindi cinema actresses, Kareena Kapoor and Aishwarya Rai, and, of course, fashion designers who prefer to showcase creations on size-zero models. It all started with Aishwarya Rai - whose net popularity skyrocketed with her marriage into the Bachchan family - dropping oodles of weight for the blockbuster, 'Dhoom II'. However, even as posters of her sculpted body created a buzz in the media, they never really kicked off a weight loss trend. After all, Rai - a former Miss World - was meant to have the unattainable perfect figure. But with the hitherto healthy Punjabi 'kudi' (girl) Kareena Kapoor - whose cinematic 'khaandan' (family) is known to relish non-vegetarian fare - shedding those extra pounds to gain long beanpole legs, hollow cheeks and a concave-shaped tummy (displayed ever so blatantly in her latest flick 'Tashan') - size zero has finally arrived. Kapoor's apparent size zero bod - reportedly a result of a sustained diet of cabbage and apples - has definitely catapulted her to dizzying heights. Suddenly the media, college-going youngsters and even middle-aged moms are discussing Kapoor and her latest weight drop, with dreams of attaining the proportionate nothingness! So what is size zero? It's a women's clothing size according to the US catalogue sizes system that is the equivalent of an UK size 4 or an Europe size 32-34. It is also a concept within the fashion media relating to models with low body mass.Thus, being a size zero means having a 31.5 "(bust) - 23" (waist) - 32" (hip), or simply being able to fit into a pair of 22-inch waistline jeans. To look like their favorite star, young women are willing to go to any extent - dangerous crash diets, strenuous exercise routines and starvation - so much so that many end up as classic cases of eating disorders like anorexia nervosa and bulimia. Anorexia nervosa is characterized by low body weight and body image distortion with an obsessive fear of gaining weight. A recurrent binge eating, followed by compensatory behavior, referred to as "purging", like self-induced vomiting, the use of laxatives, diuretics, and so on, characterizes bulimia."These girls and even boys don't realize the irreparable damage this causes to their bodies, especially the bone mass," says a very worried Dr D. Srinivas, a well-known orthopedic surgeon and consultant, attached to InLak and Shushruti Hospitals in Mumbai. Srinivas is concerned, as the number of patients coming to him with complaints of bone affiliated ailments has risen considerably, with most belonging to the vulnerable age group of 15 to 35 years. He explains that after the age of 17 for young women and 18 for men, the body stops growing physically. It then starts accumulating bone mass till around the age of 30-35 years. It is this mass that acts as a protection from osteoporosis and other bone-related ailments later in life. Reckless lifestyles and thoughtless diet choices hinder this body function. "Bone mass is like a huge bank balance, which if not accumulated properly can cause havoc at a later age," he cautions.Mumbai-based Neesha Maria Bukht, a registered dietician and an International Sports Sciences Association (ISSA) fitness expert, agrees. She says that there are dubious dieticians who promise to help youngsters reduce weight within a few days or weeks. "The unknowing clients are not told about the dangerous effects a severe diet will have on the bone mass or density of the body," reveals Bukht, who heads the Talwalkars Training Academy which provides cutting-edge programming and educational information to aspiring fitness professionals. The hurried measures taken to achieve the coveted weight can lead to other serious problems. Hair loses its sheen and the skin, its elasticity. Stamina is depleted and this leads in turn to mood swings. In severe cases, depression sets in. Irregular menstrual cycles resulting in temporary ovulation problems and, of course, osteoporosis are the more serious consequences. "Drastic weight loss may not cause permanent damage but temporarily the ovulation will be affected. The reproductive system has the capacity to regain its normal functioning. But it all depends on the age of the woman, the extent to which the body has been damaged and how healthy the other organs are," says Dr Partho Guha Roy, a consulting gynecologist. Mumbai-based fashion designer Anita Dongre admits, "Designers do create collections that are worn by thin models at fashion shows and shoots, because that adds to the look of the creation." But she is quick to add, "That does not mean that we are encouraging young girls to be the same size." She acknowledges that the fashion industry wields great influence over youngsters and often shapes the way young women feel about themselves. "Teenage girls aspire to look like their role models. If their role models are healthy it will help inspire girls to be the same. But it is also true that all thin women aren't unhealthy. Designers prefer thin models with glowing skin and lovely hair, which is not possible to get if one tries dangerous methods of losing weight," says Dongre. Losing weight slowly by maintaining correct BMI (Body Mass Index) doesn't affect health. "Diet and exercise should be controlled in such a way that only 0.5 to two kilograms is lost per month. Not more. And at all times the minimum BMI should be monitored. A BMI of less than 18.5 is not good," warns Bukht. "It is important to educate young girls who, under the thrall of fashion, either starve or force themselves to throw up, to follow a healthy lifestyle. Dieting is not bad, but starving takes a sure toll on the body. I think it is awful the way women and young girls are slotted by society because of their weight. There are more important things to worry about than one's body weight," says Dongre. "And the worst part is that youngsters who come to me with bone related complaints don't realize the root cause of their ailments is their obsession with losing weight. They refuse to believe that they are suffering from osteoporosis and need to eat properly," reveals Srinivas. Bukht admits that Kareena Kapoor, who reportedly weighs only 48 kilos, as against her ideal minimum weight of 55 kilos, may start developing problems. "And the side effects of achieving size zero within a short period of time are universal. One has to understand that there is no magic pill to lose weight. It has to be done in a controlled way," she says

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An extraordinary surgical success

Chronicling the complicated medical journey of an Indian girl born with eights limbs is a new programme on Discovery Channel that goes on the air this Saturday. “The Girl with Eight Limbs” focuses on this little girl who was born in a nondescript village in Bihar. Her neighbours believed that she was an incarnation of Goddess Lakshmi.Poonam gave birth to the girl without any form of medical supervision or antenatal care. From the day Lakshmi was born, she invoked tremendous curiosity in the village. Hordes of people began turning up from the neighbourhood to see her. The show focuses on her parents’ dilemma, public reactions and the global media attention.
Doctors concluded that Lakshmi carried a parasitic conjoined twin -- a rare anomaly that could kill her if not acted upon. She was actually two bodies united at the pelvis. Only one of the twins had a head. Two pairs of arms and legs had formed at either end of the two adjoining torsos, creating a child with eight limbs.
Her parents, Shambhu and Poonam, were in a dilemma: to accept the surgery to remove her extra limbs or to leave her as she was? Sparsh Hospital’s chairman and chief orthopaedic surgeon Sharan Patil, who conducted the surgery, says Lakshmi’s story was special for more than one reason. “The girl was deprived of good medical care. The condition she was born with was not compatible with survival. A successful surgical separation with such a medical condition was never attempted before in India.” After conducting a series of tests in Bangalore, Dr. Patil assisted by a team of doctors performed a prolonged surgery to separate Lakshmi from her conjoined parasitic twin. The show captures the complications that took place during the surgery as Lakshmi’s extra limbs belonged to a half formed conjoined twin with no head. She had a heart, lungs and liver, but only one kidney. Prior to the surgery, Lakshmi was unable to walk or crawl and had little chance of living past adolescence. Now she can stand up with help and is expected to be able to walk and lead a normal life.

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Flower Power

Treatment in which the energy surrounding beautiful flowers helps to heal instead of bitter pills... can it actually happen? can hopes be pinned on a complementary medicine like flower therapy? it is not without reason that flowers are used to convey the message ‘get well soon’. so believe dr atul shah and dr rupa shah, physicians and directors of the mumbai-based complementary medicine research centre. the allopathic doctors were looking for something that was more integrative in approach. and that is when nature’s blossoms caught their attention. dr atul, an md, has worked as a radiologist in new york’s salon kettering and his wife is an mbbs who got interested in alternative medicine. together they have opened the centre, after walking the jungles of gujarat, rajasthan, maharashtra and the himalayas for research. they have been exporting their flower remedies abroad and recently opened a franchise with nirmala tyagi in pune. atul says, “working as a radiologist was akin to being a playback singer! it was very dry and uninteractive. i wanted to understand my patients.” the couple talk to their patients, understand their behaviour pattern, preferences, attitudes, problems and then give their flower solution. they assert that these remedies can treat anxiety, depression, fear, stress, bed-wetting, thumbsucking, fatigue, memory problems, acidity, cold, cough, acne, menopause, sun stroke... you name it. the basis of their flower healing method is that every flower has its own distinct energy level which can do wonders for the human mind and body. “flower essences can cure emotional imbalances and soothe deeply embedded emotional disturbances,” says rupa. they were inspired by the bach flower remedies. “but unlike the bach remedies, we do not cut the flower from the parent plant. we have devised an apparatus through which the flower is immersed in water for two hours and then the energised water is collected in a beaker. for flowers like raatrani and rajnigandha, the process is done in moonlight and for flowers like sunflower - sunlight is important,” explains rupa. the water is called floral water and sometimes a preservative like vinegar or brandy is added. to prepare a remedy, mantras are chanted and special prayers offered to the flowering plant. the remedy is taken orally, three drops thrice a day depending on the severity. it can take anything between hours to months to heal a person. a 125 ml bottle that lasts for a month costs rs 100 to 150. amongst the cases that they claim to have cured are a 23-year-old girl who suffered from myasthenia gravis. she showed improvement after flower therapy and later even had a normal delivery. then there was a 30-year-old lady with hyperthyroid who was on thyroid hormone for nine years. she had symptoms like fatigue and anxiety. “she realised that she could express herself better with the treatment. her blood reports later showed normal thyroid levels,” says dr atul. a 13-year-old girl with rheumatoid arthritis and depression responded very well too, negating the rheumatoid factor in her blood. then there’s tyagi, who says, “my son had met with a serious accident last year and had lost self-confidence. with the flower therapy he has been able to overcome the shock, grief and lack of confidence.” what are the essences used? well, tulip tree flower essence is used to treat day dreaming, morning glory deters one from smoking, whereas chicory treats love pangs and grief which affects the heart chakra. peepal, coconut palm, neem, sandalwood, eucalyptus, lotus, jasmine, rose and hena are those primarily used. the couple has also had some success with helping cancer and hiv cases.

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'Boosting' women's egg trade

An Australian researcher says demand for eggs for stem-cell research will put vulnerable women at increased pressure to sell their ova to unscrupulous dealers. The University of Sydney's Associate Professor Catherine Waldby says the problem is most likely to affect women in poorly regulated countries who already supply eggs to rich nations for IVF programs and whose health can suffer as a result."There have been various serious medical problems develop in women involved in selling eggs," she said. Assoc Prof Waldby's findings will be published in the New Genetics and Society journal. The life sciences sociologist says she is concerned about the effect of stem-cell research on an already stretched global supply of women's eggs. She is worried about the implication of obtaining eggs for therapeutic cloning, which are already in short supply because of the popularity of IVF.
Therapeutic cloning involves removing the nucleus from an egg and replacing it with one from a non-reproductive cell, of a patient for example, to produce an embryo for stem-cell research.Assoc Prof Waldby says the onerous nature of procuring eggs means that donation is rare in countries like Australia, where women are not permitted to sell their eggs on the open market, and demand is outstripping supply.
Egg brokers But the sociologist says growth in IVF, together with cheap air travel, has led to the development of clinics that trade eggs beyond the borders of national regulation, often selling eggs from poor nations to rich ones. "They actually function as brokers between people in countries where they can't get ova and where it's very regulated, and countries where it's not," she says. Assoc Prof Waldby says trafficking of ova from women has grown in eastern Europe in recent years. She says one Romanian clinic has bought eggs from very poor women. "The clinic was paying them about $US200 a procedure, which is about two months' salary for these women," she said. Assoc Prof Waldby says one study found some women were repeatedly selling their eggs to pay for rent, clothes and even cigarettes. UK authorities banned the purchase of eggs from the clinic in 2004.
The sociologist says there were concerns the clinic was not telling women about the risks involved, or looking after them when things went wrong.
Sickness Removing eggs involves multiple hormone injections and a surgical procedure.
Assoc Prof Waldby says some of the Romanian women developed ovarian hyperstimulation syndrome, which involves painful abdominal inflammation, possible renal failure, infertility and cardiovascular problems.
She says there are a lot of countries where this could be a problem. "Both China and India have large, impoverished populations, extensive networks of fertility clinics and burgeoning stem-cell industries, setting the scene for exploitative forms of oocyte procurement," she said. US egg marketAssoc Prof Waldby says that unlike Australia and the UK, the US allows women to sell their eggs on the open market.Women with desirable characteristics can get up to $US100,000 per cycle from IVF clinics for their eggs. But she says eggs for research do not commancommand such high premiums because they depend less on characteristics. She says at least one US company has been set up specifically to procure eggs for the biotechnology industry, paying women around $US4,000 per "donation".
This is despite a US National Academy of Sciences recommendation against the use of purchased eggs for research. Assoc Prof Waldby says there should be international laws that prohibit scientists from using any cell lines derived from eggs procured in the absence of ethical guidelines and oversight.
Scientific response Australian stem-cell researcher Professor Bernie Tuch, from the Prince of Wales Hospital in Sydney, says donating eggs is difficult and risky, and it would be a pity if Assoc Prof Waldby's predictions were right. But Prof Tuch emphasises Australian law prevents trading in human eggs.
"[Waldby's concerns are] of no direct relevance to Australia," he said.He also says National Health and Medical Research Council guidelines require imported embryonic stem-cell lines to be developed under the same conditions that apply in Australia.

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Stem cell research

The seven-year embryonic stem cell research winter brought about by George W. Bush’s reactionary ‘pro-life’ policy seems to be finally coming to an end. By restricting federal funding for research on embryonic stem cell lines created before August 2001, the Bush administration stifled research and created a big roadblock to the progress of science. Researchers, frustrated by the decision that was not taken on scientific merit, can heave a sigh of relief because President-elect Barack Obama has made it clear that he is a strong supporter of embryonic stem cell research. The fact that he was the co-sponsor of the Stem Cell Research Enhancement Act of 2007, which sought the expansion of federal funding, is testimony to his political commitment to remove the hurdles in this important field of medicine. In an April 2008 statement, the man who was going to be elected the 44th President of the United States said the current policy was “preventing the advancement of important science that could potentially impact millions of suffering Americans,” and added reassuringly that “we must all work together to expand federal funding for stem cell research.”
Mr. Bush and Mr. Obama, with their opposing standpoints on embryonic stem cell research, make for an interesting comparison. If in Mr. Bush’s blinkered view, using adult stem cells in the treatment of certain diseases is all right, Mr. Obama sees them as no substitute for embryonic stem cells. Mr. Bush’s right-wing ideology, which sees the harvesting of stem cells from embryos stored in infertility clinics as destroying life, fails to take cognisance of the ultimate destruction of such embryos. Mr. Obama, on the other hand, sees them as an ideal source of stem cells. If the Bush administration’s failure to regulate stem cell research, where the possibilities of misuse are high, is shocking, the President-elect understands the need to have appropriate oversight. The lack of regulation is not the only reason why the U.S. is far behind the United Kingdom in this exciting field. By not going the whole hog in allowing the creation of embryos expressly for research, Mr. Obama will still keep his country a step behind the U.K. But he is on the right track to unfetter this promising field of medicine. He has the persuasive skills to get the 2007 Act amended by Congress so that expanded federal funding can be provided, as the community of American scientists has demanded. After his overwhelming victory of November 4, 2008, Mr. Obama certainly has the political and moral authority to get the legislative branch to do what has been overdue

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Straight from the Heart

Dr Barbosa has seen life on the streets from close quarters. As a child, she shuttled between various orphanages in Rio de Janeiro. But she overcame all adversity to become Brazil's leading cardiologist-pediatrician. Today, despite being at the zenith of a lucrative profession, Barbosa has dedicated her life to providing quality cardiac care for underprivileged children.When Barbosa returned to Brazil after studying medicine at the National Heart Hospital in London, she joined the very private and expensive Hospital Pró Cardíaco, as its head. But, unlike her predecessors, one of the first steps she took was to establish a special pediatric cardiac unit. While there is no specific data on the number of children that succumb to heart ailments in Brazil, the deadly condition is responsible for 30 per cent of the deaths - around 300,000 - each year.Poor children born with cardiac problems need specialized care, but due to the lack of infrastructure and skilled manpower in public hospitals a large number die waiting for treatment or surgery. The cost of surgery and follow-up treatments is also very high - R$ 10,000 (US$ 5,681) and R$ 150,000 (US$ 85,227), respectively.Disturbed by this situation, Barbosa set up the Pró Criança Cardíaca Foundation in 1996 to assist parents in securing competent medical care for their little ones. She arrived at an arrangement with Hospital Pró Cardíaco, wherein she could utilize the hospital infrastructure for surgeries. All the treatment is paid for through donations the foundation receives. Till October this year, 11,500 ailing children have been treated and 625 cardiac surgeries conducted.Everyone, from the members of her staff to her patients and their parents, is full of praise for the compassionate doctor. "Rosa Célia is a fighter and helps everybody. If it wasn't for her, many children would have to wait in long lines for treatment and struggle for a vacancy for surgery," says cardiac surgeon Milton Méier, 72, who is part of the staff at the foundation and has been associated with Barbosa since her student days in London.Barbosa has ailing children being referred to her from various private clinics and public hospitals. A dedicated medical team of six cardiologists and four cardiac surgeons attends to kids coming to the foundation. During the initial stages of the treatment, Barbosa attends to every child personally. Besides the treatment, the foundation offers advice on diet; provides the medicines, clothes and toys; and also has an on-call dentist, since a tooth infection can be fatal for a cardiac patient. Every child is also given a basic food basket at every appointment.Lucas, 8, who has Down's Syndrome, was operated on by the team at Pró Criança Cardíaca when he was only three months old. His mother, Elenice dos Santos, 47, says, "The whole treatment here is excellent. The team treats the children with a lot of love and affection."Another grateful parent, Edna Ramos de Andrade, whose eight-year-old son, too, has Down's Syndrome says, "Dr Rosa Célia and the team were angels that appeared in my life. We don't have health insurance and my son's problem was diagnosed at 14 weeks of gestation. Thanks to Rosa, we received first class treatment."Barbosa believes that a child with a cardiac condition needs to be monitored for the rest of his/her life. According to her, if follow-up check-ups are not done from time-to-time then the first treatment and surgery can become quite worthless. Therefore, she has many patients that are now in their teens or are adults. For example, Tainá Vieira da Costa, 16, who had her surgery as a child but still visits for routine check ups."She had the surgery when she was nine. We have to bring her here from time-to-time," reveals Tainá's mother, Márcia Vieira Cunha, who works as a saleswoman.In order to make sure that her work can reach out to many more people, the good doctor has now decided to build a hospital of her own, which promises to have best of caregivers and state-of-the-art infrastructure. "Things have improved a great deal. But we still have an enormous waiting list. The space at the Hospital Pró Cardíaco is very limited and they have no plans to expand the pediatric unit. So, I thought the only way to continue our work was by setting up a hospital of our own," explains Barbosa.The land for the dream project has already been bought. A bulk of the funds - R$3 million (around US$ 1.6 million) - for the purchase were raised at a benefit, where Roberto Carlos, the renowned and respected musician, enthralled a packed audiences."We have also been receiving monthly donations between R$30 (around US$17) to R$1,000 (around US$590). People organize birthday parties and ask their guests to donate money for the foundation instead of getting gifts. Our work has received great support from the society, the media and business people as well. I think this is because we are credible. It is very important to be truthful and ethical," says the doctor.Others who have come forward with a helping hand include Amil, a health insurance company, which has decided to pay for the architectural costs, and architect João Pedro Backheuser, who has volunteered to coordinate the project. In fact, even the Mayor of Rio, César Maia, and Governor Sérgio Cabral have expressed their solidarity to the cause.Dr Lúcia Tomoko Fukuyama, who has been working with her for the last 15 years now, says that the new hospital is a dream come true for everyone at the foundation. "She makes things happen, she is committed to improving healthcare in Brazil. As her assistants, we are very proud," she says. The new hospital, which will be equipped to treat over 1500 children a month, is expected to be complete and functional in about 18 months time.Barbosa has the final say. "I'm not the type of doctor that complains when the cell phone rings. It has to ring. I would mind very much if someone is in pain and not able to find me."

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Are All Ayurveda Drugs 100 % Safe As Claimed?

Due to the failure of modern medicines to cure diseases like Cancer, Diabetes, and Arthritis, and the yoga gurus like Baba Ramdev Ayurveda drugs are becoming very popular in all over the world. The online purchasing of medicines is a popular way to get rid of physical problems all over the world now. According to official data produced in an international symposium on cancer and Ayurveda at Gujarat cancer research institute in November 2007, information was given that as many as 60 to 70 % of cancer patients rely on herbal medicines as chief or supportive therapy even in Canada or USA.
You might have read the latest issue of JAMA. There is an article entitled "Lead, Mercury, and Arsenic in US – and Indian – manufactured Ayurvedic Medicines Sold via the Internet" JAMA. 2008;300(8):915-923. It Context that Lead, mercury, and arsenic have been detected in a substantial proportion of Indian-manufactured traditional Ayurvedic medicines. Metals may be present due to the practice of Rasa Shastra (combining herbs with metals, minerals, and gems). Whether toxic metals are present in both US – and Indian – manufactured Ayurvedic Medicines are unknown.Luckily this article has not asked for ban of these drugs neither they have been banned yet. But this is the high time to discuss this issue. Are all Ayurveda drugs 100 % safe as claimed?I would like to draw your kind attention in this regards. The classics of Ayurveda has never ever claimed that all Ayurveda drugs are 100 % non toxic. Even the poison of Snake is used as medicine in Ayurveda. This has been a myth that all Ayurveda drugs are 100% safe and can be consumed without any expert guidance or supervision. No wonder, 80% of total sale of Ayurveda drugs is OTC means over the counter! Most of the patients follow the articles published in news papers or by Babas. This has created myth for Ayurveda even in scientific fraternity. Many a times patients consumes drugs containing Nag bhasma or Parada i.e. mercury for years and years and when they approach with chronic toxicity of such metals, modern practitioners always defame the science Ayurveda. On the contrary, Ayurveda has always prescribed the drugs with precautions, and cautions. So it is always advised to take even Ayurvedic treatment under medical supervision only.The definition of TOXICITY or Heavy metals is relative. Toxicity depends upon the body reaction, Prakriti, dose and duration of the drug administered etc.We all have observed that the NRIs or foreigners, who come to India, can’t “digest” Indian foods or water either and as a result most of the times they rely on Mineral waters only. And on the contrary, almost 80% of Indians are still using that “raw” water for consumption. And they are comparatively healthy!. Ayurveda has termed it Oksatmya; means which is non-toxic due to practice. We have read the stories of Vishakanyas who were being given Visha i.e. toxins since their childhood and even if they kiss someone, he or she will die due to the Visha. This is the best example of Oksatmya. The detectable presence of these elements in dietary products and food or water is not the same as toxicity. These elements are present in many of our everyday foods and as shown in this study, Ayurvedic dietary supplements. In the case of foods and herbal products their presence can occur because:
1) they are naturally occurring in the soil, water and air, 2) from pollution as a result of human activity where in both cases theses elements are taken up by the plants, 3) from contamination in the manufacturing process, and 4) these elements are intentionally added.
Toxicity is the result of too much of the specific form of metal being ingested over time. But the most important point is, in Ayurveda or Rasashashtra, any metal is never prescribed as raw or virgin metal. It has always been processed with the procedures like Shodhana, Marana, Jarana, Amritikarana, Bhasmikarana, Satvapatana, Lauhitikarana etc. and most of them are used in sulphide form which is most suitable to the body. Some times these procedures may need 5 years! Moreover there are many standards or parameters, to check it before consumption like Rekhapurnatva, Unnamatva, desired color etc. But I really doubt how many pharmaceutical companies follow these procedures and the standard protocols even after getting the license of good manufacturing practices, as many a times it happens with the pharmaceutical companies. So for Indian patients, here are few tips, when they consume Rasashashtra or Ayurveda products.
Read the label carefully of the product you are using.
If there is a drug named as Nag Bhasma, Parada Bhasma or Somala Bhasma, then don’t use it for more than 21 days.
Regular use of Harde or Haritaki is contra indicated during pregnancy for longer period by Ayurveda. Long term use of Drugs containing Bhallataka, Lasun, Karen are contra indicated for the patients with Pitta Prakriti. Long term use of Drugs like Vasa (ardusi), Neem, are contra indicated for Vaata Prakriti. Long term use of Drugs like Shatavari is contraindicated for the patients with chronic cough.
Long term use of Drugs like shatavari, may cause constipation.
Long term and much use of Milk of buffalo is contra indicated in patients with constipation, diabetes, asthma and skin diseases.
Regular and long term use of Isabgul may cause loss of appetite and digestive problems.
Long term use of Suvarna patri (sonamukhi) can weaken the intestine’s natural movements and may cause habit. (many drugs sold in market like Kayamchurna contains such habit forming drugs)
According to the guidance of government of India drugs containing following ingredients must be consumed under strict medical supervision of Ayurveda expert.
Drugs of vegetable origin
• Ahipena Papaver somniferurn Linn.• Arka Colotropis gigantean (linn.) R. Br. Ex. Ait.• Bhallataka Semecarpus anacardium Linn. f.• Bhanga Cannabis eativa Linn.• Danti Baliospermum montanum Mall. Arg.• Dhattura Datura metal Linn.• Gunj Abrus• Jaipala (Jayapala) Croton tiglium Linn.• Karaveera Rerium indicum Mill.• Langali Gloriosa superba Linn.• Parasilka Yavani Hyocyamus inibar Linn.• Snuhi Euphorbia neriifolia Linn.• Vatsanabha Acontium chasmanthum Stapfex Holm.• Vishmushti Strychnox nuxvolnica Linn.• Shringivisha Acontium chasmanthum Stapfex Holm.
Drugs of Animal Origin
• Sarpa Visha Snake poison.
Drugs of Mineral Origin
• Gauripashna Arsenic• Hartala Arseno sulphide• Manahashila Arseno sulphide• Parada Mercury• Rasa Karpura Hydragyri subchloridum• Tuttha Copper sulphate• Hingula Cinnabar• Sindura Red oxide of lead• Girisindura Red oxide of mercury.
Following list is examples of few popular drugs which are being taken as self medication by the patients but it must be consumed under medical supervision of a qualified Vaidya:
• Vaat vidhvamsana Rasa
• Aarogyavardhini Rasa,
• Yogaraja guggulu
• Mahayograj Guggulu
• Tribhuvan Kirti Rasa
• Bruhad or Laghu Suvarna Vasant Malini Rasa
• Laxmivilas Rasa
• Panchamrita Parpati
• TamraBhasma
• Trivanga Bhasma
• Simhanada Guggulu
• SamirPannaga Rasa
• Chandraprabha vati
• Swasakuthar Rasa
• Makardhwaja Rasa etc.
The patients who are consuming any Bhasma regularly they should analyse the Bhasma before consuming it. Followings are few easy methods to check the qualities of Bhasmas,
• Varitarattwa is that specialty in which the Bhasma of some substances floats on the surface of the water and does not sink in the water. According to the Rasa Tantraic concepts, a perfectly prepared Bhasma when sprinkled in a beaker full of water, floats upon the surface and does not sink in the water, it is known as Varitara. According to the Rasa Shastric every metal or other substances are to be converted into Bhasma form. They all are heavy in comparison to water, and when they come into contact of the fire and get converted into Bhasma form, they become light and the heaviness is destroyed. They attain a fine state of division and on account of the surface tension they float on the water. Ideally bhasmas like Suvarna, Rajata, Tamra, Lauha, Nag or Vanga should float on the water. If it sunk in the water, then it is not properly prepared.
• Rekhapurnatva: This is one of the important criterions of the examination of the perfect ness of the Bhasmas. The filling of the thread grooves of the surfaces of the first finger and the thumb is known as Rekha Purnattwa. When a small quantity of the Bhasma is picked up between the first finger and thumb and on rubbing, if the thready grooves allow penetrating that Bhasma, it is said that the Bhasma is having Rekha Purnattwa.
• Unam is also an adjective attached to a perfectly prepared Bhasma Though basically, the test of Unattwa is similar to the test of Varitarattwa, and there is a little modification. After examining the Varitarattwa of a Bhasma, when small food grains are delicately placed over the layer of the Bhasma, which is floating over the water level and if the food grains do not sink and continue to float, the Bhasma is supposed to be Una i.e. very less in gravity, and as such it is just an advance test of Varitarattwa and to decide comparatively more Laghuta.
• Nirdhumattwa is the next criterion for the assessment of the perfectness of the Bhasma. Nirdhumattwa refers to a special in which anything put on burning fire and non-observance of the smoke thereof. The same meaning is applied in the context of Bhasma Pariksha. A small quantity of the Bhasma to be tested after subjecting to specific number of Putas, is put on the fire and when no smoke of any type is observed, it is inferred that the Bhasma is prepared perfectly. If the Bhasma is not prepared completely, the Apakwa substances will remit yellow or white colored smoke.
• Gatarasatva: One of the criteria of assessing the perfect Bhasma has been considered to be the absence of taste in the Bhasma and that will be free from all the side effects.
• Ishtavarnattwa : Ishta Varnattwa means the attainment of an appropriate colour. In the context of Bhasmas also the attainment of the specific color corresponding to the basic metals or substances has been considered as a quality of the Bhasma. It has been expounded that whatever method of Bhasma preparation is adopted, with a little modification the Bhasma will have a specific type of colour. In Yoga Ratnakara, the standard colors of the Bhasma have been discussed extensively. It has been stated that the Bhasma of gold attains the color resembling to the Champaka flower; the Bhasma of silver and copper are attaining the black color, while the Bhasma of Naga attains the color resembling to the pigeon neck while Vanga covers into white color if the Bhasma is prepared perfectly and correctly. Generally the Bhasma of iron, or iron containing ores acquires a red colour and as such the Loha Bhasma, Kanta Bhasma and Kashisa Bhasma, Vimala Bhasma or Makshika Bhasma, on account of their iron content, attain the red colour. The Abhraka Bhasma attains brick red color on account of its iron content. Similarly, Swarna Makshika which has about 30% iron component attains the Jamun fruit color. Similarly, other Bhasmas are also having different colors and on account of those colors, their perfection is decided.
• Chandrika is the metallic luster and its absence is considered as a criterion for assessing the perfection of a Bhasma. Various Rasa Tantric substances are having a natural luster or shine and after conversion into Bhasma form that luster should go. This absence of natural luster is an indication that the specific metal or the metallic ore has converted into Bhasma form. A small quantity of the Bhasma is taken in between the thumb and the index finger and rubbed vigorously. Then the portion stuck in the grooves of these fingers is exposed to the sunlight and viewed very carefully. If very tiny shining particles are observed on the fingers, it is presumed that the metal or the mineral or the Ore has not converted into the Bhasma form perfectly whereas its absence indicates about the perfection of the Bhasma.
• Mriduttwa: The softness is denoted by the adjective Mriduttwa. This is perception through the touch sense. All the minerals, metals etc. are Bhoomija or Parthiva Dravyas and the ancient scholars have said that the Parthiva Dravyas contain Guru, Kathin, Khara etc. qualities. When these substances attain a Mrita state or Bhasma form, they loss their physical characteristics and as such the Kharasparsha of metals gets lost and the Bhasmas are felt soft and smooth.
Disclaimer The above article is educational in nature, and is not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, please consult your physician.

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Surrogacy Boom

Smaller cities in India, such as Bhopal and Indore in Madhya Pradesh, are frequented by childless couples from other parts of India and even abroad.Unable to bear children for various reasons, such couples travel to these cities with hope. Bhopal and Indore have certainly gained popularity as a result of an increasing number of women agreeing to surrogacy (carrying another couple's embryo to full term), the many specialized Assisted Reproductive Technology (ART) clinics, and the comparatively affordable treatment.When Bhopal residents Rajesh Shrivastava, 41, and his wife, Usha, 37, were unable to conceive after 12 years of marriage, they decided to go in for ART (this includes techniques such as In-Vitro Fertilization) and surrogacy. The couple visited the ART centre run by Dr Dinesh and Dr Shefali Jain in Indore."Usha had suffered six miscarriages in 12 years. Initially, the idea of a surrogate did not appeal to them. But they agreed when one of their relatives came forward," reveals Dr Shefali Jain. This was two years ago. Now, Rajesh and Usha are proud parents of twin daughters. The treatment cost the couple just Rs 150,000 (US$1=Rs 39.90).Apart from the domestic rush (the Jains alone attend to around six surrogate queries a month), a large number of couples from abroad also travel to Bhopal and Indore to fulfill their desire for a child. Several American, Russian and British women are duly registered with the Bhopal Test Tube Baby Centre for the procedure. Often, couples have to wait for as long as eight months to a year for their turn.Their reasons for coming to India are varied. For some, the treatment is far too expensive in their own country; for others, their national laws do not permit surrogacy. Recently, a 37-year-old Russian came to Bhopal as the expense for surrogacy is prohibitive in her country - between Rs 15,00,000 and 20,00,000 - as compared to the Rs 200,000 cost in Bhopal.Dr Randhir Singh, Director, Bhopal Test Tube Baby Centre, elaborates, "Women source information about the availability of surrogate mothers in Bhopal over the Internet and then contact us. In foreign countries, surrogate mothers are not easy to find. Therefore, the interest in India."Even as an increasing number of childless couples from overseas come to India, legal experts express their reservations. Many foresee hurdles after the child is born and caution that surrogacy should be carefully considered.According to senior advocate Kirti Gupta, "At present, it is not difficult to have a baby through surrogacy in India because there is no law to control or regulate it. The technique is cheap, when compared to other countries, and surrogate mothers here charge comparatively less for the services."As there are several clinics now that perform such services - gauged by the number of advertisements in the local media as well as on the Internet - it is easy to select a clinic. However, the real problem arises after the birth of the baby. In India, in the absence of any clear laws on the issue so far, foreigners are unable to get legal assistance when it comes to taking their child back to their home country.Childless couples in India, too, must consider some issues. For example, whose name will be mentioned as parents on the birth certificate of the newborn or what should be done in case the surrogate mother refuses to hand over the child?To lay such doubts to rest, clinics that provide ART facilities take recourse to the guidelines set by the Indian Council for Medical Research that state that the surrogate mother has to sign a contract with the childless couple. But even then, counter lawyers, it is not clear whether such a contract has any legal sanctity.Doctors take their own precautionary measures. Dr Dinesh Jain says, "We allow a woman to become a surrogate only after we have fully checked her credentials and if we trust her. We also ensure that the child born is handed over to the childless couple."In Indore, which has a population of 30,00,000, many women responded to an advertisement seeking surrogate mothers, placed in a leading Hindi daily. Within 24 hours of the advertisement having appeared, a dozen women had evinced an interest. Surprisingly, none enquired about the couple. Money was the overriding concern.Women who are willing to undergo the procedure come from lower middle class backgrounds, are married, and are in need of money. So much so that, often, childless couples negotiate a better price as a result of the competition. Shweta Khanna, 35, from Indore was willing to be a surrogate mother. Initially, she asked for Rs 100,000. However, when another woman offered to do the same for Rs 75,000, Shweta had to settle for Rs 50,000. "I have been a surrogate mother before. This time I'll have no problem... my husband is also agreeable," she says. Most women insist on anonymity for fear of social stigma.But amidst all the doubts and societal taboos, the number of childless couples wishing to have a child through this technique is on the rise. It is estimated that in Indore, which has 11 ART centres, around 200 childless couples have been treated over a period of three years.

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Abetting surrogacy

Nineteen-day-old Manji Yamada at the Supreme Court in New Delhi on August 13. The future of the child, born to a surrogate mother, hung in legal limbo after the Japanese couple who planned to take her home got divorced.

COMMERCIAL surrogacy, though banned in several developed countries for obvious reasons, may soon become a reality in India thanks to the joint efforts of private medical establishments and the Union government. A Bill that seeks to legalise commercial surrogacy has been drafted by the Indian Council of Medical Research (ICMR). Resistance, if any, to the legalising of commercial surrogacy is coming from health activists and women’s organisations. Interestingly, the Bill, called the Assisted Reproductive Technology (Regulation) Bill and Rules, 2008, did not involve at any stage women’s groups or public health activists in its drafting. In fact, several people wonder what a premier institution concerned with medical research has to do with a Bill like this. Regulation of surrogacy, many feel, would give a legitimate stamp to the commercial activity that is already under way. “It is like saying we know you are exploited but here is a law that will ensure that you will be exploited less,” said a health activist who also pointed out that by regulating commercial surrogacy, the government was in a sense facilitating the process for those in the business of Assisted Reproductive Technology (ART) as well as perpetuating stereotypical notions surrounding fertility, motherhood and, maybe, eugenics. It is taken as a given that there is a burgeoning demand for children and that there are many childless couples,; and therefore, there is a demand for ART techniques. A special programme by the World Health Organisation (WHO) estimated that there are 60 to 80 million infertile couples the world over. The ART industry in India, estimated at Rs.25,000 crore, has never had it so good. Inter-country and intra-country surrogacy abound. There are websites offering egg donors and surrogate mothers. There are phone numbers and other contact details. One website gives the cost of surrogacy through in vitro fertilisation (IVF) as $15,000. The costs vary, of course.
There are hardly any data available in the country on either the number of institutions devoted to ART practices or the donors themselves, their background, their spread and so on. Nor are there any data on the extent of commercial surrogacy. ART guidelines
The guidelines for accreditation, supervision and regulation of ART clinics were formulated in 2005 by the ICMR, but there is little evidence to show that there has been any check on commercial surrogacy. The guidelines are basically meant to provide optimum benefit of these newer technologies to appropriate persons by a skilled team of experts at affordable health and economic costs in all public and private facilities in the country. So the guidelines basically aid the proliferation of the technology. The Bill is an avatar of the same. The guidelines stipulate the creation of a national registry, centrally maintained and accredited by the licensing authority. This shall contain records of treatment cycles and outcome. While the guidelines admit that there is a general element of risk associated with all ART procedures, the consent forms also state that at present there is no ethical objection to IVF or any related procedure for research or clinical application. The consent would include giving information to the donor about the various risk factors involved, including ovarian hyperstimulation, anaesthetic procedures and invasive procedures such as laparoscopy, the possibility of multiple pregnancies and the risks associated with them, ectopic gestation, increased rate of spontaneous abortion, premature births, higher perinatal and infant mortality, and possible side-effects.
A concept note prepared by the Ministry of Women and Child Development in February clearly states that the risks to the surrogate mother could be quite substantial. It notes that economically disadvantaged women could be lured into carrying the foetuses of wealthy childless couples. Even in cases of altruistic surrogacy, there is the possibility that the surrogate mother will be emotionally pressured to demonstrate family loyalty by carrying a child for a sibling. Anand district in Gujarat has reported a large number of commercial surrogacy cases ever since the guidelines were put in place. Concerned about reports on the increasing misuse of surrogacy arrangements and the welfare of children born out of this, the Ministry organised a round table on June 25 this year. The recently drafted Bill does not have a preamble, a statement of object and reasons. It begins with the constitution of a National Advisory Board for Assisted Reproductive Technology, the chairman of which would be appointed by the Ministry of Health and Family Welfare. The board is to have 16 experts, of whom six would be women, all nominated by the Central government. The functions of the advisory board are confined to promoting the cause of reproductive technology The draft legislation provides for State boards, which would more or less perform the same function as the national board. The Bill directs that ART clinics, semen banks and research organisations that use human embryos for study, which are operative on the date of notification of the Act, should obtain temporary registration within six months of the notification by the State board and regular registration within 18 months of the notification. Activists, however, are baffled at the notion of temporary registration. And more peculiarly, if the agency applying for temporary registration does not hear from the State Registration Authority within 60 days of receipt of the application , the clinic would be deemed to have received temporary registration. “If this is not facilitation of ART clinics, then what is?” wondered a health activist. There are certain ludicrous provisions as well. Under the section titled duties and rights of donors, it is laid down that no ART procedure shall be conducted unless the donor has obtained the consent in writing of his or her spouse. Given the low level of negotiating rights of the poor and especially women in reproductive matters, it is highly unlikely that there will be any spousal objection in a commercial transaction. The Bill allows individuals or couples to obtain the service of a semen bank or advertise to seek surrogacy. The advertisement for a potential surrogate mother should not contain any requirements pertaining to caste, ethnic identity or descent of any of the parties involved in surrogacy. No ART clinic shall advertise to seek surrogacy for its clients.


But what is detrimental to the health of the surrogate mother is the provision that allows for multiple pregnancies in the event of failure in transferring the first embryo. The Bill allows up to three commissioned babies. That is, the surrogate mother can accept, on mutually agreed financial terms, at the most two more successful embryo transfers for the same couple.
The Bill even facilitates surrogacy options by foreigners. It lays down that a foreigner or a foreign couple not resident in India or a non-resident Indian (individual or couple), seeking surrogacy in the country, shall appoint a local guardian who will be legally responsible for taking care of the surrogate during and after the pregnancy until the child/children are delivered to the foreigner or foreign couple by the local guardian. There is nothing at all in terms of legal or other liabilities to protect the surrogate mother in case complications arise after the delivery or after the process of surrogacy is over.
A question that activists, health experts and women’s groups are asking is whether surrogacy can be pursued and promoted as a public policy in India, given the abysmal track record as far as the health of women is concerned. Secondly, while the government encourages the small family norm, the ART guidelines and now the Bill actually allow for commissioning up to three babies. Third, public health experts like Imrana Qadeer feel that the government could do a lot more in terms of addressing the causes of secondary fertility, through effective antenatal and natal care.
Questioning the basis for a public policy on surrogacy, Imrana Qadeer points out that of the 8 to 10 per cent infertility in Indian women, only 2 per cent have primary sterility. Secondary sterility is often caused by tuberculosis, post-partum infections and reproductive tract infections. Imrana Qadeer argues that maternal mortality will not decline if surrogacy is promoted as part of what she calls legalised health tourism. The concept of promoting surrogacy as a public policy also denigrated the notion of gestational motherhood. It is ironic that when there are laws banning commercial transaction of human organs and sex selection of babies, the ART Bill comes to legalise something that has a clear potential for exploitation of the poor. Surrogacy arrangements, if any, should be limited to altruistic ones to prevent commercialisation of the same. The government argues that more than 65 per cent of the people have supported surrogacy through a public debate. Health Ministry representatives have acknowledged that the private medical sector literally gave all the inputs in the drafting of the guidelines of 2005. At that time, “expertise existed with the private sector”, they say. It can only be hoped that this time the government listens to a cross-section of people, otherwise there will be little chance of the Bill getting through Parliament. Academics, activists and doctors issued a strongly worded statement on the draft Bill at a two-day consultation recently organised by Sama, a resource group for women and health. It stated that the Bill focussed more on promoting private-sector interests than in providing a regulatory mechanism; that it was inadequate in protecting and safeguarding the rights of women and children; that the Bill did not have a clear preamble outlining the purpose or a framework emerging from the government’s own perspective; and that there was an urgent need for regulation, not just regularisation and promotion, of the present practice. Urging ICMR not to rush with the Bill until a wider debate on it was conducted, the signatories to the statement said that the Bill would promote medical tourism and encourage commercial interests at the cost of women’s health. Not only did the Bill compromise heavily on the health and rights of women and children, it also promoted invasive and expensive technology instead of encouraging adoption. Above all, the activists feared that the Bill reinforced patriarchal as well as eugenic tendencies. The signatories wanted the Bill to be kept open for public review and for public hearings involving women’s groups and health groups for at least six months.

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