Civic Liberty and Public Health

The US is the most affected country bearing 32% of global (COVID-19) disease burden. A prominent influencing factor is the fundamental percept of individual freedom, as enshrined in the constitution and supported with the first amendment. Across the US, people are protesting about the compromise of personal freedom with the Stay at Home orders. Coronavirus has challenged all frontiers of humanity, its evolution and exposed our fault lines, irrespective of the countries, economies, ethnicities, ideologies, and our model of governance.

Civic liberty or public health – How do we achieve the right balance? Finally, balance also has a context and background. While there is a tendency on part of the state to erode individual freedom, the situation with Coronavirus is obvious. The inability to impose restrictions will definitely compromise the health of the society and ultimately the individual. In fact, not doing so will abrogate the state’s duties of providing safety for the individual. The scientific principle that underlines the “flatten the Curve” is provided along with a link to the international tracker of individual freedom across the globe. Also, expert opinion from Human Rights Experts and Legal Expert from Brooking, Harvard, University of Chicago, and Columbia University is cited in my blog. Realtime R(not) factor can be tracked for your county from the link provided herein.

What is compromised? What is indispensable?

COVID has opened a dialectical discussion on individual freedom and individual freedom that can harm the wider community. Freedom of movement is enshrined in the first amendment. To a few, these are considered at odds with each other. However, it’s a matter of perception. In the case of COVID-19, the common good outweigh individual freedoms.

When can we consider individual freedom compromised?

Ideally, we can consider that individual freedom is compromised if it results in (1) enhanced surveillance powers that compromise privacy (as in China, drones, cameras, and Bluetooth trackers) (2) suspension of rights, (3) control over information; and (4) delayed elections.

None of these are used here in the US. So, it is wrong to construe that freedom is compromised. More so, the federal government has declared an emergency. Nancy Gertner, a senior lecturer on law and a retired federal judge, says that the types of surveillance measures lately used in South Korea might even be feasible here, if somewhat less likely. “The issue is whether the measures are proportionate with the purpose. Since this is a public health emergency, we’re not dealing with the usual rules and regulations.”

Testing and stepwise removal of the restriction to movement

Therefore, restrictions could ease once widespread testing for the virus becomes available. Once the Govt. ramps up the testing, then you can dovetail the precautions according to who’s vulnerable. If you’ve got no idea, you quarantine everybody. But if you can test widely you can also titrate the response. However, it worth noting that, RNA testing and not testing the antibodies, is important. Thus sensitivity and specificity of a test become important. Sensitivity is used for screening, whereas, specificity is used for diagnosis. in case of Corona, we can’t wait for the antibodies to develop since those take time to develop after the infection and before the antibodies become evident, the person is infective (even if asymptomatic) and can potentially shed the viruses. Thus, personally, I am averse to antibody testing for screening, though the opposite is currently practiced.

Lesser restrictions in favor of more fundamental freedoms is more a policy concern rather than a matter of law. Temporarily accepting lesser freedoms for the good of the country and the wider population, in general, is acceptable in order to regain fundamental freedoms of movement more quickly and permanently our, to earn a living, and to attend events and gatherings. Protests such as these are uncalled for since we don’t need proof to weigh the cost versus benefits.

How best to mitigate the concern?

Freedom of movement, due to Lockdown secondary to COVID-19, should be tied to the growing, declining curve of the infection and or testing. It cannot be blanket freedom for the entire nations. States, Counties, and Cities are displaying a distinct pattern. Those which are on the rising side of the curve, also called hotspots, should definitely have “Stay at Home” Order. Those on the declining part of the curve should be tallied with the R(not) factor (explained later). and if the R(not) is declining below one, then we should consider the removal of restrictions.

While the outcry for compromise of individual freedom is healthy, a governance and policy framework to monitor and remove the temporary restrictions on individual freedom should be tracked, monitored, and reported to provide transparency.

Citations

https://jamanetwork.com/journals/jama/fullarticle/2761556?widget=personalizedcontent&previousarticle=2764283

New restrictions on civil liberties during coronavirus

Freedom and privacy in the time of coronavirus

COVID-19 Civic Freedom Tracker: https://www.icnl.org/covid19tracker/

https://news.uchicago.edu/story/fight-against-covid-19-how-much-freedom-are-you-willing-give

https://www.cjr.org/analysis/coronavirus-press-freedom-crackdown.php

Tracking Realtime R(not) factor https://rt.live/

Facts will unravel the truth

Facts alone pave the way for unraveling the truth

The US alone contributes to 29% of the global burden of COVID-19 positive cases. As against, the US, India has a paltry 0.5%. I liked PM Modi’s lockdown, despite the criticism. Any crisis moment is likely to have its collateral damage. However, a leader has to weigh the big picture and make the right decisions at the right moment. I am not a great fan of PM Modi but let us not be partisan at such critical times. Figures talk, and they talk a lot. You cannot hide those in a country like India. If the lockdown persists for another 3 weeks, India would have controlled the giant virus adorably!

Various schools of thought are rife with speculation. Some think Indians have a healthy immunity, while data from the UK points towards a specific predilection for the Asian Indian population. From the get-go, I (Shashank Heda) have been holding a grouse against China (not the Chinese ethnicity) that they have tried a more diminutive and (an unknowingly an attenuated strain) against India. Given India’s porous borders and the uncontrolled travel and social interaction, it is possible that India was already infected with a milder version sometimes back, and now Indians have an immune response to some of those Spike proteins or possibly the hemagglutinins. Time alone will reveal the telltale genetic fingerprinting and the genesis of this virus.

In the interim, it is definitely not the time to drop the guards. Let us educate our folks for –

  • Social distancing (no social/community/outdoor activities)
  • Isolation and shelter at home
  • Masks and decontamination precautions

Most important, they need to remember to

  • destress themselves,
  • implement a balanced life,
  • keep active and connected and
  • sleep well.

They need to be reminded that, they are not alone, 40% of the global population is going through the same routine.

Excerpts from BBC below –

“Our [infection] growth rate is highly contained although we are actively chasing the fire,” she told me. “Almost all of our testing has been driven by protocol, starting with people with travel history, contact tracing of people in touch with them and so on. The probability of getting more positive cases [from this cohort] would have been much higher.” Many are also pointing to the lack of reports about any surge in hospital admissions with influenza like illness and Covid-19 patients, which would hint at a rapid community transmission.

https://www.bbc.com/news/world-asia-india-52265061

Herd Immunity

A raging debate is ongoing on Herd Immunity versus isolation. While herd immunity has been a de-facto nature’s standard for protecting the masses or herd, (not necessarily human alone), Coronavirus (SARS CoV2) has thrown this natural principle into question for several reasons – 1) it is new and has high mortality and morbidity due to its properties 2) we have no innate defense against it 3) Even the most highly industrialized nations have no capacity to accommodate the sick patients. Let us review the factors why we should not YET resort to Herd Immunity.

 

Before getting started, let us see a live example of herd immunity being practiced to counter Covid-19. Let’s visit Sweden (Updated May 4, 2020).

“herd immunity,” in which a critical mass of infection occurs in lower-risk populations that ultimately thwarts transmission. “relies more on calibrated precautions and isolating only the most vulnerable than on imposing a full lockdown.”

I am strongly convinced for Herd Immunity because that’s the only mechanism for mass protection at the lowest cost (understanding the collateral damage). Herd Immunity, should not be construed with the development of commensals, or symbiosis between the bugs and the host. Of note, let us understand the process of herd immunity and commensal development from an evolutionary basis. For these bugs (those existing in GI tract) the external environment is harsh and toxic. They cannot exist outside and so have taken refuge inside the host. Eventually, the host and the bugs take a symbiotic relationship or often, at least don’t harm the host unless in rare circumstances. Summarize to say that there is no evolutionary angle to this novel coronavirus. It is de-novo, not an adaptive organism.

Herd Immunity and Vaccination

Second, from the perspective of spreading immunity – understand that the collateral damage it may cause is irrespective of the value of the individual. At a theosophical and spiritual level, who are we to decide a 78-year-old should die or survive? We only have to create a judicious system to protect if we know the risk is higher in this population.

Biologically and from the perspective of Epidemiology, Herd Immunity, especially as it plays from a vaccine perspective, offers lesser chance unless a vaccine is introduced. It provides better protection when a vaccine is introduced in the population. They both have a synergistic effect. In fact, the lesser a population is vaccinated, the lesser the herd immunity phenomenon.

Despite, not knowing this Coronavirus ever existed, I strongly feel that Herd Immunity is best for general mass protection if the morbidity, as well as the mortality, are low and this is considering the varying Rho factors for various bugs.

UK and Sweden tried Herd Immunity and failed. In a partial sense, the US unknowingly imposed the principle of herd immunity (by not imposing the lockdown) and paid the cost. Today, the UK, the US, and Scandinavian countries all are reversing their stand on herd immunity. This is because of the grim reality of 20000 plus deaths in the US and several thousand deaths in the UK. Those sticking to Herd Immunity have taken a heavy toll because –

  • This is a new virus (as against the others which evolve) whose least quantity infects (S protein configuration, antiviral suppression, and cytokine storm)
  • There mortality and morbidity significantly high for the state to prepare and manage this huge tide.

Excerpts from Kevin Kavanaugh from the link cited below –

“Mitigation strategies can decrease a contagion’s R0. To decrease the total number of individuals with active infections, the R0 will have to be less than one. So, on average, each infected person spreads the virus to less than one person. When this happens, the epidemic will eventually burn out.

Herd immunity strategies rely on a significant portion of the population to become immune to stop the spread of the virus. The higher the R0, the larger the percentage of the population who must become immune before the total number of those with active infections decreases and the epidemic burns out. An R0 of 5 to 7 will require 80% to 85% of the population to become immune before the number of infected will start to decrease. Thus, it can be argued that without mitigation, the R0 will be far too high to be able to stop this epidemic with herd immunity. Almost all of the population would have to contract the infection before the epidemic would stop, which probably will not happen. The availability of a vaccine to prevent infections with pathogens having a high R0 is of utmost importance.

Other concerns are that immunity to coronaviruses which cause the common cold only lasts between 1 to 2 years and there is mounting evidence that cats and dogs may become infected, giving concerns of an animal host.

Thus, without a vaccine, this virus will be with us for some time. Herd immunity may slow the expanse of the epidemic, but it is not likely to meaningfully stop it without mitigation strategies. And there is significant concern that those who currently recover could be re-infected in the near future. Strategies of social distancing, not gathering in large crowds, wearing masks and protecting those at increased risk are required to manage this epidemic.Returning to life as usual with the dependence on herd immunity in a non-vaccinated population to control spread is almost certainly a false narrative”.

Thus, I feel, our ultimate recourse is our own defense – innate and adaptive complimented by herd immunity. The only reason, we are not resorting to herd immunity exclusively is because of the morbidity and mortality associated with this virus.

CItations:

https://www.nationalreview.com/2020/05/coronavirus-crisis-sweden-refused-lockdown-other-countries-following/ (Updated May 4, 2020)

https://www.infectioncontroltoday.com/covid-19/viewpoint-have-you-heard-about-herd-its-covid-19-fallacy (Kevin Kavanagh)

https://www.historyofvaccines.org/content/herd-immunity-0 (Animation)

https://www.aap.org/en-us/aap-voices/Pages/It-Takes-a-Herd.aspx (A simple scientific version)

https://www.technologyreview.com/2020/03/17/905244/what-is-herd-immunity-and-can-it-stop-the-coronavirus/

https://watermark.silverchair.com/cir007.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlIwggJOBgkqhkiG9w0BBwagggI_MIICOwIBADCCAjQGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM2OVG8xg2pfYzNM-QAgEQgIICBSi7ifrpZhiYGndgs3xVawidKzRobUyILH54jTeTTCVvKXxKjfGTstEXY_TVc27do_oKohDgo0nlz3sEmDDDyXdf08bkvBxpUii7mooK0y4Cuonz8aMhK7uIcSVRndSJMKxsIbyrpXVSlgjnaCC387cZvR4qtxWfBcQqadTp1SmLZjw2qFgFm-w6W5Z6lzhNeAo9T4z-I9fVbPBPIlHS5ja0OrR19tlb7-bqbhxSlHujS0BnE5vGEjkB3yukP_2fTAR-2tir3Kje3j0Ae8jjDw2jV2AcCxjCxI6d-AdHTOKaB0JDka3AtdPccwhK-aHmteNLQCqnf9LAPbKHp075g79itw-qyLDc2ymz3IQg5lAWgKu1KO_vMkbCwkdr0Mx196-Rta8ssMWA7BxYySK2_hzcXcNicgsyy63sjXK6VHTy5UZNgSOw_F80rslfOgrCeP_yU-lFkMXB0Ll_2PRTXV5npNHbi0CwP0C-2oaGBpAUKeLycCOIDphV7F7bKQSlaKW4kgRf-XH3bqtsjnezQWGk2NllH4l_ErIujEUBev0hTMAaTPTIEMXc6OO429S6zwpF8JHpzdsmPLDXypaadLjseQk3Goikt2WmOKQB50WdqkYMYSWlcO2SUxMDA7_HZi_SkZhRPIigFE9Ocgo23y5UxAjHk3C6k5HRTbN0mQSmmKEA4Ag

 

Click to access f26ca43be04880eaf4ad046a1f9408cb2e11.pdf

Absolute Isolation Works Absolutely

As of this writing the total deaths in the US have mounted to 10,335. Never before mankind had seen such a fast moving, swiping infection. We knew Ebola, we knew Marburg viruses, and a few Prion diseases but collectively, we had never faced such a dreaded disease with high mortality. We were caught almost unprepared or at least we ignored with complacency. I have shared my thought on why isolation is important to contain this disease and how countries like Singapore, South Korea and japan are dealing planning isolation and intelligence in dealing with this crisis.

Absolute Isolation Works Absolutely

As noted in my earlier blog, viruses are obligate parasites that need (MUST) a host cell to survive. They go through their phases of replication and eventually, after not getting proper host cells to infect, die a natural death.

Strict Isolation Social Distancing

I have had many folks across the geographies asking me a few questions?

  1. Why is the incidence of Coronovirus so high in the US?
  2. Are certain ethnicities (such as Indians) immune to the Coronavirus?

I will emphasize the control of Coronavirus based on the viruses’ obligate dependence on live cells for survival. We all know that if we practice Isolation absolutely, we should be assured of not having the disease.

Two situations preclude our ability for Isolation –

  1. Our needs for Essentials
  2. Fundamental Sense of Liberty

I owe you all a clear and concise write up on the best practices and pragmatic guidelines on “How to Manage Essentials” giving an end to end perspective, that provides the best way to avoid getting the virus inside your home. Give me until later this late evening to fulfill that commitment.

Let us talk about the “Sense of Liberty”. The US, the EU, and most developed nations have an enshrined fundamental Right of liberty to move.  Isolation or ‘Shelter in Place’ equals to ‘House Arrest’ for them. The later nullifies isolation and thus provides a continuation of the propagation of the virus by allowing it to jump from people to people (aerosol, airborne, contact and fomites).

Special intervention in community level

So after the rise of an emerging disease, goverments have a special responsibility to balance between civil liberties and special measures for protecting susceptible populations. However, three components of “scientific“, “voluntary” and civil liberty should be considered as guiding principles for decision-making and operating each special protective measure at the community level (cited).

Aerosols Airborne Fomites

I see a dichotomy based on the above two practical limitations that are increasing the spread of Coronavirus in the US. Select countries like India and Japan are strongly considering the imposition of emergency. Whereas, many have implemented strict isolation even if the idea of isolation has emerged from behind the Iron Curtain of China.

The Bhilwara Model

The Bhilwara Model for containment of COVID-19 refers to imposing a curfew in the district including suspension of essential services, extensive screening, and house-to-house surveys to check for possible cases, and detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected. A similar model was followed in Singapore, South Korea, and Taiwan. Singapore had gone a step ahead and deployed its intelligence sleuths to extract the contact tracing, whereas, the draconian Chinese Govt deployed Bluetooth tracing abandoning the privacy laws (they do not exist in China, except while the couple is conjugating, I believe!).

The success of the Bhilwara model is attributed to controlling an outbreak within the first four days of the initial incidence (remember the Rho factor.

Absolute isolation works absolutely. Yes, it does but can we forego our sense of liberty? Can we minimize our needs and limit our consumption? Please visit my next blog on “Managing the Essentials”.

 

Also read – Support your service folks (maids, handyman, lawnmowers etc.) https://mymilieu.org/2020/04/02/supporting-service-folks-during-crisis/

Why is Coronavirus highly infective? https://wp.me/p7XEWW-1go

Additional Reading:

How do I know if I have a Coronavirus infection? Before reading further, I strongly advise and recommend that this should not be construed as advice. Your best recourse is your doctor or health care professional.

Doctors in China used a triage system for fast screening. This was published in the Lancet. Below flowchart from the Lancet.

COVID Symptoms Flowchart Lancet JPEG

 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117787/

. 2020; 8(1): e41.
Published online 2020 Apr 1.
PMCID: PMC7117787

Epidemiological and Clinical Aspects of COVID-19; a Narrative Review

WHY is COVID-19 HIGHLY INFECTIVE?

The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction).

Keeping my promise of sharing ACTIONABLE  INFORMATION, let me start with why COVID is so infectious.

Airborne Dispersal

MOSTLY, if not ALWAYS INFECTION:  After exposure to COVID-19 (Highly Infective). The Spikes which you saw on the surface of the virus have a high affinity with a receptor on the human cells (ACE2). The direct implications are a definite attachment and infection of the cell. Once it has latched on to the cell, it infests and starts replication (reproduction). Visit this Youtube for learning the virus replication. https://www.youtube.com/watch?v=J4BN4dARpio

What do I do as a common man?

Isolation (lockdown), using masks and following all CDC, WHO, NIH, State, and Local guidelines. Build a staging area outside the home, do not get the virus inside the home. All essentials should be cleaned appropriately before those get ingress into your home. Presume everything from outside is contaminated until cleaned.

2) Lysogenic phase: Breaking the cells after making thousands of copies (lysogenic phase). Please visit https://www.youtube.com/watch?v=sQ0ShukSA5I. 

What do I do as a common man?

Clean after contamination. I follow the below steps – outer clothes removed in the Garage and set for laundry immediately, shower with soap/shampoo, nose blow, and peroxide gargles. The last two steps remove any adhered viruses from inside the nose and throat.

3) Early Symptoms: Step 1 follows in thousands of new normal respiratory cells. Fever, Nasal Congestion, loss of smell (because the olfactory cells are affected). Cells start producing exudate (copious secretions).

What do I do as a common man?

Get tested and isolate from other caregivers from the family and friends. Stay isolated (if mild symptoms and or test positive) until results are available or at the least 15 days after the lasts symptoms. If required, seek immediate help. DO NOT SELF MANAGE (explanation later).

4) Initial Phase of Lung Congestion: The virus travels inside to the Lungs and infects the respiratory lining cells. Visit the below video to learn more https://www.youtube.com/watch?v=4HPlSm94czk. Also, see https://www.youtube.com/watch?v=Xj1nUFFVK1E.

5) Cytokine Storm: Huge secretion of fluids (doctors call this as Cytokine Storm) blocking oxygen exchange. Ventilators are required to support oxygenation. However, I have had first-hand reports that it is painful to watch patients struggling to breathe even on ventilators.

What do I do as a common man?

Seek early help, Please do not self-treat? Why – You may have a sudden catastrophic fluid collection in the lungs. What else do I do? Of course isolation and other guidelines to be used as required)

6) Acute Respiratory Distress Syndrome and Mortality/Morbidity: This is the most dreaded step.

What do I do as a common man? Be careful at the initial steps (1-3) (Shashank Heda, MD).

COVID19 Local Statistics

Rule of Thumb

Folks, my neighbor taught me one simple rule of thumb – What is essential? Can I survive without this? If I can, then it is not essential.

Can we – STRINGENTLY FOLLOW THIS?

  • ISOLATION (LOCKDOWN)
  • PROPER DECONTAMINATION
  • EARLY PROFESSIONAL HELP
  • SPREADING AWARENESS (ask questions if required)
  • SUPPORT SERVICE FOLKS
  • No COMPLACENCY (THAT I HAVE BETTER IMMUNE SYSTEM THAN OTHERS)

 

Stay Safe!

—    —    —    —    —    —

 

Based on the latest research from Nature and Cell BioSciences and analyzing the data (first hand) from Texas, I see it important to be all the stricter with isolation. Let me take a few issues individually.

Why SARS-CoV2 (COVID-19) is so dangerous?

Primarily because of the

1) Ridge on the S protein that allows it for tighter binding to the ACE2 receptor on the human cell
2) Suppression of antiviral immune response and
3) Concurrent activation of the pro-inflammatory response
Simply speaking – SARS-CoV2’s S protein (Spike protein) after binding with the ACE2 receptor on the human cell, changes its conformation to and goes into a tight affinity, primarily because of the ridge present on the S protein. That makes the SARS-CoV2 very infectious. Now, add to that, the florid inflammatory exudate (cytokine storm) and you get a double whammy. SARS-CoV is known to be exceedingly potent in the suppression of antiviral immunity and the activation of proinflammatory response.

Researchers are working to block the affinity of S protein or reduce the affinity. Another direction for research is controlling the cytokine storm. Our Milind is working on the Stellate Ganglion Block. You should bring him back here to ask more about them later.

Excerpt from Nature below (citations removed, reference link included) – A key to tackling this epidemic is to understand the virus’s receptor recognition mechanism, which regulates its infectivity, pathogenesis and host range. SARS-CoV-2 and SARS-CoV recognize the same receptor – human ACE2 (hACE2). SARS-CoV-2 receptor-binding domain (RBD) (engineered to facilitate crystallization) in complex with hACE2. Compared with the SARS-CoV RBD, a hACE2-binding ridge in SARS-CoV-2 RBD takes a more compact conformation; moreover, several residue changes in SARS-CoV-2 RBD stabilize two virus-binding hotspots at the RBD/hACE2 interface. These structural features of SARS-CoV-2 RBD enhance its hACE2-binding affinity. Additionally, we show that RaTG13, a bat coronavirus closely related to SARS-CoV-2, also uses hACE2 as its receptor. The differences among SARS-CoV-2, SARS-CoV, and RaTG13 in hACE2 recognition shed light on the potential animal-to-human transmission of SARS-CoV-2. This study provides guidance for intervention strategies targeting receptor recognition by SARS-CoV-2.

(Simplified – @ Shashank )

https://www.nature.com/articles/s41586-020-2179-y

—    —    —    —

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074995/

The origins of SARS-CoV-2 and COVID-19. To make a long story short, two parental viruses of SARS-CoV-2 have now been identified. The first one is bat coronavirus RaTG13 found in Rhinolophus affinis from Yunnan Province and it shares 96.2% overall genome sequence identity with SARS-CoV-2 [3]. However, RaTG13 might not be the immediate ancestor of SARS-CoV-2 because it is not predicted to use the same ACE2 receptor used by SARS-CoV-2 due to sequence divergence in the receptor-binding domain sharing 89% identity in amino acid sequence with that of SARS-CoV-2. The second one is a group of betacoronaviruses found in the endangered species of small mammals known as pangolins [4], which are often consumed as a source of meat in southern China. They share about 90% overall nucleotide sequence identity with SARS-CoV-2 but carries a receptor-binding domain predicted to interact with ACE2 and sharing 97.4% identity in amino acid sequence with that of SARS-CoV-2. They are closely related to both SARS-CoV-2 and RaTG13, but apparently they are unlikely the immediate ancestor of SARS-CoV-2 in view of the sequence divergence over the whole genome. Many hypotheses involving recombination, convergence and adaptation have been put forward to suggest a probable evolutionary pathway for SARS-CoV-2, but none is supported by direct evidence. The jury is still out as to what animals might serve as reservoir and intermediate hosts of SARS-CoV-2. Although Huanan seafood wholesale market was suggested as the original source of SARS-CoV-2 and COVID-19, there is evidence for the involvement of other wild animal markets in Wuhan. In addition, the possibility for a human superspreader in the Huanan market has not been excluded. Further investigations are required to shed light on the origins of SARS-CoV-2 and COVID-19

 

 

Supporting Service Folks during Crisis

We all have lawnmowers, handyman, maids, and others working with us regularly. During this COVID-19 crisis, all have a significant reduction in their work or most like you, are lockdown. It is frustratingly painful to run families during such times.

Service Support

Unfortunately institutionalizing any charitable donations in the US, suck up 80% of the revenue for their operations and maintenance. So, after giving a thought, I realized, the best way is to support our service folks directly, rather than any institutional donation. My best suggestion would be to support your folks. On the contrary, my support on the farm was busy with work to take care of him. I did not offer anything to him since he is already on the job.

Recently, I unconditionally paid money to my handyman and maid. Both were extremely thankful. My handyman just moved to Georgia and he was broke. It came at the best time. Our maid has to run a family of 3 kids as a single mom. She was extremely thankful. Both offered to work after this is over. However, I made no conditions for this support. Though I did not promise, I will do a similar amount in the next 2-3 weeks.

If you haven’t done it, now is the time to think of supporting, little in your own way. Let us support them to support their families. Indirectly, it helps the economy keep going.

Demystifying Fasting and Cancer

All faiths across the globe different faith from Zoroastrians, Buddhism, Christianity, Islam, Judaism, Taoism, Jainism, and Hinduism advocate fasting. Fasting is definitely helpful for health and longevity. Social media is abuzz with Fasting and how it treats cancer. There is a sudden surge of colloquial and rudimentary messages on health. Often, these are relied with credence when it comes especially from revered spiritual leaders. One such message is from Sadhguru, a highly respected spiritual leader. In this video, Sadhguru is talking about the ubiquitously presence of cancer cells in our body. To deter the spread of these cancerous cells, he is recommending fasting.

First and foremost, we need to visit the definition of cancer cells. A key characteristic of cancer cell is uncontrolled growth of cells that have accumulated genetic changes (mutations) due to a carcinogen (a cancer causing agent). Second, cancer cells are not goondas that collect in one place as they advance. In fact, as the cancer stage advances these cells spread across their site of origin. Third, fasting is helpful only in select cases, not every cancer. Also, fasting is helpful beyond cancer, however it depends upon the state of metabolism, activities, age, at the least.

While we need people like Sadhguru to bring the social transformation, we definitely want these messengers to provide a solid rationale that is resting on scientific pedestals, devoid of which we will create confusion and loss of credibility. In this article, I have provided a scientific rationale for understanding the causes of cancer and if fasting can help stop the development or progression of cancer.

Words 2492, reading time 9 – 12 minutes. Background in Medicine helpful.

This 2.34-minute video from Sadhguru is truly insightful.  In the below article, I provided the rationale for reconciling scientific understanding of Cancer and Diet with those Vedic practices that are proposed by Sadhguru. More importantly, scientific literature provides a mixed body of the rationale for dietary practice for cancer prevention and or treatment. To rephrase, dietary restrictions can be a feasible option for select cancers, NOT ALL the types of cancer.

I got this video from Singapore, from a good colleague with whom I worked several years ago. With deep respect and reverence to Sadhguru. I listened to this video wherein Sadhguru talked about cancer as –

1) Always present within the body and get stimulated because of stimulants and intoxication.

2) They get organized into one place and later become overwhelming for the body to counter.

3) That these cancer cells consume 27-28 times the normal calories.

His solution according to Yogic culture is –

1) Spacing meals 8 – 12 hours a day

2) Fasting once or twice a month

It immediately drew my attention to the landmark paper by Hanahan and Weinberg, in which the authors talked about ‘The Hallmark of Cancer”. As an Oncology fellow, I remember having read it at least 2-3 times as it was foundational and disruptive in 2000.

As undergraduates, we were tutored on the existence of Oncogenes (1970) and Tumor Suppressor Genes (1986) and Knudson’s two-hit hypothesis (1971). Then, it might have not had such a reminiscent influence on my mind, until I started my post-graduation in pathology. However, Hanahan and Wienberg’s paper was a step ahead in explaining the different pathways for cancer. It served me when I lead the exploratory search for the epigenetics (methylation of TSG) and downregulation of several caspases (genes) in the apoptotic pathway.

I was definitely perplexed when I read the version of Sadhguru on the existence and or progression of cancer for several reasons –

 

  1. I mentioned the key developments in cancer as a stepwise accumulation of mutations in the genes of the cancer cell. These mutations occur due to several factors called carcinogens – viruses, chemicals, hormones, persistent inflammation, UV radiations, etc. We also know that cancer can occur de novo due to improper repair mechanism or existence of germline mutation (mutation inherited from parents). However, stimulants and intoxicants (especially the former), are definitely not carcinogenic and intoxicants like alcohol are considered co-carcinogens, not directly implicated in the development of cancer causation. I especially exclude the 300 plus carcinogens found in cigarettes as a stimulant and include nicotine as the stimulant, which is not a carcinogen, as proven by ‘comet assay’.

I realized, like thousands of other researchers across the globe, that tumorigenesis is a multi-step process and follows a multistep pathway. Germline mutations (those acquired from parents) like BRCA1, BRCA2 or RB genes occur in hereditary cancers. We can call these as existing in all cells in folks who inherit them from parents. However, the percentage of germline mutations are minuscule, possibly representing less one percent of the population. For these hereditary acquired cancers, one single hit drives a normal cell towards cancer progression. Where, in a normal population, any mutation has to hit two times to drive the cells to cancer progression. This Two hit hypothesis was proposed by Knudson in 1971 and is the underlying mechanism for most genetic aberrations occurring in a normal population. Of note, cancer cells do not exist universally in our bodies unless those are inherited from our parents (a less than 1% probability).

TSG and Cancer

 

  1. Though we know that cancer cells consume most of the host nutrition, it is hard to believe that these (cancer) cells organize (like gangs of Goondas) and rob the body of the nutrition. In fact, it is the other way around. Cancer cachexia, a state common in terminal cancer, is primarily due to diversion of nutrition towards metastasized (spread out) cancer cells, not when they come together.

 

  1. The solution offered by Sadhguru, that we should fast at least once or twice to avoid cancer is so much inadequate if not wrong,  as we all know that those who fast frequently have cancer and those obese who are voracious eaters don’t necessarily have cancer (but other metabolic diseases).

 

I specifically mentioned ‘The Hallmark of Cancer” that was published in 2000. This paper made a major stride in advancing our understanding of cancer (the paper was revised by Hanahan and Weinberg in 2011). It is worth revisiting the 6 facets of the hallmark in the above illustration.

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Warburg Effect

Recently, a debate is intensifying on the existence of the mechanism of cancer causation other than carcinogen-induced genetic abnormalities. Immune modification and metabolic abnormalities have also been implicated. The later is called the Warburg effect. Warburg effect proposes that the cancer cells metabolize via the glycolytic pathway even in the presence of aerobic state instead of the much more efficient oxidative phosphorylation pathway.

Let us understand two aspects –

1) Does fasting help the initiation of cancer and

2) Once established and or advanced, will fasting help cancer to regress and or get into control?

Does fasting help cancer?

Recent Geroscience literature reveals that cancer and aging are characterized by dysregulated metabolism consisting of upregulation of glycolysis and down-modulation of oxidative phosphorylation. Based on the research on Geriatric patients, metabolic interventions have been explored as promising strategies to promote longevity and to prevent or delay age-related disorders including cancer.

Will fasting help regression and or control of Cancer?

Select metabolic intervention approaches include chronic calorie restriction, periodic fasting/ fasting-mimicking diets, and pharmacological interventions mimicking calorie restriction.  These are considered as adjuvant anticancer strategies, not the mainstay of cancer therapeutics. By adjuvant, I mean they are supplemented along with standard cancer therapy (chemotherapy, radiation, and targeted therapy). However, to summarize, calorie restriction is subjective and second, where it is effective, it has an adjuvant effect.

Animal studies (in rodents) have shown that chronic caloric restriction reduces and delays cancer incidence, and inhibits tumor progression and metastasis. Also, there is mounting evidence that cancer incidence and mortality are strongly reduced in chronic calorie-restricted non-human primates. Studies of long-term calorie-restricted human subjects have shown a reduction of metabolic and hormonal factors associated with cancer risk. However, chronic caloric restriction is not a feasible clinical intervention. Evident difficulties, such as the long period required to be effective, and unacceptable weight loss, hamper clinical application in cancer patients.

Autophagy: definition and mechanisms

In the 1990’s Yoshinori Ohsumi first proposed autophagy. He received a Nobel Prize in 2016 for Physiology or Medicine for his seminal work in establishing a morphological and molecular mechanism of autophagy.

Autophagy is an evolutionarily conserved lysosomal catabolic process by which cells degrade and recycle intracellular endogenous (damaged organelles, misfolded or mutant proteins, and macromolecules) and exogenous (viruses and bacteria) components to maintain cellular homeostasis. The specificity of the cargo and the delivery route to lysosomes distinguishes the three major types of autophagy –

  • Mircroautophagy involves the direct engulfment of cargo in endosomal/lysosomal membrane invaginations.
  • Chaperone-mediated autophagy (CMA) recycles soluble proteins with an exposed amino acid motif (KFERQ) that is recognized by the heat shock protein hsc70; these proteins are internalized by binding to lysosomal receptors (LAMP-2A) 6.
  • Macroautophagy (herein referred to as autophagy) is the best-characterized process; in this process, cytoplasmic constituents are engulfed within double-membrane vesicles called autophagosomes, which subsequently fuse with lysosomes to form autolysosomes, where the cargo are degraded or recycled. The degradation products include sugars, nucleosides/nucleotides, amino acids and fatty acids that can be redirected to new metabolic routes for cellular maintenance.

Autophagy occurs at basal levels under physiological conditions and can also be upregulated in response to stressful stimuli such as hypoxia, nutritional deprivation, DNA damage, and cytotoxic agents. Autophagy has attracted considerable attention as a potential target of pharmacological agents or dietary interventions that inhibit or activate this process for several human disorders, including infections and inflammatory diseases, neurodegeneration, metabolic and cardiovascular diseases, obesity and cancer.

Autophagy and cancer
The role of autophagy in cancer is complex, and its function may vary according to several biological factors, including tumor type, progression stage, and genetic landscape, along with oncogene activation and tumor suppressor inactivation. Thus, autophagy can be related either to the prevention of tumorigenesis or due to the enabling of cancer cell adaptation, proliferation, survival, and metastasis. The initial indication that autophagy could have an important role in tumor suppression came from several studies exploring the essential autophagy gene BECN1, which encodes the Beclin-1 protein that is frequently deleted in ovarian, breast and testicular cancer.

BECN1 is located adjacent to the well-known tumor suppressor gene BRCA1, which is commonly deleted in hereditary breast cancer. These deletions are generally extensive and affect BRCA1 along with several other genes, including BECN1, suggesting that the deletion of BRCA1, not the deletion of BECN1, is the driver mutation in breast cancer. Furthermore, the activation of oncogenes (e.g., PI3KCA) and inactivation of tumor suppressors (e.g., PTEN and LKB1) are associated with autophagy inhibition and tumorigenesis. Animal models note that the tumor suppressor function of autophagy is associated with cell protection from oxidative stress, DNA damage, inflammation and the accumulation of dysfunctional organelles. Collectively, these phenomena are important factors that could trigger genomic instabilities leading to tumor development.

However, the loss of function of autophagy genes has not yet been identified and demonstrated in humans, raising doubts about the relevance of autophagy to tumor initiation in different types of cancer. In addition, the autophagic machinery is not a common target of somatic mutations, indicating that autophagy may have a fundamental role in the survival and progression of tumor cells.

Once the tumor is established, the main function of autophagy is to provide a means to cope with cellular stressors, including hypoxia, nutritional and growth factor deprivation, and damaging stimuli, thus allowing tumor adaptation, proliferation, survival, and dissemination. Autophagy, by degrading macromolecules and defective organelles, supplies metabolites and upregulates mitochondrial function, supporting tumor cell viability even in constantly stressful environments. Studies have demonstrated that autophagy increases in hypoxic regions of solid tumors, favoring cell survival (a factor that does not favor fasting to help cancer regression and or cure).

The inhibition of autophagy leads to an intense induction of cell death in these regions. Moreover, tumors frequently have mutations or deletions in the tumor suppressor protein p53, which also favors autophagy induction to recycle intracellular components for tumor growth. Although the basal autophagy rate is generally low in normal cells under physiological conditions, some tumors show a high level of basal autophagy, reinforcing the prosurvival role of autophagy in cancer. RAS-transformed cancer cells undergo autophagy upregulation to supply metabolic needs and maintain functional mitochondria, which in turn favors tumor establishment. Autophagy also has a supportive role in metastasis by interfering with epithelial-mesenchymal transition constituents to favor tumor cell dissemination. Finally, studies have demonstrated that autophagy is commonly induced as a survival mechanism against antitumor treatments, such as chemotherapy, radiotherapy and targeted therapy, contributing to treatment resistance.

How does dietary restriction modulate autophagy and cancer therapy?

Autophagy and cancer therapeutics have a mixed relationship. Because autophagy can inhibit tumor development or favor tumor growth, progression, invasion and treatment resistance, researchers proposed that autophagy modulation could be a new therapeutic strategy in the treatment of some malignancies. In preclinical studies, dietary restriction (DR) has been shown to extend the lifespan and reduce the development of age-related diseases such as diabetes, cancer, and neurodegenerative and cardiovascular diseases. DR promotes metabolic and cellular changes in organisms from prokaryotes to humans that allow adaptation to periods of limited nutrient availability. The main changes include decreased blood glucose levels and growth factor signaling and the activation of stress resistance pathways affecting cell growth, energy metabolism, and protection against oxidative stress, inflammation, and cell death. Nutrient starvation also activates autophagy in most cultured cells and organs, such as the liver and muscle, as an adaptive mechanism to stressful conditions.

Studies demonstrate that dietary interventions can reduce tumor incidence and potentiate the effectiveness of chemo- and radiotherapy in different tumor models, highlighting dietary manipulation as a possible adjunct to standard cancer therapies. Among the many diet regimens that have been assessed, caloric restriction (CR) and fasting are the methods under intense investigation in oncology. CR is defined as a chronic reduction in the daily caloric intake by 20-40% without the incurrence of malnutrition and with the maintenance of meal frequency. In contrast, fasting is characterized by the complete deprivation of food but not water, with intervening periods of normal food intake. Based on the duration, fasting can be classified as –

(i) intermittent fasting (IF—e.g., alternate day fasting (≥16 hours) or 48 hours of fasting/week) or
(ii) periodic fasting (PF—e.g., a minimum of 3 days of fasting every 2 or more weeks).

Conclusion

Every stride in translational medicine helps in advancing our understanding of cancer and subsequently, the management of this malady. However, when a person of Sadhguru’s respected stature talks about fiction based on Yogic culture, we tend to degrade our Yogic culture and deprive the credibility of our repute.

However, as stated earlier, there is a mixed bag of information on dietary restriction and cancer prevention or treatment. 

There is a perfect need for interpreting a way of life (Sanatan Dharma and its various plural forms of ideologies for a living). I accept and understand that ancient Vedic science stood on significantly advanced scientific thinking, however, our times are different and we should rely on the current body of knowledge and refine our thinking of ancient yogic culture.

Note: I believe in providing direct feedback. I made an attempt to reach Sadhguru’s office at Coimbatore. No one answered. Possibly, I will make a few more attempts.

Citations:

http://cubocube.com/dashboard.php?a=1582&b=1585&c=1

Effect of short term fasting on cancer treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530042/

Autophagy and intermittent fasting: the connection for cancer therapy? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257056/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608686/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648937/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442682/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107564/

Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment – A Review (2015)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553893/

https://www.britannica.com/topic/fasting

 

Detecting Fake Pills

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

I read this interesting article from my IEEE Spectrum subscription and I immediately correlated that with my recent experience of fake or substandard pills. The magnitude of the problem is humongous. Diabetic medicines that are not effective, to cancer cells that are not killed completely and eventually escape to proliferate further and become out of control to seemingly innocuous infections that are treated not with adequate dose (MIC levels). Sometimes, it scares me to think a patient dying because he had inadequate dose of chemo, and who knows, the antibiotic resistant bugs have evolved due to human greed. It is a massive industry fraud and the entire supply chain is involved.

Fake Pills

In my experience, substandard medicines are not just common in developing and underdeveloped nations. Recently, I took my pills for evaluation to Walgreen’s, a major pharmacy retailer, to inform them that the medicine I got from them was not effective, that a similar pill from another brand was effective and that, another patient, who was given a pill with same but one quarter ingredient had matching size. They evaluated and informed that the manufacturer from China was discontinued. However, their tracking was impressive, there was a alpha numeric inscribed on the tablet, which was visible only with a lens. This Alpha numeric correlated with the source and manufacturer.

It’s no exaggeration to compare illicit medicines with the nuclear and biological weapons of mass destruction we all fear. These WMDs, though, are largely aimed at people in poor countries who are already facing a multitude of social and economic ills. Sadly, these “track and trace” approaches suffer from a fundamental shortcoming: They authenticate the package, not its contents. A package of medicine is assumed to be genuine simply because it has a valid security mark. Unscrupulous manufacturers can readily circumvent such measures by putting the wrong stuff in the right package. And these approaches offer no help in detecting degradation.

When you purchase medicine at the drugstore, you assume that it’s what you think it is and that the active ingredient in the drug is present in the specified concentration. Unfortunately, your assumption might be all wrong. Counterfeit and substandard medicines have become widespread, particularly in low- and middle-income countries with weak regulatory systems. Indeed, according to the World Health Organization (WHO), one out of 10 medicines sold in developing countries should be considered “substandard.” Your drug could even be an outright fake.

Using a physical phenomenon called nuclear quadrupole resonance (NQR), you can test your pill and eat it, too. Nuclear quadrupole resonance requires an atomic nucleus with a nonspherical distribution of positive electric charge, which creates an electric quadrupole moment. The word quadrupole refers to the four electric poles that produce an equivalent nonspherical charge distribution when added to a set of spherically distributed charges. The electronic tester measures the NQR response of the sample at different frequencies. The resulting NQR spectrum is generated by energy transitions within the atomic nuclei of the chemical, providing a unique fingerprint for that compound. Nuclear quadrupole resonance is useful for testing specimens that are solids or powders, but not liquids. While that’s an obvious limitation, NQR has a lot of other things going for it. In particular, it’s insensitive to the presence of coatings or packaging materials. So it can be used to examine pills while they’re still in the bottle or blister pack. Indeed, it could be used to test an entire shipping carton of such bottles or packs, or a drum of powdered material. What’s more, the equipment could be built at low cost and would be amenable to miniaturization. And because NQR instrumentation relies on radio waves of relatively low frequency and power, it is inherently safe and could be used without special training. The prototype drug-­authentication device is portable, performs measurements automatically, and doesn’t require any special skills to operate. It could thus be used anywhere in the drug supply chain. It is estimated that such a device could be manufactured at a cost of about $100, which would, presumably, translate to a price for the end user of less than $1,000.

Credits –

The technology was invented at Nanoscape Research Laboratory Florida and Case Western University by Swarup Bhunia, a professor of electrical and computer engineering at the former, and Soumyajit Mandal, an assistant professor of electrical engineering and computer science works at the later, where he oversees the Integrated Circuits and Sensor Physics Lab. This article was published on August 21, 2019 in IEEE Spectrum and was accessed from my account. Excerpts are copied and credited.

https://spectrum.ieee.org/biomedical/devices/detecting-fake-pills-with-nuclear-quadrupole-resonance

Identifying Rapid Spread of Flesh Eating Infections

 

Thought of sharing this news since it may be a common occurrence if exposed to the bugs in hot swimming pool or any contaminated body of water with open wound.

A woman in her 70’s got flesh eating infection after a usual bruise and succumbed to her wounds. In medical parlance, this is called ‘Necrotizing Fasciitis’. Seemingly a small wound, the bacteria enter the body and start irreversible destruction of the soft tissues.

How do we identify and how to prevent?

The infection often spreads very quickly. Early symptoms of necrotizing fasciitis can include:

  • A red or swollen area of skin that spreads quickly
  • Severe pain, including pain beyond the area of the skin that is red or swollen
  • Fever
  • Ulcers, blisters, or black spots on the skin
  • Changes in the color of the skin
  • Pus or oozing from the infected area
  • Dizziness
  • Fatigue (tiredness)
  • Diarrhea or nausea

How to spot necrotizing fasciitis early on? Watch for –

  • Changes in skin color
  • A rapidly spreading inflamed or swollen area of the skin
  • Severe pain, including pain beyond the area of the skin that is red or swollen, and
  • Fever

Who is prone to Flesh Eating Bacterial Disease? Those with weak immune system are more prone to this disease:

  • Diabetes
  • Kidney disease
  • Scarring (cirrhosis) of the liver
  • Cancer

What to do if you suspect Necrotizing Fasciitis?

Clean wound with clean water, possible use soap and contact a medical facility to evaluate and manage. In my experience, Hydrogen Peroxide works great. Anytime, you have a cut bruise or bleed, washing with clean water and thereafter with peroxide, will remove all the dead tissues and bacteria.

https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html

https://www.cnn.com/2019/07/01/health/flesh-eating-florida-woman-trnd/index.html

The Ailment – Part 1

Intelligence (and great analysis) is not leadership, that’s what we have in many leaders currently. We have intelligent self-serving folks, focused on themselves with no ability to risk their own popularity with outcome from a tough strategic decision. These folks are less connected with the root cause rather than the rhetoric and who think the rules don’t apply to them. They maintain and operate through a coterie and bunch of sycophants. Why should a coterie or follower, follow them if these leaders can’t provide them any benefit? That last word, ‘Benefit’ is important. Corrupt leaders know that they need to benefit their coterie, that’s why they encourage corrupt folks under them. It thus forms an ecosystem of corrupt, a self-serving politico-corrupt ecosystem. Thus a contagious bad apple effect percolates within the ecosystem they create.

This four point proposal was after a long reflection of the underlying dynamics of frustrations, prevalent at that time. It was a synthesis after a long deliberation and evaluation of several socially disadvantaged people not getting the benefits. Now, after 34-35 years, we see that ‘Akrosh’, that ‘Udrek’ that resentment so intense. May be something should have been done long back, on lines similar to what I proposed in 1985-86.

Not too long back, during the independence struggle, the leaders had the stature and commanded respect from their populace. Their character traits encompassed selfless, dedication and benevolent acts overarching all humanitarian pursuits, notwithstanding their religious, ethnic or regional affiliations. They had a collective vision and a dedication to drive towards that common shared common destiny. Masses respected, supported and followed these leaders. Remember, revolutions are borne out of the hungry stomach or incessant injustice. That hunger and or injustice was pervasive. Masses were looking for someone with those aforementioned qualities. These were not born, not charismatic, but they earned that respect through these traits.

Equality Versus Equity

Tienanmen were quashed because the economy and opportunities were booming. People have a certain level of tolerance (also called as resilience), to such inadequacies if they are busy with their lives. Over a period of time, social values degraded and that zest to lead fell to decadence. An element of that vacuum of dedicated leaders was filled in by leaders needing sycophants, because they were intrinsically weak, lacked that innate leadership quality and that organic connect with the masses. These leaders were intelligent though, and let me say, intelligence is not higher education. I have seen visionary leaders and able administrators who had a grasp of the state and benefited the masses.

Unfortunately, Rotten Apples are intelligent

Again, intelligence (and great analysis) is not leadership, that’s what we have in many leaders currently. We have intelligent and selfish folks who are self-serving, focused on themselves (with no ability to risk their popularity and voter outcome), less connected with the root cause rather than the rhetoric and who think the rules don’t apply to them. Why should a coterie or follower, follow them if it does not benefit? That last word is important, ‘Benefit’. Corrupt leaders know that that’s why they ignore corrupt folks under them. It thus forms an ecosystem where there is a hierarchy of corrupt, within a self-serving ecosystem. Thus a contagious bad apple effect percolates within the ecosystem they create.

This nurtures a system that becomes hollow and eroded inside. Gradually, it becomes a norm, culture, and way of life. We never realize how we landed in this state of despair. I am not very hopeful that any change of political party, banner or face will change anything. It is a system problem and they have to get aligned or be ejected, like an allergen or a thorn, out of the body. In a doctor’s parlance, incompatible organs get rejected. That’s what will happen if a different hue (party, banner or face) will try to do.

An often asked question – can intelligence or education make a difference? The answer is obvious.  I definitely rue the state of Indian affairs. It’s Matrubhumi, a place for identity and despite, a place we, unfortunately, left behind, but our heartaches and it swells with pride when a rocket is launched or an extraordinary achievement is done.

I can write about the recent demonstrations against reservation (affirmative action), against aggravated nationalism, about religious intolerance, about the current generation as a legacy of our evolved culture. I find the current state in ruins but should we be hopeless? Definitely not and if you ask me, why? I don’t have a reason to justify (given the state of affairs) but I have a deep trust that India will rise. Time alone is an answer and that we are seeing events in time snapshot, like a frozen frame (in time).  That trust within us and that faith in those founding principles laid by the moldings from Sanatan dharma will see it rising like a sphinx. Time alone is an answer, probably you and I won’t survive to see that, but that will happen, not with dreamy eyes but a reality and of course, I am not making a prophecy so that also means we have to make concerted efforts in that direction.

That ‘WE’ of Nationhood

That WE are important (that I am very is very dilapidated in front of that WE). That WE include this huge diversity – of regions, religions, ideologies, aspirations, ethnicities, etc.). Exclusion is formidable and incompatible to us as a nation. Inclusion is our ethos and when we walk together, we make that WE and a great nation. The path is long but achievable and we are making those strides.

Change is imminent and change is required. We have to dismantle old models, reinvent ourselves and make gargantuan huge machinery that works in unison, completely in sync. Change to ‘reservation (affirmative actions)’, ‘radical ‘religious right-wing’ movement, innovation in farming, creating locally dispersed opportunities (and consequently, labor) are few things that need prioritization.

We are simultaneously beset with several cultural blocks. We lack a concerted national vision, and unfortunately, we don’t realize that our very existence is under that nation. Religion, ethnic, family, regional and language ties come later, after that national vision. Right now, it is reverse, we care for our compatriot even if she/he is corrupt or inapt, we care for our ethnic or religious group despite knowing those are on flawed grounds, so also, we struggle to oppose kinship. However, we hate a specific ethnic group. We have biases and prejudices and prototypes, and we call them Marwadis or Gujjus, etc. That rhetoric has continued to build over the last 70 years. We have to end this schism. That’s just one prejudice.

Affirmative Action – a palpable ailment

We also have to remember, collectively as a society, we have exploited a class or strata and it is our collective responsibility to undo that injustice. If affirmative action was inscribed in the constitution, it was envisioned to bring this huge swath of populace into the emerging sense of nationality. Those who haven’t been the beneficiaries of this action, often insist that affirmative action was planned for only a decade. I often rue, is a decade enough to roll back the changes that have been inflicted for centuries now? I strongly feel, though the vision was carved into the constitution, it was only more a vision and those visionaries lacked creativity in rolling out a plan to understand the dynamics of how it would unfurl over decades amongst the diverse growing masses.

In 1985-86, during college elections, I saw casteism for the first time. Medical College Student elections were contested on caste affiliations, they would call it packing. Like packs of caste based groups aligned to vote as en lot. We were the first batch to start Non-Casteist Panel (NCP before Sharadrao coined that term 🤓). However, I was fortunate to be closer to one of the sons of a prominent leader from socially disadvantaged class. He and I had open discussions on caste based reservations. I proposed that’s 1985-86, I proposed below items for changing the reservation. I cited his own example.

The Four Point Proposal –

  1. One reservation for graduation, one for the job.
  2. If you get the job/education without reservation, that credit can be saved for that individual, which he can enjoy anytime.
  3. Once a family is elevated with reservation benefits, they exhaust the benefits for the next generation.
  4. The reservation percent would stay the same, not decrease so that other layers within their society get the benefit.

This four-point proposal was a long reflection of the underlying dynamics and frustrations, prevalent at that time. These came as a synthesis after long deliberation and evaluation of several backward communities not being benefited despite a robust reservation program. Now, after 34-35 years, we see that ‘akrosh’, that ‘udrek’ that resent growing intense. May be something should have been done long back, on lines similar to what I proposed in 1985-86.

Today, we see an all pervasive, festering frustration. Millennia of new generations are born from whom opportunities are not alone deprived but we are creating a schism and a divide with our rigid reservation system Where is this heading?

tmg-facebook_social

The answers are unlikely to be simple, so also they are unlikely to be acceptable to all. That does not mean we leave those alone, untouched because reworking would land us in controversy. Irrespective of the current ruling regime – Congress, BJP, or any combination thereof, all have decided not to open this Pandora box. They are afraid, the bees would bite most to those who are closer to the reworking the problem. However, as time stands today – no political entity or character has the creativity, ability, capacity or vision to solve this festering problem.

Two moot points of learning from this national affirmative action program –

  1. Good intention is not enough, a leader needs to be a visionary to unravel such a deeply impactful program will unfurl over a period of time. Articulate and dynamic leaders are required to unleash and embed a program of such national importance.
  2. Such initiatives should be time-bound and change to understand, include and assimilate the diverse needs of times.

Except for good intent, both these characters were lacking when these reservations were made. Time and events can’t be undone, however, it is still time to make decisive actions and roll out changes that are commensurate with the needs of the current time.

—-

Updated on May 22, 2019

We are so incorrigible to the core that we hardly want to see a perspective beyond ours if in the process; we have to give away our benefits for the wider good. Such issues are not uncommon in advanced economies; however, they strive to find an innovative solution with a sincere intent to benefit those who are at the receiving end.

Citing a recent example from SAT, an exam conducted in the US for admission to colleges. Over a period, people have tried influencing and getting the best for their wards but the system has evolved and stopped those mutations.

You might have heard an example of how influential parents bribed their way into prestigious colleges. So also, those safeguarding and defining the system have modified it to provide a benefit to those students who struggle in adverse situations. This is similar to the picture I uploaded in my blog, wherein these new laws are implemented to create an equal playing field for those coming from an adverse situation.

They call it ‘Adversity Score’ and those students facing such disadvantage get additional scores to make these students stand on the same pedestals as those who are from an affluent background. This is worth reading.

Link below https://www.brookings.edu/blog/the-avenue/2019/05/17/students-need-more-than-an-sat-adversity-score-they-need-a-boost-in-wealth/?utm_campaign=Brookings%20Brief&utm_source=hs_email&utm_medium=email&utm_content=72802588

While reservations have created another chasm in society by creating an artificial class of sufferers, such things can be mitigated by creating a mechanism similar to ‘Adversity Score’ for SAT. However, I am staying away from making any recommendation as it needs a thorough understanding of the root cause. It is upon those who strongly feel the need for a change of reservation system to evaluate and come up with an action plan.

http://bharatkalyan1.rssing.com/chan-6237423/all_p343.html