The Tribune, Chandigarh, India

Catching Hasan Ali
Judges must be discreet while passing obiter dicta

THURSDAY, March 3, was an important day for the Supreme Court of India. While a three-member Bench headed by Chief Justice S.H. Kapadia quashed the appointment of Mr P.J. Thomas as the Central Vigilance Commissioner, another Bench comprising Justice B. Sudershan Reddy and Justice S.S. Nijjar pulled up the government for its inaction on black money. Specifically, it expressed its anguish over the manner in which Hasan Ali Khan was roaming free even though he had allegedly stashed away around $8 billion in foreign banks and had been served a tax notice for Rs 40,000 crore. “What the hell is going on in this country?”, thundered Justice Reddy. When senior counsel Anil Divan blamed the Enforcement Directorate (ED) for giving repeated adjournments, Justice Reddy observed that “the authorities were hoodwinking everybody” and wondered whether the same leniency would be shown to petty offenders.

The judges were unconvinced with Solicitor-General of India Gopal Subramanium’s explanation citing the measures being taken by the Centre against offenders like Hasan Ali Khan and asked him why he was not subjected to custodial interrogation so far. Interestingly, when Mr Anil Divan submitted that three key officials probing Khan’s case had been peremptorily transferred, the court ordered their immediate reinstatement. Going a step further, Justice Reddy made it clear that if the government’s response to the court’s directions was not satisfactory, he would pass an order on March 8 and appoint a special officer for supervising the probe.

Admittedly, the Supreme Court’s pro-active approach in this case seems to have worked because Mumbai’s Enforcement Directorate has now summoned Hasan Ali Khan on March 7, a day before the Centre is expected to explain to the court about its efforts to nab him. The judiciary’s anguish over the state of affairs and the need to set things right is understandable. However, the judges ought to be discreet while passing obiter dicta (an opinion voiced by a judge that has only incidental bearing on the case in question and is, therefore, not binding or forms a part of any ruling or judgment). Otherwise, it would send wrong signals and may even disturb the delicate constitutional balance between the judiciary and the executive. Obiter dicta by themselves are not legally significant though these may have evolved as a routine part of jurisprudence worldwide. But the judges ought to tread with caution while dealing with top functionaries like the Prime Minister as also the executive and the legislature.

Spare Bhagat Singh
Don’t politicise martyrdom

Punjab politicians are falling over one another in a distasteful way to cash in on the mass appeal of Shaheed Bhagat Singh. This year his martyrdom day on March 23 is set to witness unseemly acts of political one-upmanship. The Congress and the Shiromani Akali Dal are all mobilising their supporters to converge at Khatkar Kalan, the martyr’s birthplace in Nawanshehr district of Punjab. Former Finance Minister Manpreet Singh Badal’s decision to launch a political party on March 23 at Khatkar Kalan had led the two major political parties of Punjab to organise similar shows of strength. However, Manpreet Badal has wisely postponed the launch of his party to March 27.

It is amazing how Bhagat Singh’s appeal has grown over the years and across the political spectrum. Earlier, the Leftists and Naxalites drew inspiration from him. Bhagat Singh had embraced Marxism in his later years and wanted India to be a socialist state. Though Rajguru, Sukhdev and Bhagat Singh had rejected Irish-style terrorism and favoured the path of Marxist-Leninist revolution, Punjab militants killed innocents, while blindly worshipping Shaheed Bhagat Singh. A religion-based party like the Akali Dal too swears by the revolutionary, who wrote an essay “Why I am an Atheist” while on death row.

Bhagat Singh had differences with Mahatma Gandhi over non-violence and also with other Congress leaders like Jawaharlal Nehru. Yet he conducted himself with dignity in public life. He held conferences, published pamphlets and posters to spread his message and not to run down opponents. The dropping of the bomb in the assembly, the hunger strike in prison to uphold the rights of prisoners and the final trial were all aimed to draw public attention to his ideas. While remembering the Shaheed-e-Azam, politicians should ensure that the sombre mood of martyrdom is not marred by petty political attacks on the pattern of what happens every year during the Jor Mela at Fatehgarh Sahib and the Maghi Mela at Muktsar.

Thought for the Day

Writers seldom choose as friends those self-contained characters who are never in trouble, never unhappy or ill, never make mistakes, and always count their change when it is handed to them. — Catherine D. Bowen

ARTICLE

Defence in times of resource crunch
Ample scope to improve capabilities
by N.S. Sisodia

In India’s 2011-12 Budget, Finance Minister Pranab Mukherjee has allocated Rs.1,64,415 crore ($ 36 bn) for Defence. An increase of 11.59 per cent over the budget estimate of Rs 1,47,344 crore for fiscal 2010-11, this amounts to just 1.8 per cent of the country’s gross domestic product (GDP).

According to the Stockholm International Peace Research Institute (SIPRI) database, India is among the world’s 10 highest military spenders. However, its per capita defence expenditure is the lowest among the world’s top defence spenders. Even as the percentage share of the GDP, India’s defence expenditure has been lower than the global average.

Many defence experts consider 2011-12 outlay highly inadequate, given India’s dangerous neighbourhood. Pakistan is drifting into a chaotic state, while West Asia’s turmoil seems to be getting more complex. The experts’ biggest concern is China’s growing assertiveness and huge military budget. According to SIPRI Year Book 2010, India’s military expenditure has grown from $ 22 bn in 2000 to $ 37 bn in 2009, whereas China’s has more than tripled during the same period, from $ 31 bn to $ 99 bn.

In this context, critics of India’s defence budget argue that it should have been a minimum of 3 per cent of the GDP. Such an expectation was, of course, unrealistic. Finance Ministers have to deal with a difficult challenge of balancing competing demands. In Mr Mukhejee’s case, he had to address the worrying fiscal deficit and also meet a number of vital requirements of sectors like education, health and agriculture. He has, however, assured that “any further requirement for the country’s defence will be met”.

This outlay needs to be viewed in the context of the chronic problem of underutilisation that ails the Defence Ministry. While examining the expenditure pattern in the years 2006-07 to 2009-10, the Sixth Report of the Standing Committee on Defence observes: “…notwithstanding the growth in the allocation, there is underutilisation of the allocations made to them (services) in all the years.” Therefore, while advocating a higher outlay, the critics need to keep in view the current spending capacity of the defence establishment. A 3 per cent share of the GDP will amount to over Rs.2,69,000 crore, a jump of over Rs 1 lakh crore, which will be a wholly unrealistic outlay, as much of it will have to be surrendered. There is certainly a strong case for enhancing the defence outlay, by stages, to around 2.5 per cent of the GDP, but first the spending capacity of the defence apparatus will have to be augmented on the basis of a sound long-term national security strategy and capability development plans.

The good news from the Defence Ministry is that last year it was able to fully utilise and, in fact, exceed its capital budget, meant chiefly for modernisation. Another positive feature is the growing share of the defence budget’s capital outlay. The revenue-to-capital ratio was just 74:26 in the ninth defence plan; it increased to 63:37 in the tenth defence plan and this year nearly 42 per cent of the defence budget has been allocated to the capital head. This trend indicates an increasing emphasis on defence modernisation.

Even within the constraints of a relatively modest defence budget, there is ample scope to improve the country’s defence capabilities. The same resources can be innovatively applied to much greater effect. Substantial scope exists for securing greater value for money by harnessing the great potential of India’s domestic industry. This would need sharing adequate information about capabilities (not equipment) required in the future, formulating broad specifications or qualitative requirements in consultation with the industry and encouraging the domestic private industry to participate in the procurement process. The manner in which specifications are currently formulated, most prospective Indian vendors get excluded from the competition. As in the developed countries, our defence forces will also have to learn the art of effecting performance - cost trade-offs and not always aspire for the most perfect equipment or weapon systems. Experience shows that reasonable compromises at the margins of performance parameters can result in huge time and cost savings and enable the local industry to enter the market presently monopolised by a handful of dominant global players.

The second innovation can be to outsource logistics, product support and maintenance to the industry to the extent possible. This measure can lead to greater efficiencies and cost savings. It is a growing practice in the West. There is no need to own and manage non-core services, if these can be handled by industry or service providers. This practice will also lead to substantial savings in terms of smaller inventories and minimising their obsolescence.

A third measure should be reform in project and process management combined with the intelligent use of information technology (IT). IT can greatly improve inventory management, logistics and in general decision -making. A major problem affecting many sectors in the country, including defence, is inordinate delays in project management. Given the huge outlays in defence, the cost of delays is particularly prohibitive. Speedier processing of major programmes and efficient project management can generate substantial resources for defence which can then be deployed for other vital capabilities.

While a robust defence for the country requires more money, it is perhaps equally important to secure maximum value from the available resources.

The writer, Director-General, Institute for Defence Studies and Analyses, was a Secretary in the Ministry of Defence.

MIDDLE

Uncle Pai
by Sai R. Vaidyanathan

Where do you get so many mythological and historical examples from?” This is an oft-repeated question that many respondents ask me.

After having written about 80 episodes of Happiness@work, a weekly column in The Tribune, I confess it is all due to my guru Uncle Pai.

Though I never met him (and now, I never will. He passed away on February 24), he taught me much more than many of my school teachers put together did. Through his Amar Chitra Kathas (ACK) and Tinkles, he imparted unforgettable lessons to me in English, mythology, history, science and drawing. And all in good fun.

“Tell your son to practice drawing at home. He is not good at my subject,” my arts teacher in school had told my father at the parent-teacher meeting. And the first drawing I copied was Abhimanyu, the 16-year-old hero in the Mahabharata, from the ACK title by the same name.

The figures, colours and the scenes had me hooked on for long with the result that I turned out on top in the technical drawing class during my engineering.

For me, he was more than a distance educator. He was a freedom fighter. In his own sweet way, he repaired the damage done by the British education system that told us that we were only worthy of being slaves.

Uncle Pai’s titles infused fresh life into Indian heroes right from Chandragupta Maurya to Shivaji to Mahatma Gandhi.

To an India that had embraced secularism after Independence, he made sure we didn’t forget our rich religious past through titles like Guru Nanak, Buddha and Kabir. After all, no other country is the birthplace of four religions - Hinduism, Buddhism, Jainism and Sikhism.

And he did to Ved Vyas what Ved Vyas did to the Vedas - simplified these for the masses. The ancient seer, who rearranged the Vedas in their present form millenniums ago, wrote their essence for popular consumption in the form of the Mahabharata.

Anant Pai, through his sketches and colours, made the consumption of epics like the Mahabharata (and Ramayana) far easier for us children.

Many years ago, our household was abuzz. A letter from Uncle Pai had arrived. My entry about a real-life incident had been selected for Tinkle’s feature, “This happened to me”.

A few weeks later, a book of children’s stories arrived with a “thank you” letter signed by Anant Pai. It still adorns my bookshelf.

Thank you, Uncle Pai.

OPED HEALTH

Breast cancer is a multi-factorial disease, with the risk factors ranging from the hormonal to the genetic. A timely diagnosis is crucial for curbing and curing it. Some guiding points…
Breast cancer: Causative factors and concerns
Geeta Pandya

Cancer is a disease in which the cells in the body grow uncontrollably. Rapidly growing cells form a lump or a mass called a lesion or a tumor. A tumor can be malignant (cancerous) or benign (non-cancerous).

When cancer spreads from one part of the body to the next it is called 'metastasis.'`85

Risk factors

Certain diseases have well-established risk factors. Smoking, for example, can lead to lung cancer; tobacco chewing is responsible for the cancer of the tongue; increased cholesterol is known to cause heart disease.

However, in the case of breast cancer, a definite cause is hard to arrive at. Breast cancer is a multi-factorial disease, with many risk factors, which may interact in a manner that is not clearly understood. Nearly, 70 per cent of patients with breast cancer do not mirror any of the perilous choices or conditions associated with the disease.

However, there are some factors that add an element of risk.

We can list them under one of the five categories.

n General risk factors

n Hormonal risk factors

n Genetic risk factors

n External risk factors: diet, environmental, or behavioural issues

n Stress

General risk factors

n Gender: A woman by virtue of being a woman is at a higher risk for breast cancer. However, a small percentage of men can also develop this disease.

n Age: Children do not get breast cancer. However, it is difficult to say precisely after what age a woman is more likely to get the disease. We used to think that women under the age of 35 did not get breast cancer. However, it has been increasingly seen in younger women in their late 20s and early 30s. The youngest patient I diagnosed with breast cancer was a girl who was 28 years old.

However, cases are reported of even

those as young as 25 years.

n Menstrual cycle: There is no relationship between breast cancer and the pattern of the menstrual cycle whether regular, irregular, scanty or heavy. However, the age at which menses start, and the age at which menopause occurs has some significance. This will be further discussed under 'hormonal risk factors'.

n Breast feeding: It is a common belief that a woman who cannot or does not breast-feed her child has a higher likelihood of getting breast cancer.

n Alcohol: Regularly drinking more than 1 unit of alcohol per day slightly increases the risk of breast cancer.

n Breast conditions: Certain breast conditions like atypical hyperplasia can increase the risk of developing breast cancer.

n Obesity: Being overweight later in life increases the risk of breast cancer. This is because when a woman's ovaries stop producing estrogen after menopause, fat cells become the main source of estrogen. Thus, obese women are exposed to more estrogen than their body can handle, which can stimulate the growth of abnormal cells.

n Family history: A strong family history of breast cancer increases the risk of developing the disease.

n Sexuality: Lesbians are at a greater risk of having breast cancer than those in heterosexual relationships.

Hormonal risk factors

Hormones, especially estrogen, play a huge role in the development of breasts. They also control menarche (the onset of the first period), cyclic changes during menstruation, and are closely related to the development of menopause.

Estrogen is often identified as the main culprit responsible for breast cancer. The breasts, as we had discussed earlier, have estrogen and progesterone receptors. The hormone estrogen stimulates the breast estrogen receptors, leading to a proliferation of these cells. Thus, whenever there is an excessive amount of unopposed estrogen the risk of breast cancer increases. This is especially seen under the following circumstances:

Menstruation: When menstruation starts early, especially before the age of 12, a girl is at a higher risk of developing breast cancer.

Menopause: When menopause starts late, after the age of 55, again, a woman is at a higher risk of developing breast cancer.

Pregnancy: There is a theory that between menarche and the first pregnancy, the breast tissue is sensitive to carcinogens. Thus, if a woman has never been pregnant or gets pregnant after the age of 30, she is at a greater risk of getting breast cancer.

Weight: If the woman concerned is overweight, and especially if she has excess fat around her waist, the hormone estrogen gets stored in such fat and this increases the risk of breast cancer.

Hormone replacement therapy: If the patient has gone through hormone replacement therapy (HRT), without regular check-ups, she is at a higher risk of breast cancer, as stated in reports of a study of HRT, in July 2002.

Certain birth control pills: In the past, when birth control pills had just reached medical counters, they came with high levels of estrogen, which made pill-consumers more susceptible to breast cancer. But over the past four decades, the amount of estrogen in the pill has reduced substantially.

Also progesterone given with estrogen, opposes estrogen, and makes the ovaries quiescent. Thus, there is no fear and risk of getting breast cancer due to low hormonal birth control pills.

Hysterectomy without the removal of ovaries: During a hysterectomy (removal of the uterus), if the ovaries are removed, the risk of developing breast cancer is reduced considerably. However, if the ovaries are not removed, then estrogen from the ovaries makes the breast more vulnerable to cancer. There may also be an incident of ovarian cancer, if the ovaries are left intact. Thus, based on the various risk factors at play and the age at which the operation is performed, a decision about the removal or preservation of ovaries must be taken.

Genetic factors

Factors such as an individual's family history can cause a great deal of anxiety, or worse still, lead to a false sense of security if the person concerned has no family history of breast cancer.

It is, therefore, important to be acquainted with the precise nature of genes and their influence. These are some of the key warning signs.

Family history: If one member of the family has breast cancer, a person's risk of developing the disease is double that of the general population. If more than one relative has had breast cancer, a person's risk of developing the disease is five times higher. This is true irrespective of whether the family member in question happens to be a close relation (such as, a grandmother, mother, sister or daughter), a distant relative (such as the mother's or father's sisters or their children), or a male relative...

Breast cancer gene: Genetic tests are not done routinely, due to their non-availability and non-affordability. But if and when done and a woman is found to be a carrier of the gene, she is at a higher risk of developing the disease. A woman is likely to have a breast cancer gene if she has been diagnosed with breast cancer before the age of 40, if several family members have been diagnosed with breast and/or ovarian cancer, or if there has been a diagnosis of bilateral breast cancer (cancer in both the breasts)`85

External risk factors

Alcohol, smoking and excessive
consumption of caffeinated drinks:

Radiation: In the case of some skin conditions treated with radiation, there is risk of developing breast cancer.

Breast inflammation: This can sometimes spiral into skin cancer.

Diet and stress: Diet and stress will be discussed at length under life-style changes. . .

A diagnosis of breast cancer

To make a diagnosis of breast cancer, the type, and the spread of the disease , one has to understand the anatomy of the breast . . .

Anatomy

Lymphatics carry lymph fluid to the lymph nodes, situated in the axilla (under arm), around the collar bone and chest. They act as barriers of the immune system. It filters infective cells and foreign material.

Thus the lymph nodes are the first to get enlarged whenever an infection occurs. A classic example of this is "tonsils." The tonsils are a lymph gland, and they get swollen and painful whenever infection occurs in the mouth and throat. . .

Diagnostic methods

To make a diagnosis of breast cancer one needs to suspect that there is a lump which could be non-cancerous or malignant. Sometimes a lump may not even be present, but a woman may be worried and may wish to confirm that there is no malignant growth. This is especially so, if the woman concerned has family history of breast cancer, or has just heard about a friend or a relative having developed the disease.

As listed earlier, a lump in the breast may be detected while a woman is bathing, during a massage, in the course of sex play, after a fair amount of weight loss, subsequent to an ultrasound, during a routine mammography or after an examination of the breasts.

A lump, however, could be either cancerous or non-cancerous.

To determine if the lump is malignant, it is important for a woman to get examined by family physician, gynaecologist, general surgeon, or onco-surgeon (cancer surgeon). It is also imperative for her to get a mammography, an MRI, or a sonomammography done.

A fine needle aspiration biopsy (FNAC) or a MRI-guided core needle biopsy may be recommended.

An open surgical biopsy with frozen section (to send the tissue or material received for urgent histo-pathology reporting) may be required. If the report is positive, it is advised to undertake surgery under the same anaesthesia.

If cancer is confirmed, a CT scan may also be required to assess the involvement of the lymph nodes.

Breast cancer set to overtake cervical cancer

By 2020, breast cancer is expected to overtake cervical cancer, which is now the most reported cancer among women in India.

In a written reply in the Rajya Sabha in August 2010, Minister of State for Health S. Gandhiselvan had said that by 2020, breast cancer was expected to overtake cervical cancer at the current rate of increase in such cases. At the moment, cervical cancer tops the list of cancers detected among Indian women, as its symptoms are not easily detected.

According to the National Cancer Registry Programme report on time trends in cancer incidence rates (1982-2005) of the Indian Council of Medical Research (ICMR), the estimated number of breast cancer cases in India in 2010 was 90,659 and of cervical cancer1,03,821.

The National Programme for Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke had been approved with an outlay of Rs.731.52 crore for cancer for the remaining two years of the 11th Five Year Plan (2010-11 and 2011-12) for strengthening cancer care facilities in the country.

Under the scheme, it is planned to increase awareness, prevention, early detection and treatment for cancer cases, besides strengthening the healthcare delivery.

Stages of cancer

Stage 0 : Cancer in situ, where only few cells have started multiplying.

Stage 1 : The lump is not larger than 1 cm and is still inside the basement membrane.

Stage 2 : The lump is between 1 cm to 2 cm and has spread to the lymph nodes. Alternatively, the lump is larger than 2 cm but has not spread to the lymph nodes.

Stage 3 A : The lump is larger than 2 cm and has spread to the lymph nodes.

Stage 3 B : The lump has spread to the skin, chest wall, ribs, muscles and the inner lymph nodes.

Stage 4 : The lump has spread to several other parts of the body, the other breast, bone, lungs, liver or brain. (Inflammatory breast cancer is rare.)

Excerpt used with permission from ‘Know Your Breasts’ by Dr Geeta Pandya. Published by Vakils, Feffer & Simons. Pages 118. Rs 300