The Tribune, Chandigarh, India

A damning report
India needs to fill gaps in air defence

THE recent revelation that the Indian Air Force has been unable to meet its critical requirement of jam-resistant and secure air defence communication links is a matter of grave concern. A recent report prepared by the Comptroller and Auditor General (CAG) has detailed a disappointing account of how the country’s premier aeronautical agency, the Hindustan Aeronautics Limited, produced a vital communication system that was both unreliable and severely deficient in performance.

The communication system in question assumes considerable importance keeping in view that it was meant for use in a sophisticated high-technology environment that involved data linking and communication with the Israeli-supplied airborne warning and control system (AWACS) that have recently been inducted into the air force. A secure and advanced communication system is paramount in today’s complex battle environment that comprises highly advanced electronic warfare systems capable of jamming, intercepting and distorting communication. The AWACS, a key force multiplier inducted by the air force, functions as a long distance eye in the sky and will play a vital role in the event of a war. Hence, developing a secure communications system becomes even more vital. The recent CAG report is but one among a long list of reports in which anomalies in India’s defence have been figuring with monotonous regularity. For example, most of India’s artillery, a sizable portion of tank regiments and a large portion of the air force fighter, transport and helicopter fleet are vintage and are in dire need for either urgent replacement or modernisation.

India, with its size, importance and security concerns, can ill afford such gaps in its defence preparedness. Both the 1999 Kargil War and the Indian military’s mobilisation in December 2001 following the terror attacks on Indian Parliament revealed shortcomings in the country’s military. A decade later, successive reports prepared by CAG and by the Parliamentary Standing Committee on Defence continue to expose deficiencies in India’s military capabilities. The government needs to seriously review India’s defence preparedness and ensure that that there are no serious gaps.

Message from Kabul
It may be back to square one after 2014

Tuesday’s attacks on the US Embassy and the NATO headquarters in Kabul by the Taliban have provided proof yet again that the extremists can strike at will anytime, anywhere in Afghanistan. There has been clear resurgence in their activities for the past few years with the troops from the US and its allies showing signs of fatigue. Now all Taliban factions are feeling emboldened with the US-led foreign forces preparing for their complete withdrawal from Afghanistan by 2014. Two days after the 10th anniversary of the 9/11 attacks on the US the Taliban has sent across the message that it is on the way to recapturing power it had lost. Taliban activists launched a major assault at the British Council centre in August and Intercontinental Hotel in June in Kabul, exposing the incapacity of Afghanistan’s national security forces to effectively maintain law and order once the foreign troops have flown back to their respective countries. If this is the situation in Kabul, one can imagine how strong the Taliban’s hold will be in the rest of the war-torn country.

Leaders of the Taliban, closely allied to Al-Qaida, know it well that despite pressure from various quarters mounting on the US to review its withdrawal policy in view of the emerging dangerous scenario, Washington cannot afford to do so under the circumstances. The economic crisis it is faced with is too serious to allow it the luxury of huge non-productive investments in foreign lands. Moreover, President Barack Obama at this stage would only like to cash in on the popularity of his Afghanistan and Iraq withdrawal policy to ensure a second stint for him in the White House.

However, there remains a big question mark over the multinational drive against terrorism. What is the gain after an investment of billions of dollars and in terms of a large number of human lives lost? The US success in killing Osama bin Laden after a long campaign is, in fact, no gain to celebrate when the indications are that Afghanistan will again be ruled by the Taliban. This situation of going back to square one shows that the much trumpeted war on global terrorism has virtually been lost.

Thought for the Day

Leadership is the wise use of power. Power is the capacity to translate intention into reality and sustain it. — Warren G. Bennis

ARTICLE

Drive against corruption
WikiLeaks, Anna Hazare and worldview
by G. Parthasarathy

MOST of the WikiLeaks documents on India carried nothing new or sensational. They merely confirmed that many well-connected Indians were given to talking indiscreetly to Americans. The latest revelations confirm what many Indians have heard earlier about Kashmiri separatist leaders like Mirwaiz Umar Farooq and Yaseen Malik receiving “payoffs done by intelligence agencies of India and Pakistan” and about how “Indian and Pakistani money has made all Kashmiri political leaders dependent on handouts”. The contempt of the Americans is evident from Ambassador Mulford’s scathing remark that “Kashmiri politics is as filthy as the Dal Lake.” There is little doubt that the cables from diplomatic missions in Delhi to their capitals on the Anna Hazare-led movement will carry similar assessments about corruption all across India.

International media coverage about the recent movement against rampant corruption eroding public confidence in the ruling classes and the bureaucracy has been highly critical of the government’s handling of the issue of corruption. It has graphically reflected public anger on the issue. The Washington Post reported: “Hazare, a disciple of Mahatma Gandhi, is the face of a nationwide movement against corruption that has gathered pace this year after a string of high-profile scandals”. The Daily Mail averred that Hazare’s hunger strike “was certain to embarrass India’s scandal-plagued government. Hazare’s demand for tougher anti-corruption laws has galvanised Indians, fed up with the bribery and favouritism that has infested the government at all levels.” The Washington Times wrote: “Mr. Hazare, a 73-year-old activist, has become an anti-corruption icon by channelling the tactics of freedom fighter Mohandas K Gandhi.”

The media in Pakistan paid substantial attention to the Hazare-led anti-corruption movement. Lahore’s The News noted that “corruption has become a key issue of public discontent in India, and Hazare has emerged as a prominent national figure for this campaign”. An editorial in the influential Dawn newspaper said: “Indian Prime Minister Manmohan Singh should realise that many in his country are beginning to rise peacefully against corruption”. The Dawn editorial significantly added: “The time may come for the same sort of dissent in Pakistan.” Like their counterparts in India, the international media has been scathing in its criticism of the extent that corruption is eroding the moral fibre of our society and polity. While the international media showed sympathy and understanding for Hazare and the thousands across India who backed his fast, India itself has emerged with flying colours, being depicted as a country where democratic freedoms determine its destiny and direction.

Media reaction in China was surprising. The Chinese media often asserts that “Indian democracy is hindering its development”. There was, however, factual coverage of the protests in India. I gave an interview to the Beijing-based Sanlian Weekly which was published unedited, at my insistence. Responding to queries on the protest movement, I made it clear that the movement reflected growing public anger against corruption in high places and explained the constitutional role of the Supreme Court and the C & AG. Responding to a query on whether there was any similarity between events in India and the Arab world, I said: “Unlike the Arab world, people in India, which is a parliamentary democracy, are free to demonstrate publicly. Such non-violent public demonstrations are legal and happen routinely and fairly regularly in different parts of India. They have nothing to do with the Arab world where people are demonstrating for democratic freedoms.” Surprisingly, this distinction between democratic and authoritarian societies was published in full. China’s rulers may, in a carefully controlled and gradual manner, be giving more space than hitherto given for the publication of views that do not entirely correspond to conventional Communist Party thinking.

Mayur Vihar and neighbouring Trilokpuri in East Delhi are localities full of cooperative society apartments. These are localities bereft of palatial residences of the rich and powerful. On August 16, Anna Hazare was suddenly picked up and arrested from a Housing Society known as Supreme Apartments, just behind the Mayur Vihar apartment complex where I reside. An astonishing series of events followed. My normally calm and law-abiding neighbours (primarily journalists, young professionals and lawyers) came out on the streets and virtually blocked the police from taking Hazare away. Within an hour, the citizens of neighbouring localities, irrespective of age, profession, religion and income, came out on the streets and marched towards Rajghat, in an orderly manner, without blocking traffic. Later that evening a group of young college students met me and said: “Uncle, please join us tonight for a candle light vigil for Anna Hazare and those arrested.”

I have lived on and off in Delhi since the 1940s. I have never seen such public outrage all these years. I could not but sympathise with and admire the peaceful manner in which the entire agitation took place. The predominant view across the Capital was that the action of arresting Hazare and his associates and sending them to Tihar Jail, in the company of the likes of A. Raja and Suresh Kalmadi, were actions of a government “intoxicated by the arrogance of power” and “out of touch with reality”. A distinguished former Commissioner of the Delhi Police remarked that he was shocked how an honest police officer like Kiran Bedi, who was admired by the lower ranks of the Delhi Police, could be publicly humiliated the way she was, on August 16.

We saw our parliamentarians, who unfortunately receive scant credit for the sterling work they often do in the Standing Committees of Parliament, rise to the highest standards of parliamentary debate during the discussion on the Lokpal Bill. It was particularly heartening to see young MPs like Varun Gandhi and Jyotiraditya Scindia speak with such eloquence and conviction. But, sadly, the impression remains that with an estimated 153 members of the Lok Sabha facing criminal charges and with the government’s credibility lower than ever before, neither our government nor our parliamentarians will act decisively to end corruption, criminalisation and the influence of muscle and money power in politics. Political life is today seen as the preserve of the rich, the corrupt and the powerful. It is not surprising that it is people like Anna Hazare, Justice Santosh Hegde and former Chief Election Commissioner James Lyngdoh who are seen as role models by the youth and the public at large.

According to Transparency International, the poor in India are forced to pay Rs. 900 crore annually as bribes for access to entitled basic services. This is so even as an estimated $ 19 billion is moved out of the country illegally every year. Surely, the people of India deserve better.n

MIDDLE

Teacher’s pet
by Vinod Prakash Gupta

ALL subtleties aside, coming of age has a lot of tangibility attached to it with certain phases marked out as milestones in the process of growing up. In my time, one such phase was graduating to the ninth standard. Suddenly, the status of a ‘senior’ was thrust upon you in the form of wearing full pants instead of half. This filled the students with a sense of pride, self-respect, arrogance and ego: a torrent of emotions one feels on the threshold of manhood.

During this time, a new teacher, Mrs Raj Mehta, was assigned to our class as the class teacher. She announced that students must wait for the bell to ring before darting out of the class for lunch. My friends and I, as usual, were all set to bolt out of the class five minutes before the bell rang. The moment we saw the peon languorously walking towards the bell, we bolted out of the class disregarding the teacher’s instructions.

After the recess, as soon as we entered class, she asked us to stay out. My friends were allowed back into the class after an apology but I was told to stay out for leading the march. Deeply humiliated and hurt, I stayed out. My equation with the teacher took a terrible beating and things started going from bad to worse. I lost interest in her classes. What added insult to injury is that my bench mates, Mohinder and Charandas, became her favourites, both below-average students.

One evening, I saw Charandas walking next to our class teacher holding the leash of her pet dog, beaming with pride. Jealousy filled every pore of my body. I was one of the brightest students in my class and it was unfair that this imbecile was enjoying the position that I so rightly deserved. I wrote the teacher off in my head as unfair and partial.

Soon the first terminal exams got over and it was time for our teacher to announce the results. Now, it was my turn to smile. I had stood first in the entire section with a remarkable margin. My teacher’s eyes met mine. What I saw surprised me. The contours of her face and her eyes showed immense affection for me and pride at my achievement. I understood in that silent moment what she had done. It is not enough to just teach lessons in class but teachers shape your personality for the rest of your life. My pride and anger needed to be reined in and a lesson in temperance was imperative. My anger gave way to heartfelt respect.

Later in the evening, Charandas came to my house and announced that the teacher had summoned me. I ran to her house. The three of us went for a walk that evening, with me holding her pet dog’s leash. The order in the world had been restored. It was one of the happiest days of my life. A day I learnt an important lesson in responsibility and a teacher’s affection for her students.

It marked the first milestone in my coming of age.

OPED HEALTH

CT scan has become a screening tool for patients even with minor
complaints in abdomen, head or chest. The potential carcinogenic
effects are underestimated or overlooked.
Hazards of CT scan
Dr S.M.Bose

Thinkstockphotos/ Getty images
Thinkstockphotos/ Getty images

Computed Tomography (CT) scan, an X-ray based investigation, providing a 3-D view of a particular organ or tissue, came as a boon for diagnosis and staging of the disease, especially in patients of cancer and trauma. It has become one of the commonest advised radiological investigations for a patient of today. It is prescribed not only for a seriously ill patient or for establishing the diagnosis but in this era of commercialisation misuse of every investigation is rampant — CT scan is no exception.

Unfortunately, CT scan has become a screening tool for patients even with minor complaints in abdomen, head or chest. This has become a global problem. It was reported in 2007 that more than 62 million CT scans were done in United States per year, compared to three million in 1980.

The popularity of CT scan can be gauged easily from the fact that Chandigarh and Mohali with a total population of 15 lakh have about 25 CT scan machines and the demand is so great that most of these equipment are being used round the clock.

A strong segment of medical profession is of the opinion that these scans are being used too frequently and in some cases unnecessarily. Let us analyse to find out the health consequences of having too many CT scans over the course of a person's life?

points to be remembered by patients and clinicians
Avoid CT scan if you can , it is better to substitute it with other imaging modalities, like, Ultra Sound / MRI Scans /Endoscopic and Laparoscopic evaluations, This is more important for getting repeated scans.
Whole body CT scan is not recommended for screening .
PET-CT scan may become necessary in patients of cancer but it should not be repeated too frequently as it will not make us any wiser but will surely give lot of radiation.
Go to a good CT scan centre, where latest technology is being used so as to avoid higher doses of radiation including long duration exposures.
While high-tech imaging can be beneficial in certain cases, it must be used SPARINGLY and only when absolutely necessary because it exposes your body to dangerous ionizing radiation — radiation that is proven to cause cancer
Correct interpretation of the images is also very important, and this requires an experienced expert. In the absence of this not only a repeat CT scan becomes mandatory but false positive and negative reports can bring serious problems.
Unseen danger
CT scans result in a far larger radiation exposure compared with conventional plain-film X-ray.
These result in a marked increase in the average personal radiation exposure to the patient.
The cumulative effect is worse and may result in future public health problems.
Japanese atomic bomb survivors who were about two miles away from the explosions, actually received radiation doses quite similar to those from a CT scan.
Sixty years of study of these survivors have provided direct evidence that there will be an increased individual cancer risk, though small, for those who have this same dose of radiation from CT scans.
It is estimated that about a third of all CT scans are unnecessary and at least these people can be protected from this potential risk.

It is widely believed that all radiological examinations are essentially harmless, because of the small amounts of ionising radiation involved but this is not true. In a Nov. 29, 2007 article in New England Journal of Medicine, David J. Brenner, Ph.D., and Eric J. Hall, Ph.D., from the Center for Radiological Research at Columbia University Medical Center, argue that the potential carcinogenic effects from using CT scans may be underestimated or overlooked. CT scans result in a far larger radiation exposure compared with conventional plain-film X-ray, these results in a marked increase in the average personal radiation exposure to the patient; the cumulative effect is worse and may result in a future public health problem. Dr. Jon LaPook, CBS News medical correspondent, estimates the percentage of cancers caused by CT scans — currently 0.4 percent — will increase to as much as 2 per cent in a few decades because the number of scans has increased so dramatically.

A whole body scan, which usually is made from mid-thighs to the top of the head, takes from 5 minutes to 40 minutes depending on the acquisition protocol and technology of the equipment used. The radiation and risk from one CT scan is low, but it carries a dose 50 to 100 times greater than a traditional X-ray, reports LaPook. A CT scan of the chest involves 10 to 15 millisieverts (a measure of dose) versus 0.01 to 0.15 for a regular chest X-ray, 3 for a mammogram and a mere 0.005 for a dental X-ray. Eric J. Hall, of Columbia University, therefore, is very much concerned about the built-up public health risk over a long period of time.

Atomic bomb explosions in Hiroshima and Nagasaki have markedly increased the number of cancer patients in these areas; as a matter of fact; the increased incidence is seen even today because of the radiation effects of that time.

Drs. Brenner and Hall have stated that Japanese atomic bomb survivors who were about two miles away from the explosions, actually received radiation doses quite similar to those from a CT scan. Sixty years of study of these survivors have provided direct evidence that there will be an increased individual cancer risk, though small, for those who have this same dose of radiation from CT scans. In particular, Drs. Brenner and Hall suggest that, in a few decades, about 1½ to 2 percent of all cancers in the United States may be due to the radiation from CT scans being done now. This is particularly important for children, who are more sensitive to radiation exposure as compared to adults

This is of particular concern, because perhaps one-third of all CT scans performed may not be medically necessary, the radiation researchers say.

Compounding the issue, surveys suggest that the majority of doctors who prescribe CT Scans and radiologists who undertake the procedure may not even appreciate that CT scans are likely to increase the lifetime risk of cancer.

I tried to gather this information from a number of doctors, who are either prescribing CT scans or are performing these in radiology departments and I was shocked to know that more than 90 per cent users had no clue about the radiation effects of CT scan.

About a decade or two back, CT scan would be advised sparingly. I vividly remember that in nineties even in an institute like PGI, Chandigarh, a CT scan requisition had to be countersigned either by the head of department or unit in-charge but at present there are no such restrictions and the number of these radiological investigations have multiplied manifold. The commonly performed radiological studies of earlier years like Barium Meal \ Enema; Fistulogram \ Sinogram; I.V.P.\ Retrograde Pyelography; myelogram \ ventriculogram ; used to give radiation not only to the patient but also to the radiologist and technician performing the test and so radiological procedures were ordered and carried out with lot of caution and reservation but no such problem exists with CT scan.

What can be done?

Drs. Brenner and Hall suggest three strategies for proactively addressing the potential increased radiation risks associated with CT scans:

Reduce the CT-related radiation dose in individual patients.

Replace CT use, when appropriate, with other options that have no radiation risk, such as ultrasound or magnetic resonance imaging (MRI).

Decrease the total number of CT scans prescribed.

Drs. Brenner and Hall suggest in their paper's conclusion that these strategies could potentially keep 20 million adults and, crucially, more than one million children annually in the United States from being irradiated unnecessarily. They stress, however, that in the majority of individual cases, the benefits associated with a correct diagnosis through CT will far outweigh the individual risk of all cancers. They estimate that about a third of all CT scans are unnecessary and at least these people can be protected from this potential risk.

Controversy remains, and in a statement issued on November 30, Dr John M. Boone, chairman of AAPM's science council, says that the "science community remains divided" over the radiation dose effects of CT scans and that the findings in the Journal article were based on "flawed assumptions" and were not conclusive.

The problem arises when the patients are not examined thoroughly and worst being not following the patient closely, it is believed by senior and experienced doctors that majority of the patients can be managed correctly and successfully without undertaking repeated CT scans.

Boone responds in his statement that the assumptions about the hazards of CT scan radiation exposure "remain controversial, even among experts in radiation biology." The method of determining risk used in the article is derived from Japanese citizens exposed to large amounts of radiation during the atomic bomb attacks on Hiroshima and Nagasaki in World War II, and the extrapolation of those extremely high radiation exposure rates down to the low CT exposures "remains very controversial," Boone says.

Another "significant flaw" in the article was the attempt to compare the Japanese bomb victims to "patients receiving CT in the US in 2007," Boone says. The article "did not correct for the many underlying confounding age dependent variables that differ between (the Japanese population) and older Americans, such as the incidence of obesity and diabetes."

However, it should be remembered that there has been significant advances in CT technology that make it extremely user-friendly, for both the patient and the physician. The largest increases in CT use, however, have been in the categories of pediatric diagnosis and adult screening and these trends can be expected to continue for the next few years. The growth of CT use in children has been driven primarily by the decrease in the time needed to perform a scan - now less than 1 second - largely eliminating the need for anesthesia to prevent the child from moving during image acquisition.

A large part of the projected increase in CT scanning for adults will probably come from new CT-based screening programmes for asymptomatic patients. The four areas attracting the most interest for adult screening by CT Scan are CT colonography (virtual colonoscopy), CT lung screening for current and former smokers, CT cardiac screening, and CT whole-body screening.

The writer is a former President of Association of Surgeons of India and a former Senior Professor and Head of Surgery, PGI, Chandigarh