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Raja out on bail
A double blow |
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Police makeover
The cartoon controversy
Music at night
Osteoarthritis has overtaken hypertension as India’s top ailment. According to last year’s estimates, around 66 million people, who are more than 65 years of age, were at an enhanced risk of osteoarthritis
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Raja out on bail
The
bail granted to prime 2G scam accused and former Telecom Minister A. Raja by a CBI special court on Tuesday cannot be faulted considering that all the other accused in the case had been enlarged on bail before him and much of the evidence against him is documentary in nature and in the custody of the court. That Mr Raja was in detention for 15 months was adequate time for the CBI to probe his links, establish the money trail and build up a strong case if it had the right intentions. By laying down that Mr Raja will neither visit the Department of Telecommunications in New Delhi nor go to Chennai without court permission the court has tried to ensure that the former minister does not exercise any undue influence to tamper with evidence. But the establishment will have to be vigilant because even without going to these places influence can be exercised by remote control. Significantly, Raja’s party the DMK which got a severe drubbing in the assembly elections largely due to the negative fallout of the 2G scam has given Raja a much better reception than the treatment it had given him when he was arrested. Party supremo Karunanidhi who had said “bad friends will get you into trouble” when Raja was arrested welcomed his release on bail. Karunanidhi’s sons Azhagiri and Stalin who were initially hostile to him upon his arrest and berated him for being close to their step-sister Kanimozhi later built bridges with him. Raja’s status as a leader of Dalits came in handy for the controversial politician. Perhaps, Raja who presided over one of the biggest scams in independent India knows too much for political leaders, especially of his party not to be wary of him. Tamil Nadu Chief Minister J. Jayalalithaa’s remark that Raja’s release could mark the beginning of dilution of the 2G spectrum allocation case may seem overdrawn but cannot be dismissed outright. Parliamentarians as well as public interest groups must be on their guard against any attempt to tutor witnesses and tamper with evidence. At the same time, Raja’s life must be protected from those who have a stake in keeping some skeletons from tumbling out of cupboards.
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A double blow
India
is faced with the twin problem of a falling rupee and rising inflation, which has serious implications. The rupee touched a new low of 54.49 against the dollar on Wednesday. Its previous low of 54.30 happened in December, 2011. The RBI interventions have failed to arrest the rupee decline as foreign investors are quitting the country partly due to domestic policy inaction, political resistance to second-generation reforms and slowing growth, and partly due to the euro zone crisis, which has worsened after the French and Greek elections. Such has been the loss of faith in the Indian growth story that even the postponement of the controversial GAAR (General Anti-Avoidance Rules) by a year has not been able to hold them back. In these turbulent times the US is seen as a safer place for parking surplus funds. Since investment inflows have got reduced to a trickle, capital outflows have taken their toll on the rupee. The falling rupee has significantly inflated the country’s import bill. The benefit from the recent easing of the oil prices has been eroded by the depreciating rupee. The removal of the excise duty on gold ornaments has re-ignited the demand for gold, which after oil is the second largest imported item. The steep fall in stock markets means companies will not be able to raise public money for ongoing and new projects. The latest spurt in inflation, which jumped to 7.2 per cent in April from 6.9 per cent in March, will discourage the RBI from further cutting interest rates in the near future. This will keep the cost of capital high for corporate and individual borrowers. High food inflation has come back to haunt the UPA government. This is happening despite record food production and prospects of a normal monsoon. Imported food items like pulses and edible oils have become costlier due to the rupee’s decline. The government cannot wash its hands off the problem by blaming it on the mess in the eurozone. Ruling parties often have to pay a heavy price for high food inflation — whatever the cause.
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Police makeover
Punjab
Deputy Chief Minister Sukhbir Singh Badal, who also holds the Home portfolio, has gone to town about his new policy of ensuring all SHOs in the state are posted as per established norms of rank and cadre. Also, that they are not to be appointed — anymore — by the local Akali leader. He deserves credit for “restoring merit” in policing, but not before he is able to explain where did the criterion of merit go during his previous tenure? This is probably the only downside of a consecutive term in power — you can’t blame the ills of the past five years on anyone but yourself. It was he who instituted the system of SHOs being named by the local party MLA, or even the party candidate who lost the last election! Police station jurisdictions were delineated according to Assembly constituencies, so one SHO didn’t end up reporting to two MLAs. That was no experiment in giving “power to the people”. The state DGP by his side, the Deputy CM also pronounced the SSPs would not treat SHOs as part of their “baggage” to take along every time they were transferred. A sound piece of advice. It is about time the governments of the day realised the SSPs were also not their “baggage” to pick and choose against established norms. Why is it that the SAD-BJP government found only two IPS officers fit for posting as district SSP while ordering nine fresh postings last month? The rest were from the state police cadre. The touchstone of merit would be useful here too. That said, the move to free police stations of political interference — whatever be the motive — is welcome, and would be appreciated particularly at the grassroots. The police force is the cutting edge of a government, and SHO the face. Pleasing one party leader at the cost of a dozen voters is simply bad mathematics. If Sukhbir Badal has actually realised that a voter convinced, rather than coerced, stays with you longer, the voter may be prepared to let bygones be bygones.
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Fortune favours the prepared mind. — Louis Pasteur
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The cartoon controversy
The
country has just witnessed a Shakespearan tragedy when both Houses of Parliament self-patted themselves and resolved to keep the dignity of Parliament at the highest. The members were, however, forgetful of the shameful furore in Parliament on May 11 over the reproduction of a cartoon in 1949 by Shankar depicting the delay in finalising the Constitution (which was done on November 26, 1949) and which has been included in the NCERT textbooks on political science of Class XI — the cartoon was alleged to have insulted Nehru and Dr Ambedkar. The more worrying aspect was the almost craven response of the HRD Minister that he was directing the NCERT to stop the distribution of these textbooks and to review the same. He even gratuitously said that the government would review all the cartoons and this year the present textbooks would not be distributed. How sad? The sneezing irrelevant remark of a legislator is enough to give them shivers down the spine and to agree to delete the cartoons, ignoring the fact that these had been selected by two of our respected social scientists. Such is the panic of caste-based politics that apparently even sober legislators of all parties jumped in to support the suppression of the cartoon oblivious to the fact that both Nehru and Ambedkar took this cartoon as an expression of a right of free speech guaranteed to Indian citizens. It may help the legislators to know that Nehru had inaugurated Shankar's Weekly much earlier in 1948 and encouraged the cartoonist by openly telling him, "Do not spare me, Shankar". And Shankar went about the work but never did Pt Nehru or Parliament took any objection. It was a surprisingly puerile and deliberately provocative suggestion by a lone member of Parliament (picked up immediately by all the parties, panic-ridden as they are by election phobia) that the cartoon should be treated as a castist slur on Ambedkar. How ironic that these self-proclaimed admirers of Ambedkar want to pigeon-hole him as a Dalit leader while in reality Dr Ambedkar's contribution to Constitution-making has been universally recognised and, in fact, was openly praised and complimented when President Rajendra Prasad, speaking during the closing address in the Constituent Assembly, said, "We could never make a decision which was or could be so right as when we put him on drafting committee and made him a Chairman. He has added lustre to the work which he has done." The response of Dr Ambedkar was equally gracious when he said, "I feel so overwhelmed that I cannot find adequate words to express my gratitude to them. I am grateful to the Constituent Assembly reposing in me so much trust and confidence and have chosen me as their instrument and given me this opportunity of serving to country." How can then small self-appointed Dalit leaders dare to say that the contribution of Dr Ambedkar was not fully recognised during his lifetime. Let me remind everyone that Dr Lohia, himself one of the tallest leaders of India, had openly stated that he considered Dr Ambedkar as the next biggest leader after Mahatma Gandhi that modern India had produced. It pains one to say that while the country is so proud of its Fundamental Rights, including the Right of Speech and Press, the discussion in Parliament should have revolved on how to suppress the freedom of the Press by deleting the cartoon and also interfering with the freedom of the students to know about the trends and currents at the time the Constitution was being framed. This action of Parliament is antithetical to the strongly held view of Pt Nehru who said, "You do not change anything, you merely suppress the public manifestation of certain things thereby causing the idea and thought underlying them to spread further." The argument of the parliamentarians that these cartoons will spread a wrong notion of the politicians is a self-serving congratulatory observation and is an insult to the independent and wise-thinking of teachers and students themselves. Have we not already had in our country the unfortunate results of yielding to the threats of goons in banning the globally recognised paintings of Hussain who unfortunately, even after his death, could not have his paintings shown at an exhibition arranged by a government-appointed body on the unacceptable excuse that the organisers could not save the paintings from being damaged at the instance of some unruly elements. The intolerance against certain opinions is spoiling the free atmosphere at the universities as was demonstrated when Delhi University banned the teaching of three Ramayanas, a very researched and documented version by a well-known historian. The present discussion, if it leads to the deletion of these passages from the textbooks, would strike at one of our proudest Fundamental Right of Freedom of Speech, a constituent of democracy. It is well to remind everyone what John Stuart Mill in his essay on liberty said, "The need for allowing even erroneous opinions to be expressed on the ground that the correct ones become more firmly established by what may be called the dialectical process of a struggle with wrong ones which expose errors.” The Supreme Court has also emphasised that "intellectual advances made by our civilisation would have been impossible without freedom of speech and expression. The court has drawn its strength from the well-known expression of democratic faith expressed by the great French philosopher, Voltaire, "I do not agree with a word you say but I will defend to death your right to say it." The court has reminded that "Champions of human freedom of thought and expression through ages have relied that intellectual paralysis creeps over society which denies, in however subtle form, due freedom of thought and expression to its members. Dr Ambedkar was conscious of the danger to the dignity of an individual in our political system and gave the warning thus, "There is nothing wrong in being grateful to great men who have rendered life-long services to the country. But there are limits to gratefulness….. no nation can be grateful at the cost of liberty. This caution is far more necessary in the case of India than in the case of any other country. For in India Bhakti or what may be called path of devotion or hero worship plays a part in its politics unlike any other country in the world. Bhakti in religion may be a road to the salvation of the soul. But in politics Bhakti or hero-worship is a sure road to degradation and to eventual dictatorship".n The writer is a former Chief Justice of the Delhi High Court.
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Music at night IT was 1983. While I was pursuing my master degree in laws, I
organised a trip to Prasanthi Nilayam with friends for birthday
celebrations of Sri Sathya Sai Baba. One British physicist, who used
to have a long chat with me on inner quest, while returning, gifted me
Aldous Huxley's anthology of essays, "Music at Night". It
was past midnight. The musical effect of patter of rain lashing the
train was robbing the silence of 'noon' of night. While all the
passengers in the bogey were caught into sleep, it eluded me. I,
therefore, chose to give a fleeting glance to the book. As the train
was steaming through the hilly terrains of Vijaywada, an inevitable
misfortune was rolling into us. Oh, soon there was a head-on
collision. Our bogey consequently got detached with a thud and rolled
down the valley. It kept oscillating midair before it stuck somehow to
a cluster of trees down the slope. For a while, a feeble thought, "durr
ke aage jeet hai", prompted me to jump out like a paratrooper
but soon I realised that it was a real nightmare, not a mere reel
shoot. As all the lights went off, I was reminded of Nehru's quote: "There
was darkness everywhere". I could never imagine that the
rhythm of "Music at Night" would tune into jarring
dissonance so abruptly. The captives, however, kept cool and
reconciled to their "tryst with destiny". Though many
were badly bruised, we sang songs and played "antakshari"
to diffuse the trauma. It was certainly like re-playing the
heroics of "Homer's Odyssey" as referred to in one of
the essays, "Tragedy and the Whole Truth". How could
men behave so normal while wading through such an abnormal situation
baffled me. It was apparently the never-give-in attitude, I felt,
which made all the difference. Interestingly, however, I once again
experienced yet another similar incident, last month, though on a
different scale, with lesser intensity. One of my senior colleagues
organised a dinner party for the outgoing Chief Secretary, Urvashi
Gulati, and her successor, PK Chaudhery. True to his image, the
planning was expected to be astute and meticulous. There was unusual
aroma in the air. The luminous charm, apparently borrowed from the
moon hovering in the sky, added to the glamour. All the who's who of
the Tricity and the beaming ladies descended there like "the
carved angels, ever eager-eyed", as depicted by Keats in "The
Eve of St. Agnes". The evening was intended to begin with
melody throb Roshan Lal lightening up the flickering romanticism. But
the ill-timed rain played spoilsport. We all ran for cover; took
refuse wherever the space permitted, be it the bedroom, the garage,
the anteroom or the kitchen. The washrooms, however, were the first
choice for the smokers. A few enterprising ladies ventured out to
fetch their food from the solitary food counter operating in one
secluded corner. I took it as a nature-inspired opportunity to floor
my wife. I enthusiastically served all the dishes to her. Having
earned the title of an understanding husband, other on-looking ladies
prompted their men to follow my footsteps. Though the hosts
helplessly watched the downpour taking its toll, the never-feel-down
attitude of the attendees kept them enthused. Even the incessant rain
failing to dampen our fervour, we perfectly re-enacted the spirit of "Homer's
Odyssey" into "Khandelwals' Odyssey". Hurrah!
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Osteoarthritis has overtaken hypertension as India’s top ailment. According to last year’s estimates, around 66 million people, who are more than 65 years of age, were at an enhanced risk of osteoarthritis
Osteoarthritis
(OA) is a disorder of the joints which results from the degeneration of the joint cartilage. Cartilage is a white glistening protein, having a highly smooth and finished surface, which facilitates frictionless motion at the joints. In some people, it appears earlier and causes more symptoms, while in others despite its presence in the joints, there may be minimal or no symptoms. The disease is more commonly seen in women after the age of 55. A higher incidence of osteoarthritis of the knee joints is seen in Asians probably due to genetic factors and the habit of squatting. Causes At the molecular level, OA is caused by an increase in the water content of the cartilage and degeneration of its protein structure causing fissuring and flaking on the surface of the joint, which results in friction during motion. The enhanced friction irritates the joint lining (synovial membrane), causing inflammation, pain and accumulation of fluid in the joint (effusion). Finally, there is formation of new bony spikes and spurs at the margins of the bones (osteophytes). The factors that promote wear and tear also enhance the onset of osteoarthritis. In the layman's language, our joints may be equated with the tyres of a car, which, on an average, have fixed life in terms of mileage (kilometres) when driven in the ideal driving conditions. Factors like mal-alignment of the car suspension, faulty shockers, running the car on a bad road in an overloaded condition and poor driving habits can result in an early wear and tear of the tyres. Similarly, in the case of the weight-bearing joints like the knee, overweight (obesity), mal-alignment of the knees (knock knees or bow legs), neglected injuries of shock absorbers of joints (ligaments/ meniscal injuries etc), rough and improper use of the joints (competitive sports requiring aggressive use of the joint in an unsupervised and faulty manner) are the common predisposing factors of osteoarthritis. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition. Arthritic conditions like gout, rheumatoid arthritis, haemophilia (bleeding disorder), ankylosing spondylitis etc result in the early and severe onset of all the changes brought about by osteoarthritis. Hormone disturbances, such as diabetes and growth hormone disturbances, are also associated with early cartilage wear and secondary osteoarthritis. Symptoms Diagnosis An MRI may be required in young patients to see the pathology of some soft tissue structures inside or around the knee joint (menisci/ ligaments). The torn menisci and/ or ligaments worsen the progression of the OA by altering biomechanics of the joint and increasing the friction. Blood tests, as such, have no role for the diagnosis of osteoarthritis. Sometimes these are required to exclude the secondary causes of osteoarthritis like gout, rheumatoid arthritis, infection etc. Blood tests may also be required to assess the overall health status of the patient if a surgical intervention is being planned. Aspiration of the joint fluid with a needle may be required in some patients to test the joint fluid for the exclusion of causes of secondary arthritis, and also to relieve the pain in some patients resulting from the sudden accumulation of fluid inside the joint. Treatment The treatment modalities are non-operative and operative. Non-operative modalities are first exhausted before resorting to operative modalities. The non-operative modalities include rest, exercise, diet control for weight reduction, physical therapy, occupational therapy and mechanical support devices, such as knee braces. Oral medications, topical applications or injections into the joints are used to decrease joint inflammation and pain. Giving rest to the joints during severe pain decreases stress on the joints and relieves pain and swelling. Exercise strengthens the muscles around the joints thus protecting them from further wear and tear. Applying local heat before and cold packs after exercise can relieve pain and inflammation. Obese patients should avoid loading exercises like treadmill, jogging and running. Swimming is good because it causes little stress to the joints. Other useful exercises include walking, cycling and light-weight training. The devices like splints, canes, walkers and braces help in reducing stress on the joints. Physiotherapy modalities like paraffin wax dips, warm water soaks, short-wave diathermy etc can be useful during acute inflammation and stiffness. Simple pain medications like aspirin and acetaminophen may be sufficient in a majority of patients. For severe pain, non-steroidal anti-inflammatory drugs (NSAIDs) which include ibuprofen, diclofenac, aceclofenac, celecoxib, naproxen, indomethacin etc. can be used. In between the oral medications, local application creams and other physical therapy measures are often sufficient. Other medications include chondro-protective drugs namely glucosamine, chondroitin and diacerin. These drugs are supposed to decelerate the cartilage degeneration and also relieve symptoms in some patients. Fish-oil supplements also have been shown to have some anti-inflammatory properties. While oral steroids (cortisone) are not used in treating osteoarthritis, steroid injection into the joint can swiftly relieve pain. Repeated cortisone injections can harm the joint, so these are reserved for patients with disabling symptoms, who want to buy time for undergoing surgery. Injections of hyaluronic acid preparations into the joint have also been tried in OA. These act by replacing the thinned out synovial fluid of an arthritic joint with a thick fluid allowing better lubrication, and also probably by directly affecting pain receptors. These injections can relieve pain for six months to an year, sometimes longer. However, these do not help everyone and are quite expensive. Surgery is an option for severe OA resistant to conservative treatments. The surgical interventions include arthroscopic debridement, osteotomy, total joint replacement and arthrodesis. Arthroscopy is a minimal invasive surgery done by making tiny cuts wherein damaged parts (debris) of the joint are removed (called debridement). Any loose particles and inflammatory materials are flushed from the joint with the help of fluid known as irrigation. Arthroscopy is, however, useful only in selective patients where there are demonstrable debris, loose bodies or torn menisci and blocking osteophytes in the joint and may only provide temporary relief from pain. Osteotomy is a surgical procedure used to correct the mal-alignment of the joint. It is mainly recommended in younger patients with osteoarthritis confined to a part of the joint. These patients may also require total joint replacement also in future. Total joint replacement is a rewarding option for severe disabling OA resistant to conservative options. It is a major surgery involving high cost in which the damaged parts of the joint are replaced with artificial metallic and plastic components. The life of an artificial joint usually ranges between 10 and 20 years so this operation is often not advised in patients younger than 60 years. For poor patients requiring painless, strong joint with minimal cost, the operation of fusion of the joint (arthrodesis) can be considered in which the bones constituting the joint are surgically fused with each other. This operation provides a painless joint which, however, has no movement at all.
The writer is Professor, Department of Orthopaedia, GMCH, Sector 32, Chandigarh
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Osteoarthritis affects more than 25 million persons in the USA. According to a rough estimate, more than 360 million persons worldwide and about 150 million persons in India constituting 15 per cent of the population will suffer from osteoarthritis. According to the 2007 TNS Arogya study, osteoarthritis has overtaken hypertension as India's no 1 ailment. Around 66 million persons, who are 65 years plus, were at an enhanced risk of osteoarthritis according to last year's estimates.
Every
patient should be individually assessed for degree of the disease so
that specific treatment option can be selected. Surgical modalities
are usually recommended after the non-operative treatment has been
exhausted. Arthroscopy and osteotomy may be useful in some patients
for prolonging or avoiding the surgery of total joint replacement. The
joint replacement surgery can bring life back to a patient who is
socially and physically disabled. Surgery for joint replacement,
however, generally provides a restricted lifestyle to the patient. The
patients requiring high exertive demands from the joint should be
counselled before selecting this option because patients undergoing
joint replacement are advised to avoid activities like sitting on the
floor, running, jumping etc