Daily Excelsior... Editorial

EDITORIAL

By Mahendra Ved

In a parliamentary democracy like ours political decisionmaker is supreme, but officials play a pivotal role, both in implementing the decision and giving it a measure of legitimacy. It therefore, becomes incumbent for the bureaucracy to help the political leadership to tackle a crisis and also help in policy formulation. The relationship is intertwined. ....more

Talibanisation of Pakistan?

By Sreedhar

Recent reports coming from Pakistan indicate that not too old Taliban rule in adjacent Afghanistan (1993-2001) is being unlamented in Pakistan. The defiance of burqa clad in Women of Lal Masjid in Islambad against its demolition by authorities is one example. The highly publicized fatwa against Nilofer Bukhtiar for hugging a male paraglider, again from Lal Masjid, should be punished is another example. The chief cleric of Lal Masjid, Abuld Rashid saw Tourism Minister Nilofer's action as Un-Islamic. ..more.

Leadership crisis in
pharmaceutical research

By Ashok B Vaidya

EDITORIAL

Delayed surgery

It is possible that if we run into an experienced medical practitioner we may be extensively lectured on the difference between surgery and emergency surgery. We are likely to be told that most surgery is elective. It is done after a diagnosis based upon history and physical condition of a patient. Till its execution there are a series of tests and employment of strategies to ensure that there is no further deterioration in the health of the concerned individual. Emergency surgery, on the other hand, is a non-elective surgery. It comes into play when a patient's life is in direct jeopardy. In a case like this a surgeon has little time and information at his disposal. He has to act rather fast. We may be enlightened that these emergencies include: invasive types of resuscitation for acute respiratory failure, pulmonary embolism and pulmonary obstructions; blunt and penetrating head, chest, abdomen injuries, largely from automobile accidents and gun shot wounds; burns; cardiac events, including heart attacks, cardiac shock and cardiac arrhythmia; aneurysms; brain injuries and other neurological conditions and perforated ulcer and appendix, and peritonitis. Since we are not used to tongue-twisting medical terms we may hurry to say "thank you" to the giver of all information. For us as the ordinary citizens what is important is that there is a problem and if it requires a surgical treatment it must get it without delay. If there is a wound it must be healed the soonest possible. Left open it is certain to develop infection. A fracture ought to be mended. We will appreciate if doctors and surgeons put their knowledge into practice for the benefit of society as a whole. It seems, however, that those in the Government Medical College in this city have their own brand of surgery --- the delayed surgery. There is no sense of urgency on their part.

During the last fortnight we have reported two shocking instances in this newspaper in which the Medical College experts have put off surgeries for long. In the first, a 19-month old baby examined for a congenital defect on December 18 last year has been given March 25, 2008 as the date of surgery. How can anyone --- that too a surgeon trained to save precious human lives --- be so callous? The other example is equally scandalous. After making several trips to the Medical College a 38-year old tailor suffering from burn injuries has been told on April 16 this year to turn up next on June 15, 2009 for the grafting of his non-healing right leg. By virtue of his profession the tailor may have heard of the phrase "a stitch in time saves nine." Surgeons can claim ignorance in this behalf. However, they can't run away from their responsibility.

Our reports indicate that professional rivalry is one of the reasons for such indifferent approach. If true it is something that surgeons must sort out among themselves. They can't be permitted to hold the public to ransom. For its part the Government should bring the guilty to the book. It will be a pity were it to be misled by some long-winding medical explanations. Why should the people be let down badly in an institution raised with their hard-earned money? Delayed surgery is like delayed justice.

Plug loopholes

Why do all good things come to an end? This is a question that has always bothered the human mind. At times we may be in a state of euphoria. We will like it to last eternally. This is just not possible. Each and everything around us is prone to transformation. We know it from own experience. Our body and mind witness upheavals as we grow in years. There is another point of view: "All good things must come to an end, but all bad things can continue forever." This is the other extreme and is also not true. The fact is that like the good the bad is also temporary. Happiness can't be there for ever. So can't be sorrow. Long before we woke up to this truth Heraclitus had spoken it in a few words: "Nothing is permanent but change." Heraclitus is regarded as the first Western philosopher to have created a robust thinking process. Not for nothing the influence of his writings is visible on Socrates and Plato, among others. He has put it very clearly: "Everything flows and nothing abides; everything gives way and nothing stays fixed... Cool things become warm, the warm grows cool; the moist dries, the parched becomes moist... It is in changing that things find repose." Of course, in our school books we sometimes come across a pointed reference: "Change is the sauce of life." According to Aristotle, "change is always sweet." Slain United States President John F. Kennedy had spoken from his personal experience: "There is nothing more certain and unchanging than uncertainty and change." He had said it matter-of-factly: "Change is the law of life. And those who look only to the past or present are certain to miss future." That is why it is said that those who don't evolve with the passage of time altogether miss the bus. Each day has to be treated to hone one's skills. Likewise each event has to be constantly improved to make it appear attractive for all ages. One is persuaded to narrate all this in view of the comments that have been made in the wake of the recent Jammu festival. There has been praise for its successful organisation. At the same time a desire has been expressed including on this page for brushing it up further. One will agree on both the counts.

It was really a delight to see an emphasis being laid on ethnic food and local culture and history. A sort of fever was generated and the entire town seemed to be in its grip. The people raced from one venue to the other to imbibe all moments of joy. Simultaneously, however, several gaps have come to the fore. These have to be bridged. There is no cause of alarm in this behalf. It is only that some of them are the difficulties that this city faces in any case. Parking, for instance, is an enormous headache. A pity was that there were no dustbins near food stalls. One may regrettably point out that the people made the situation worse by throwing leftovers all over. Our civic sense thus is depicted in a bad light. We must remove these shortcomings. We need to do it "because every new beginning comes from some other beginning's end."

Changing face of bureaucracy

By Mahendra Ved

If the political leader has scaled down from the lofty heights that the freedom movement and the early years placed him, the bureaucrat too has departed from the high qualities of being a "steel frame" during the British era to "cast iron frame".

All of it is true, and all of it needs to be placed in a perspective to be understood and appreciated, if one is to scrutinize the country’s governance. The assessment needs to be done in the context of the changing relationship and the respective roles in the new century where opportunities have grown and so have the challenges.

Consolidating the Gains

The national goal in the new century must be that India consolidates its current strides and emerges as an economic super power in the next two decades or so. The pace at which Indian economy is getting linked to the global economy, leaves little room for unplanned action and delayed, reactions.

To achieve rapid economic goals, the human development indicators would need to be vastly improved. Assuming that the political leadership means it, the implementation of the policies would need to be carried out by the bureaucracy at all levels. And to achieve this, it is imperative that besides commitment, it is also necessary to change the mindset.

Why is this expected of the official? Because, while a politician’s role is transient in nature, the bureaucrat’s is permanent.

The structure of the civil service in our country continues to be what it was over fifty years ago, modelled after the British system. Officers join the various services — IAS, IPS, IFS etc — on the basis of a competitive examination, climb through different levels and end up as Secretaries to Government or Heads of Departments. It is essentially a career-oriented service where an officer looks forward to promotions at regular intervals subject to an acceptable level of performance.

All this could change. There is already talk in some quarters about resulted-linked, or performance-linked promotions. This means that joining a central, or state-level service does not mean automatic promotions and placements. There is indeed a need to devise a way to ensure performance-based progress in the bureaucracy if governance has to improve.

In the present system, the civil servant is expected to be politically neutral and render objective and impartial advice. If he is a law enforcing or project implementing authority, he must act according to the law or in the public interest.

Need for Reorientation

The time has come to consider some radical changes in the system. In the United States, the top civil servants come and go with the political regime. Their relationship with the political leaders is based on trust. If they have serious differences with their boss, they quit. Donald Rumsfeld and Paul Wolfowitz are two recent examples.

Would the American model suit India? It needs to be examined along with other alternative systems and a suitable model evolved for India. The crucial issue is one of accountability. The Secretary is accountable for most of the decisions and actions of government. He appears before the Parliamentary/Legislature Committees to answer their questions. He has to defend decisions to which he may not be a party.

Is it not better to have a system where a person who defends the decision of the government and also takes the responsibility to ensure its implementation shares its philosophy as well as its consequences?

New Challenges

In this context, one needs to ponder over systemic changes. A public discussion has not taken place about the system of Civil Service that India should have. Bureaucratic leadership is as important for the success of plans and programmes as political leadership is for policy and direction. Hence restructuring the bureaucracy must take place along with political reforms. It is time there is a serious debate on the issue.

While codification of the delegation of powers between ministers and the bureaucracy is necessary, it must also be ensured that the delegated powers are exercised. There is a need to reduce levels in the hierarchy and make administration officer-oriented so that responsibility can be fixed on an individual. Audit should focus more on the output of a scheme than on procedures. Instead of post-audit, concurrent audit must be introduced.

Departments such as police and revenue which have direct dealings with the people must be assessed, at least once in three years, by an independent professional organization consisting of eminent men from the public, including non government organizations (NGOs).

Action against corrupt officers in many states cannot be initiated now as the power to sanction prosecution is vested in the state governments. This may be made a semi-judicial process where a designated authority can sanction prosecution on receipt of complaint from the investigating agencies.

There is a difference between planning, legislating, and implementing programmes. Especially those meant for the weaker sections. The people now take the issue of implementation to the judiciary. This is being seen as judicial activism! It is actually a positive sign that people are taking the bureaucracy’s failure to the judiciary.

It is necessary that governance is improved at all levels – political, bureaucratic and legislative levels, so that people do not have to use judiciary as the last resort. (PIB)

Talibanisation of Pakistan?

By Sreedhar

If one goes to interiors of Pakistan, especially to provinces like NWFP and Balochistan and Federally Administered Tribal Areas similar instances are far soo many. The so called Talibanists raided barber shops in NWFP to dissuade men from trimming their beards! In Quetta, music shops have been torched and television artists were abused. According to one report, Taliban activists are noting down numbers of cars driven by women without male accomplice to take punitive action at a later stage.

This extraordinary phenomenon is going unpunished by the Government in Islamabad. The immediate question that arises is why the Government is not acting against these self proclaimed rulers? Why the people at large are silently accepting these dictats from Talibanites?

One explanation could be: there has been a total break down of law and order in Pakistan. The vital institutions for governance, like Judiciary and politics, have been discredited by the ruling military Junta. The situation may not be exactly like in Afghanistan in 1980s; but is fast approaching to a similar situation in Pakistan. Therefore, ordinary people, not finding basic security for life, have started tilting towards Taliban type of rule by mullahs and maulvis. The redressal for any grievance by these mullahs is swift and decisive unlike the courts and ineffective police machinery.

On closer scrutiny of such developments in Pakistan, however, it reveals that these radical groups that talk in terms of implementing Shariat have tacit support from the ruling elite. From the days of Zia-ul-Haq assuming power in 1970s, these radical groups were cultivated by him to make a support base for his rule. Over the years, especially during Afghan refugees fight against the Red Army, the radical groups gained certain amount of respectability and acceptability in Pakistani polity. Quite a few Pakistani elite even articulated that Taliban type of Government is the best solutions to root out evils in the Pakistani policy.

The success of Taliban Government in neighbouring Afghanistan in 1990s gave further credence to the support to Islamic redicals.

The end of military rule and return of popularly elected Government in 1988, no way diminished the support to radical Islamic groups. Both, Benazir Bhutto and Nawaz Sharif, the elected Prime Ministers of Pakistan continued to appease these radical Islamic groups for increasing their political clout and their influence at the grass root level. The return of the army to rule in October 1999 has not altered situation in any way. In the last elections, the radical Islamic groups under the banner of MMA managed to gain absolute majority in NWFP assembly and a big chunk in the Balochistan assembly.

In addition, Gen. Musharraf, after the 1999 Kargil war debacle, realized that Islamic radical groups will be an ideal pressure point to force India to resolve the Kashmir issue. In Gen. Musharraf's perception, if the radical Islamic groups are preoccupied with Kashmir valley on East and resurgence of their movement in West (Afghanistan), they will not pose any threat to his regime.

Unfortunately, his assessment is going wrong. The Islamic radical's activities came under severe opposition on both fronts. Not only the Indian and Afghan Governments dealt with them militarily in a punitive fashion but also widely publicized Islamabad's involvement with them.

Having suffered severe military reversals in both the countries, the Islamic radicals recently started looking inwardly. As one commentator pointed out "they went to set Taliban type of Government in Pakistan and show case it as an example to the rest of the Islamic World. Added to it, Gen. Musharraf Government, whatever may be the pressure from the international community, will not act like the caretaker Government in Bangladesh arresting and then executing the top leadership of radical Islamic groups. The radical Islamists of Pakistan feel that Gen. Musharraf needs their support badly in the forthcoming elections".

Besides, the radical Islamic groups in Pakistan are well prepared to meet any challenge from the security forces. Some of the radical groups even claim that they have "considerable amount of sympathy and support among the men in uniform". This means the Talibanised Islamic radicals in Pakistan are not going to give up so easily like their counterparts in Bangladesh.

The next question that arises is whether Talibanisation of Pakistan can take place in the foreseeable future? The answer seems to be yes for two reasons. As long as the Taliban leadership like Mullah Omar continues to operate from Pakistani soil, the movement cannot be wiped out. And it is a known secret that Mullah Omar and his right hand men live in Pakistan. Even some of the western intelligence agencies provided specific information about his hideouts in places like Quetta.

Over the years Mullah Omar along with Osama bin Laden have emerged as cult figures among people of Pakistan, especially in NWFP and Balochistan provinces.

The political vacuum created by Gen. Musharraf by discrediting political parties is being rapidly filled by Taliban sympathizers and supporters.

At another level, Gen. Musharraf is perceived as a person who made Pakistan a client state of the US; who is doing every thing that the US wants him to do. With the Bush administration demands getting tougher and tougher, many Pakistani observers feel that Gen.Musharraf may finally yield at any time.

If this is the course through which Pakistan is going to move, one need not be surprised if radical Islamic group with Taliban ideology as their slogan, succeed in the forthcoming elections. And if they capture power once through ballot box it will be difficult to dislodge them afterwards.

The survivor instinct in Gen. Musharraf is making him to do some quick thinking and bring corrections in the Pakistan polity. How far these corrections that he is contemplating will check the Islamic radical groups is to be seen. -CNF

Leadership crisis in pharmaceutical research

By Ashok B Vaidya

India is one of the largest manufacturers of drugs in the world; it is number fourth in the total volume of drugs produced and the thirteenth in terms of the market value. With very low prices of drugs in India, the basic research in new drugs is not only considered difficult but almost impossible to support. Only few Indian companies have engaged in a quest for new molecules, which can be patented globally and probably become blockbuster drugs. Ranbaxy, Dr. Reddy's NPIL, Cadilla and some other companies are now on the learning curve of the drug discovery path.

The current estimates of a new drug, being discovered and launched, are around $1.3 billion. The multinational companies, with huge global sales, are also finding it difficult to be productive in their R&D process. Besides the cost in terms of money, the other constraints are also daunting. It takes one in 50,000 molecules to emerge as a drug. The time taken is anywhere between six to twelve years for the drug to reach market. Hundreds of scientists of multidisciplinary expertise have to dedicate to chemistry, pharmacology, toxicology and clinical research on new molecules. Despite such massive inputs the pipeline of new drugs is almost dry for even the big multinational drug companies. No wonder there is a global rethinking on the conventional way of drug discovery - combinatorial chemistry, genomic-proteomic targets and most expensive toxicity studies and extensive clinical trials. Indeed there appears to be a leadership crisis in pharmaceutical research.

Over the years, without the process patent regime the pharmaceutical industry would not have grown to its current size and quality. But imitation of drug molecules, for too long, by some minor but patent-savvy process variations does not equip research scientists for innovation. And the way sizeable revenue has been generated by imitation, it has led to a mindset of the Indian pharma industrial czars that is of complacency and inertial. There was a one-man crusade against this bleak scenario of "We cannot discover". That person is Dr. R.A. Mashelkar. As the Director General of the Council of Scientific and Industrial Research (CSIR), he received all the accolades and honours by the industry, Government and academia, while he held the office. As soon as he left that position, there was unfortunately an avalanche of aspersions on his integrity and motives. Dr. Mashelkar has expressed his deep pain for the unfounded allegations.

The CSIR under Dr. Mashelkar has emphasised (1) the public-private partnerships in drug research, (2) enhancement of networked projects of CSIR Laboratories in products for defined diseases, (3) the golden triangle approach of integrated research in modern medicine, traditional medicine and basic sciences, (4) new millennium Indian technology leadership initiative (NMITLI) for drugs inspired by Ayurveda, through reverse pharmacology, systems biology and ethnobotany paths, (5) facilitation of intellectual property rights for Indian drugs, (6) enchancing the national property rights and traditional products through traditional knowledge digital library in several foreign languages, (7) personal encouragements to a large number of young drug researchers, within and outside CSIR. The list is quite a long one. The CSIR succeeded in opening up of Indian sciences to global challenges.

What could be the research strategy for pharmaceutical industry in India? The captains of Indian Pharmaceutical industry should prepare for a paradigm shift in new drug research. Then possibly the crisis of leadership will reduce and aping the western model of new drug research will cease. There is a need to include as a mentor on the Board of the Company Directors, leaders of Life and drug sciences, with a proven track record. The mentor would monitor the new drug R&D path of the company and also scan for rapid opportunities.

The industry should also establish excellent post-marketing drug surveillance units in the company for a continued survey of safety, efficacy and novel unforeseen effects. The latter can serve as opportunities in therapeutics. The industry should also consider: To sponsor hospital facilities of excellence for phase 0, 1 and 2 clinical trials and human pharmacology. Only judiciously the contract research organizations, have to be used for defined projects on phase 3 and special studies; to promote the novel Reverse Pharmacology path, by sponsoring units of Pharmacoepidemiology and Observational Therapeutics at outstanding medical institutes and hospitals; to scan and activity do talent-scouting in academic, chemical, pharmaceutical, medical and biological institutions for innovative paths; to support the institutions of excellence in pharmaceutical and biological research.

It may be also take up those molecules, discovered in India, but not taken beyond.

Phase 1 or 2, for political or not-invented-here (NIH) approach of some of the MNCs. Several such candidates do exist and are still relevant e.g. CGI 13744, as an antidiabetic agent. There is also need to encourage basic research, in orphan or tropical diseases relevant to India, through time-bound networked programmes among the national laboratories and universities and to invest and engage in a serious effort to explore the wealth of Ayurveda for natural drugs: as activity - standardised extracts, fractions, active molecules or their more active or safer derivatives, with the state-of-the art scientific evidence.

The aforesaid suggestions are to be given a suitable company-specific business plan with investment needs and also time-frame for the deliverables. That demands a type of top management leadership that does not shy of a paradigm shift and also a major shake-up of their existing R&D set up. Essentially, the paradigm shift is to be back to the patient as central stage. The bedside is the best side to discover not only the pathogenesis of diseases but also their reversal. Too long, the chemists have dominated the field of drug discovery. Biologists have now entered and are close to the centre-stage. But clinical Pharmacologists and clinical scientists are not still enjoying the status of drug discoverers. It is time that these investigator "clinicians" cease to be mere handmade on the Clinical trialists of the CROs and pharma as academic clinical drug - discovery scientists. They have to use the paths of observations, pharmacoepidemiology and reserve pharmacology to identify clinical hits, develop experimental therapeutic leads and select new drug candidates, through a networked R&D programme.

PTI Feature