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Editorials | Article | Middle | Oped

EDITORIALS

Treading the beaten path
BJP needs to change to win back public trust
The results of the recent Lok Sabha election may hold many lessons for the BJP, but there are no signs that the party is introspecting and seeking to learn from its mistakes. Its prime ministerial challenger, Mr L.K. Advani, whose monumental failure to assess the conditions at the ground level and poor strategising contributed in large measure to the defeat, has been chosen leader of the BJP Parliamentary Party and whatever introspection there is in the party is in hushed tones. Much as they may try to cover up differences among leaders, it is no secret that Mr Advani and party president Rajnath Singh do not see eye to eye on even some basic issues.

Killing for dowry
SC favours hanging as punishment
The Supreme Court’s tough stand on the increasing cases of bride-burning in the country and its emphasis on the need to hang the perpetrators of this horrendous crime needs to be commended. Justice Markandey Katju, heading the Vacation Bench, was most forthright in his stand when he said that no mercy should be shown towards such culprits.


EARLIER STORIES

Friends, or foes?
June 2, 2009
Better days ahead
June 1, 2009
The fury of cyclone Aila
May 31, 2009
Tasks assigned
May 30, 2009
Team Manmohan
May 29, 2009
Lahore again
May 28, 2009
Let peace prevail
May 27, 2009
PM’s appeal
May 26, 2009
Mayawati goes berserk
May 25, 2009
Mandate for Manmohan
May 24, 2009
Manmohan Singh’s A team
May 23, 2009


The politics of ‘halts’
Mamata must get to the root of it
While ordering an inquiry into the “whimsical” withdrawal of stoppages notified by the East Central Railway ( ECR) in Bihar, apparently without her knowledge or approval, Railway Minister Mamata Banerjee spoke of a conspiracy aimed at derailing her tenure at Rail Bhavan and possibly to trigger a row between the neighbouring states of Bihar and West Bengal. While her apprehension is debatable, there is little doubt that overzealous railway officials jumped the gun.

ARTICLE

Pak offensive against Taliban
Handling the root causes may help
by Gen V.P. Malik (retd)
A distinguished Pakistani citizen said in an interview recently that the Army should have struck the Pakistani Taliban three years ago. The anguished gentleman could not answer more questions because he did not know what was happening in Swat, except for the large exodus of local civilians during the conduct of military operations.

MIDDLE

The hotel and the shrine 
by Suchita Malik
IT happened to be my first visit to Japan, the much acclaimed land of the rising sun, and I got an opportunity to discover the Tokyo town on my own. I visited a couple of tourist spots, including the Asakusa temple, a much acclaimed Shinto shrine followed by a shopping spree in the narrow lane almost leading to and far from it.

OPED

India and Southeast Asia
Vietnam backs Delhi’s Look East Policy
by Paramjit S. Sahai
I have returned after participating in an international conference at Ho Chi Minh City in Vietnam, which was billed as historic and the first of its kind in facilitating an academic discourse between Indian and Vietnamese experts — academicians, research scholars, former diplomats and bureaucrats.

From Northeast to Parliament
by Sanjoy Hazarika
The new Council of Ministers, with a predominance of Congress representatives, shows a fascinating compromise that Prime Minister Manmohan Singh and Congress president Sonia Gandhi as well as their chief aides and Rahul Gandhi, have manoeuvred.

A doctor as an employee
by Ronald J. Glasser
A few decades ago, the biggest problem in medicine was diagnosis. Is that a heart attack or heartburn? The beginnings of dementia or a stroke? Is the tumor benign or malignant? Medical technology has changed all that.



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Treading the beaten path
BJP needs to change to win back public trust

The results of the recent Lok Sabha election may hold many lessons for the BJP, but there are no signs that the party is introspecting and seeking to learn from its mistakes. Its prime ministerial challenger, Mr L.K. Advani, whose monumental failure to assess the conditions at the ground level and poor strategising contributed in large measure to the defeat, has been chosen leader of the BJP Parliamentary Party and whatever introspection there is in the party is in hushed tones. Much as they may try to cover up differences among leaders, it is no secret that Mr Advani and party president Rajnath Singh do not see eye to eye on even some basic issues.

There are several unresolved dilemmas which were evident in the election campaign and have been conveniently buried under the carpet. The most glaring of these is the Ram mandir issue and the building of an inclusive India. While the BJP leadership sought to revive the issue, the Congress shrewdly projected an inclusive agenda.The negative campaign of the BJP criticising the Congress for weak and indecisive governance failed to cut much ice in the face of a positive Congress campaign based on its policies and programmes.

The more Mr Advani mocked at Dr Manmohan Singh as a weak and ineffective leader, the more it recoiled on him. The open support to Mr Varun Gandhi’s hate speech by Mr Rajnath Singh and leaders like Shiv Sena supremo Bal Thackeray went down badly with the people. Even the projection of Gujarat Chief Minister Narendra Modi as future prime minister misfired with the masses.

The people wanted to hear more about fast-track economic reforms and ways to tackle the world economic crisis, but the BJP failed to decipher the public mood. Even on the nuclear deal, the BJP by opposing it in Parliament failed to capitalise on the fact that the NDA government had initiated it. All this calls for deep introspection within the party and a break with the discredited past.

The BJP must realise that it cannot fire the imagination of the people with an old, unresponsive leadership and retrograde policies which seek to drive a wedge between religious groups. Nor can it win the battle through unruly behaviour and negative tactics in Parliament. It must project a bright new face and a fresh approach if it is to bounce back into reckoning.

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Killing for dowry
SC favours hanging as punishment

The Supreme Court’s tough stand on the increasing cases of bride-burning in the country and its emphasis on the need to hang the perpetrators of this horrendous crime needs to be commended. Justice Markandey Katju, heading the Vacation Bench, was most forthright in his stand when he said that no mercy should be shown towards such culprits.

Thundering at Prem Kumar Gulati from Bhiwani in Haryana, who was challenging the life term awarded to him for burning his younger brother’s wife in 2003, he said: “You poured kerosene over a young woman and set her on fire…You have got life sentence. You should have got death.” Few will disagree with his observation that only if persons like Gulati are hanged that this barbaric practice will stop. The judge’s comments, though an obiter dicta, should be taken with due weight as they bring out the apex court’s deep anguish over this menace and the imperative need to tackle it firmly.

Unfortunately, cases of harassment, torture and burning of brides due to dowry demands are on the rise everywhere. Punjab has the dubious distinction of having one dowry death every week and 55 deaths every year. According to a study by the Punjab State Chemical Laboratory, Patiala, one-third cases were reported from Doaba alone and most victims in 2008 were poisoned.

Dowry-related complaints are reported mostly in the 18-35 age group and from all sections. The criminal justice system is so slow and inefficient that 98 per cent of cases end up in acquittal. It is indeed imperative that all possible steps be taken to ensure that women have their rightful place in society.

Curiously, the parents’ propensity to organise lavish marriages of their daughters and give fat dowry to the bridegrooms is the root cause of the problem. Some Punjabis even borrow loans from moneylenders, go bankrupt and then commit suicide. There is need for a powerful reform movement to change their mindset on dowry. Women should also come forward and reject dowry seekers. Clearly, as Justice Katju has said, this evil can be curbed only if those found guilty of bride-burning are not shown any leniency by the courts and hanged from the nearest lamppost.

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The politics of ‘halts’
Mamata must get to the root of it

While ordering an inquiry into the “whimsical” withdrawal of stoppages notified by the East Central Railway ( ECR) in Bihar, apparently without her knowledge or approval, Railway Minister Mamata Banerjee spoke of a conspiracy aimed at derailing her tenure at Rail Bhavan and possibly to trigger a row between the neighbouring states of Bihar and West Bengal. While her apprehension is debatable, there is little doubt that overzealous railway officials jumped the gun.

The timing of the notification, issued during a transition period when a caretaker minister is giving way to the new incumbent, does arouse suspicion of mischief. Reports, after all, suggest that the over 250 authorised and unauthorised ‘halts’ in Bihar came up during the last five years. Other reports suggest that they span a longer period and came up during the tenure of the last three ministers.

Whatever be the correct position, there does not appear to be a direct provocation for officials to arbitrarily withdraw the benefit enjoyed by passengers over several months, if not years. This position is supported by railway officials themselves who are quoted as saying that not all ‘halts’ were found to be unviable.

Indeed, if newspaper reports are to be believed, ECR officials had shortlisted just about three dozen halts out of the 250 or so as economically unviable. It is not clear if the ‘halts’, hitherto unscheduled stoppages, are unique to Bihar. One does hope the mob fury unleashed in Bihar on Monday, in which two trains were torched by mobs angry at trains not stopping as expected and leaving them stranded, would eventually help expose the “politics of halts”.

Although Bihar has given to the country a disproportionately high number of Railway Ministers who appear to have forced the Railway Board to favour the state in matters of investment, launching new trains and creating new zones, the passengers in Bihar have always had a raw deal. With the Railways looking at maximising profit through freight, the poor passengers in the state have been left to clutch at small mercies like the ‘halts’.

For thousands of commuters in the state, travelling to work or to educational institutions continues to be an ordeal that daily takes up several hours. But it is unfortunate that they have to torch trains while drawing attention to their plight. Ms Mamata Banerjee has the opportunity to seize the initiative and provide them with a more lasting solution than ‘halts’.

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Thought for the Day

It takes little talent to see clearly what lies under one’s nose, a good deal of it to know in which direction to point that organ. — W.H. Auden

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Pak offensive against Taliban
Handling the root causes may help
by Gen V.P. Malik (retd)

A distinguished Pakistani citizen said in an interview recently that the Army should have struck the Pakistani Taliban three years ago. The anguished gentleman could not answer more questions because he did not know what was happening in Swat, except for the large exodus of local civilians during the conduct of military operations.

There can be many reasons for the delay in launching this operation for which Pakistan and its Army have now to pay a heavy price. These could be the ISI and Taliban nexus, a misperceived threat from India, or wanting and waiting to strike a profitable deal with the US. But an important one, I believe, could be a historical military perspective.

About 50 years ago, Gen Ayub Khan, a Pakhtoon tribal and Pakistan’s first military ruler, had stated that “withdrawal of Pakistani troops from Waziristan was the most sensible thing to do.” Ayub Khan wrote in his memoirs about the “sheer futility” of campaigns in the North-West regions by the Pakistani forces.

He said “…when Pakistan was established, there were several Army divisions as well as scouts and levies tied up on the Frontier. All they did was to provide a constant irritation to the tribesmen and a target for them to fire at. Also no real progress would be possible in this part of Pakistan while this state of affairs continued…. It was a great waste of time; and a great waste of men.”

What can be expected from this operation in which the Pakistan Army has thrown over 15000 troops with tanks, artillery, gun-ships and fighter jets against the militants?

There is a widespread perception that for too long the Pakistan Army has focused on a potential war with India, its nuclear deterrent, and the power and pelf that it has enjoyed. Its counter-insurgency capabilities are almost non-existent. Currently, it is using tactics with heavy ground and aerial weapons which go against the accepted best-practice in counter-insurgency operations.

It will be easy for the armed forces with such heavy fire-power to enter cities, towns or villages but will take considerable time for the civil administration and the police to be able to govern the area. Meanwhile, the insurgents will avoid frontal clashes. With the advantage of a terrain which favours guerrilla operations, and tribal loyalty, they would break up into smaller groups, withdraw into the mountains, and step up small-scale raids and suicide attacks.

Insurgencies tend to behave like a balloon: when squashed in one spot, they quickly inflate in other areas. A Taliban setback in Swat will affect the neighbouring tribal areas. It may serve as a catalyst for binding the loose confederation of the Taliban operating in the North-West Frontier Province and thus produce a more united militant force. On the other hand, a Taliban victory in Swat, even a stalemate, will be a disaster which cannot be mitigated. It would embolden the Taliban further and thus spell ruin for Pakistan.

There is also the likelihood of increased terrorist attacks in the rest of Pakistan, as we have seen in the back-to-back suicide attacks on the ISI office in Lahore and police posts in Peshawar and Dera Ismail Khan. Already, Taliban supporters are painting the walls with threats in Islamabad, compelling the administration to erase these messages quickly.

A heavy-handed offensive and indiscriminate use of fire-power will definitely eliminate some rebels. But it is bound to alienate many more people and thus cause socio-political instability. The collateral damage — over 1.5 million internally displaced persons (IDP) and a large number of civilian casualties — has already started causing public concern. Pakistan will have to maintain IDP camps for a long time, just as India has done for Kashmiri Pandits.

An intriguing aspect of the Pakistani military operation is its total lack of transparency. The media has no access to information about the operation other than what is handed over to journalists in military briefs. The official claims of militants and Pakistani Army casualties keep rising daily. But there is no way of independent verification of the successes claimed, or of distinguishing between the dead fighters and collateral civilian casualties. Such an action can lead to excessive human rights violations, rumours and disinformation, and affect the morale of the troops belonging to the affected areas.

The media moulds national and international opinion. It is a potent force-multiplier or a force degrader. In counter-insurgency operations, the battle for hearts and minds is of paramount importance. There is no point in winning the battle of bullets if you lose the war due to popular alienation.

The Pakistan government and the Army have stated that they would like to bring the operation to an early end. That is wishful thinking. In this situation, the proximity to Pashtun tribes in Waziristan and across the Durand Line will create complex problems in hot pursuit and operational coordination. A few days ago, General Musharraf stated in the US that it would be possible to control the Pakistani Taliban only when the Taliban in Afghanistan are defeated and cannot extend weapons and drug money support to the former. Such operations tend to suck in troops and take years, sometimes decades, to bring about normalcy.

Taliban insurgency cannot be eliminated through military operations alone unless the people themselves are convinced of the dangerous consequences of the Taliban’s activities. Unless the root causes — socio-economic and socio-political factors, and dispensation of justice — are tackled simultaneously, such operations will produce only a temporary relief, if at all. Pakistan and its Army are up not only against the armed Taliban but also, more importantly, the very idea of the Taliban.

The Pakistan government is in a precarious security situation. It can neither refuse American aid nor defy the resultant pressure, whether its people like it or not. A related issue is President Obama’s stated endeavour to pull out American troops from Afghanistan as early as possible. This could motivate the Taliban to adopt a hard line and leave the Pakistani forces fighting them in the lurch. Having faced a similar situation in Afghanistan in the 1990s, the Pakistani political and military authorities would be wary of such a move. The US long-term commitment in Afghanistan, therefore, is in its own best interest, and that of Pakistan and the region.

The writer, a former Chief of the Army Staff, is currently the President of the ORF Institute of Security Studies, New Delhi.

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The hotel and the shrine 
by Suchita Malik

IT happened to be my first visit to Japan, the much acclaimed land of the rising sun, and I got an opportunity to discover the Tokyo town on my own. I visited a couple of tourist spots, including the Asakusa temple, a much acclaimed Shinto shrine followed by a shopping spree in the narrow lane almost leading to and far from it.

Richer by a couple of buys and poorer by thousands of Yens, I came back to the hotel and chose to wait for my husband in the lobby itself enjoying the vibrant ambience of the place.

I waited for him for about an hour hoping that he would be back after finishing with his official engagements and then decided to retire to my room for a catnap.

My peaceful sleep was soon disturbed by a loud hankering bell and I found my husband asking me to get up and get ready for an evening excursion, if I so wanted. As I prepared to get ready, I looked for my handbag but could not locate it anywhere. A hurried recalling of my itinerary led me to believe that the clutch-bag was probably left behind in the lobby itself where I had waited not long ago.

A quick walk down the elevator and I was back in the lobby looking desperately for my lost treasure and looking askance at people around. The fruitless search ended in a casual query at the reception counter as the last resort.

Lo and behold! The polite hosts suddenly came into devilish activity and soon located the guard in charge of that corridor who, in turn, quietly and graciously produced the handbag from behind a counter and that too neatly wrapped in a polythene cover and asked me to check the contents promptly. A careful search through the interior of the purse testified the presence of the all-important passport as well as the trinkets of the travel jewellery, not to talk of the over-precious yens.

All this, and that too with the most humble smile, the half-bent posture and a determined resolve not to accept any reward except a simple “thank you”. I was greatly taken in by the sheer honesty and strength of character of the “nationalistic” hosts while being acutely conscious of our own lack of it somewhere in our hearts.

The next couple of days saw us saunter through some of the most scenic places around till we came to the last leg of our visit to the most spectacular Japanese shrine in Kyoto where we were expected to take off our shoes at the entrance. As we did so most reverently, our guide politely asked us to take a polythene bag from the nearby box, put our shoes into it and carry it along as we moved through the shrine. Our baffled look did not take her long to explain to us the fear of a theft of shoes.

As I burst into laughter, it was only my husband who could understand the irony behind the enigma of the hotel and the shrine. This time, it was for the guide to give us a baffled look in a bemused manner. We had a hard time explaining to her the weirdest of the situations. “The hotel and the shrine” will remain embedded in my memory for a long time, I suppose.

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India and Southeast Asia
Vietnam backs Delhi’s Look East Policy
by Paramjit S. Sahai

I have returned after participating in an international conference at Ho Chi Minh City in Vietnam, which was billed as historic and the first of its kind in facilitating an academic discourse between Indian and Vietnamese experts — academicians, research scholars, former diplomats and bureaucrats.

The theme of the conference was: “Relationship between India and Southeast Asia — A Strategic Commitment or Regional Integration” that afforded an opportunity to get a Vietnamese perspective on India’s role in Southeast Asia.

The conference was jointly organised by the Maulana Abul Kalam Azad Institute of Asian Studies Kolkatta, and the University of Social Sciences and Humanities, Ho Chi Minh City. Over 50 experts from Vietnam, India, Thailand and Cambodia participated.

The conference covered a whole gamut of India-Southeast relationship. The Vietnamese academicians lauded India’s Look East Policy, appreciating its thrust, but noted the slow progress in the implementation of various programmes.

The key question raised and answered was whether India’s Look East Policy was a manifestation of India’s desire for power, viewing the region as a buffer zone between India and China or regional cooperation, give the complementarities between India and Southeast Asia.

The overwhelming response was for regional cooperation as India had not shown hegemonic designs and had no military conflicts in the region and was viewed as a benign power, whether in the present-day context or when Indian cultural influence took roots in Southeast Asia.

The scholars agreed that the main driving impulse for India’s Look East Policy was India’s economic engagement with Southeast Asia, consequent to the dismantling of the Cold War and India’s economic liberalisation in 1991. They noted the increase in trade and investment linkages between India and Southeast Asian countries.

In Vietnam, India was emerging as an important investor, even though the United States was leading the pack. Concerns were, however, expressed on account of Vietnamese’ adverse trade balance with India.

The experts, however, failed to recognise that Indian investments were contributing to employment and augmenting exports and thus helping in addressing the overall adverse balance of Vietnamese external trade.

There was, however, a sense of satisfaction that the present global economic meltdown had not affected India’s commitment to Vietnam, as reiterated by the visiting entrepreneurs from Indian multinationals like the Tatas, the Godrejs etc. In fact, for Godrej, Vietnam has emerged as the regional hub as they had migrated from Malaysia.

Vietnam was also emerging as an important hub for IT education. Two leading Indian companies — NIIT and Aptech — were involved in a big way, training 8000 students in 34 centres and 37,000 students in 28 centres in Vietnam. The Indian presence in IT education in Vietnam could be further stepped up, if this was linked to the study of the English language.

There is, therefore, a need for opening additional Indian centres in Vietnam, where English could be taught. Academic linkages between India and Vietnam are, however, limited and these need to be strengthened as Vietnamese perceptions should form an important component in India’s foreign, defence and economic policy formulations. The same would also be true, in reverse.

Vietnamese concerns over the Chinese strategic role were openly expressed. It was, therefore, not surprising that some experts would like to see the establishment of a new triangle — India, Vietnam and Japan.

Equally, there were concerns over the presence of Chinese diaspora, resulting in Vietnam adopting a restricted visa policy towards China. No such fears existed towards India or Indian diaspora.

In fact, the role of the Indian diaspora was viewed in a positive light not only in Vietnam, but the whole of Southeast Asia. Indian diaspora was seen as a bridge builder between India and other countries in the region.

The number of Indians in Vietnam is growing; it has touched over 600 families in Ho Chi Minh City, which is substantial from its earlier meager presence and is reflective of India’s growing involvement in Vietnam.

The unmistakable message from Vietnam was that it applauds India’s Look East Policy, but feels that much more needs to be achieved in concrete terms. Cultural bonds and values still bind the two countries and peoples.

India’s profile has to further increase in the economic arena in Vietnam, leading towards greater economic integration with Southeast Asia. There is need for greater economic integration of Northeast India with other parts in Southeast Asia.

Vietnam, on its part, would be willing to support India in an expanded role in the Asia-Pacific beyond Southeast Asia. India’s increasing role in the region would be welcome for the unstated reason that it could act as a counterpoise to the other Asian giant.

We also cannot overlook the fact that India shares maritime boundary with Southeast Asia, as only 80 miles separate the southernmost islands of Andaman Nicobar from the northern-western tip of Sumatra in Indonesia.

Is India listening and willing to convert its Look East Policy into an action-oriented policy, which is mutually advantageous at the bilateral and regional levels? The conference started with a Hindi song by a student which said “we would succeed and spread the message of peace” and this should become the centrality of India-Vietnamese relations, as India forges ahead in Southeast Asia,

The visit of Indian President Pratibha Patil to Vietnam in November 2008 sent this signal, as it reiterated commitment to our Look East Policy, as it expected this visit to become “another milestone in ensuring that our engagement remains strong and beneficial to all concerned”.

Could we transform this relationship from heart to heart into strategic partnership’, which was the title of one of the papers, and again, return to ‘heart to heart’, as it is cultural understanding, which connects people and promotes a more long lasting relationship, which goes beyond a change in government.

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From Northeast to Parliament
by Sanjoy Hazarika

Agatha Sangma
Agatha Sangma

The new Council of Ministers, with a predominance of Congress representatives, shows a fascinating compromise that Prime Minister Manmohan Singh and Congress president Sonia Gandhi as well as their chief aides and Rahul Gandhi, have manoeuvred.

And nowhere is the delicate, difficult and thankless task of coalition building seen best as in the case of little Meghalaya, where both members of Parliament have found a place.

The reason is not far to seek: it is an interesting reflection of the complex and inconsistent reality both of Indian politics as well as of the immense challenges that the Northeast presents to New Delhi.

In one way it’s simple: Purno Sangma’s daughter, Agatha, won from the Tura constituency, which was her father’s fiefdom for 30 years. The youngest member of the Lok Sabha at 28, she defeated her nearest rival, Deborah Marak, by a bare 17,945 votes. It was clearly a close call and her opponent, a former minister in the state government, gave her a tough fight.

But the facts are much more complex — first, Agatha defeated a candidate from the very Congress party which is allied to her party, the Nationalist Congress Party of her father and Sharad Pawar, in other parts of the country.

Yet in Meghalaya, the two parties are at daggers drawn, with Sangma first cobbling together an anti-Congress coalition and the Congress having its revenge by toppling Sangma’s coalition a few months later.

Secondly, to placate the state Congress, the party leadership had no option but to give the party’s winner in Shillong, Vincent Pala, who in contrast to Agatha, won by over 100,000 votes, a minister of state post. Pala is a Khasi, the majority tribe in Meghalaya, and Agatha is Garo, and the relationship between the two regions and ethnic groups is, to put it mildly, not particularly charged with bonhomie.

So, as a result, there are three ministers from the Northeast (if you exclude the Prime Minister who is elected to the Rajya Sabha from Assam), two first-timers from one of the smallest states of the country, not just of the region — Meghalaya has a population of about two million — and a Cabinet minister, Bijoy Krishna Handique from Assam.

Handique is one of the longest serving MPs from the state and was a minister of state in the earlier Manmohan Singh ministry. There are a total of 25 MPs from the Northeast region, of whom 13 are from the Congress. Noises are heard in Assam about the lack of representation to the state.

In Delhi’s balancing act, at least two interesting figures from the Northeast were left out: one is Thokchom Meiyna, the gentle professor of mathematics from Manipur who has been winning elections back to back for the Congress and P.D. Rai, the first IIT and IIM graduate to make to the Lok Sabha ever.

‘PD’, as he is known, is an ecologist and management specialist, who would have done well in government, given his experience back home. He was elected from Sikkim on the Peoples Democratic Front (PDF) ticket.

Incidentally, the PDF made a clean sweep of all 32 state assembly seats (the state legislature was elected at the same time) and is allied with the Congress. There is quite frankly the need for better representation of the region’s ethnic, social and political diversity.

The Assam United Democratic Front of Baddruddin Ajmal may have won only Ajmal’s own seat but it ensured the defeat of the Congress in no less than three seats, including the crushing failure of former Industries Minister Santosh Mohon Dev who trailed Ajmal in his home constituency of Silchar (the BJP won the seat). And interestingly it ensured the defeat of the regional Asom Gana Parishad in two constituencies. — IANS

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A doctor as an employee
by Ronald J. Glasser

A few decades ago, the biggest problem in medicine was diagnosis. Is that a heart attack or heartburn? The beginnings of dementia or a stroke? Is the tumor benign or malignant? Medical technology has changed all that.

The biggest problem in medicine today is not determining what’s wrong with you. It’s knowing whom to call at 2 a.m. — other than 911 — when something happens. And the nasty little secret is not that your doctor is no longer available, but that he or she is no longer in charge.

Of the 15,000 students who will graduate from medical school this year — and the roughly 8,000 physicians and surgeons who will finish their specialty training — more than 93 percent will become employees of large clinics, managed-care companies or hospital systems.

These physicians, as I have seen in my own practice in Minneapolis, are no longer patient advocates. In many ways, they’ve abandoned the patient to the work rules of health plans and the professional demands of managed care. The Hippocratic Oath has been discarded, and the Golden Rule has become: He who has the gold sets the rules.

What this means is that the care you get — and how long you get it — is only the care your health plan will reimburse your doctor for. You can see your psychiatrist or psychologist for five visits; you can stay in the hospital for 48 hours following a hip replacement, or three days after a radical prostatectomy.

Simple mastectomies go home the same day, and gall-bladder removals as soon as they wake up from the anesthesia. If the drug prescribed is not on your health plan’s list, then your doctor will have to prescribe an approved alternative that may not be as effective.

Why have we witnessed a shift from independent medical practitioner to employee? The accepted reason is the steady growth of managed health care since the late 1970s. Thousands of small-group practices, faced with one or two dominant health plans in a city or geographic area, have been forced to merge to cut better deals on reimbursements. But the shift also appears to be generational. Consciously or unconsciously, we have raised a generation that views the medical profession in economic terms, as a career rather than as a calling.

Not long ago, a senior member of one of the Twin Cities’ largest gastroenterology groups confided to me that no one in the group over the age of 55 could tolerate being part of the search committee hiring new physicians.

“It isn’t like it used to be when you and I were looking to be hired a few decades ago,” he said. “We were dutiful and respectful and excited to even be offered a job. ... Now, it’s, `When will I be completely vested in the retirement plan?’ `I can’t work a full day on Friday because the kids play football or soccer on Friday night.’ `I don’t want to be on call more than twice a month. And if I do work here, I would like a signing bonus to cover the expenses to move here and the time it would take me to get up to speed.’ “

Similarly, Claus Pierach, a professor of medicine who serves on the admissions committee at the University of Minnesota Medical School recently told me that the committee had begun to notice something new a few years ago. When asked “Why do you want to be a doctor?,” most applicants still answered as expected: “Because I want to help people.” But every so often, a candidate would reply that the reason was “job security.”

At first, the committee bristled at this answer. But now members have grown used to hearing it. It is a frequent and unembarrassed response, usually accompanied by the stated desire to go into one of the more lucrative procedure- or diagnostic-based areas of medicine: radiology, dermatology, orthopedics or cardiology.

A good income and more desirable lifestyle matter more than the type of patient the doctor might see. Taking care of the needy is no longer on anyone’s radar screen. When the administration of a large Minneapolis medical clinic surveyed its 600 doctors this year about whether they’d be willing to work more hours, most said no. When asked whether they would work more hours for more pay, they still said no.

Troublingly, medical school professors have helped push the shift to physicians as employees. They’ve dismissed the concept of a small group practice as unworkable.

— By arrangement with LA Times-Washington Post

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