... Achievement motivation in Gita 99-125 characteristics of achievement- oriented individual 100-103 its significance for Indian management 108-109 Aquinas ...

With the increasing prevalence of Internet usage, Internet-Delivered Psychological Treatment (IDPT) has become a valuable tool to develop improved treatments of mental disorders. IDPT becomes complicated and labor intensive because of overlapping emotion in mental health. To create a usable learning application for IDPT requires diverse labeled datasets containing an adequate set of linguistic properties to extract word representations and segmentations of emotions. In medical applications, it is challenging to successfully refine such datasets since emotion-aware labeling is time consuming. Other (...) known issues include vocabulary sizes per class, data source, method of creation, and baseline for the human performance level. This paper focuses on the application of personalized mental health interventions using Natural Language Processing (NLP) and attention-based in-depth entropy active learning. The objective of this research is to increase the trainable instances using a semantic clustering mechanism. For this purpose, we propose a method based on synonym expansion by semantic vectors. Semantic vectors based on semantic information derived from the context in which it appears are clustered. The resulting similarity metrics help to select the subset of unlabeled text by using semantic information. The proposed method separates unlabeled text and includes it in the next active learning mechanism cycle. Our method updates model training by using the new training points. The cycle continues until it reaches an optimal solution, and it converts all the unlabeled text into the training set. Our in-depth experimental results show that the synonym expansion semantic vectors help enhance training accuracy while not harming the results. The bidirectional Long Short-Term Memory (LSTM) architecture with an attention mechanism achieved 0.85 Receiver Operating Characteristic (ROC curve) on the blind test set. The learned embedding is then used to visualize the activated word's contribution to each symptom and find the psychiatrist's qualitative agreement. Our method improves the detection rate of depression symptoms from online forum text using the unlabeled forum texts. (shrink)

This article featuring India constitutes one of five articles in a collection of essays on local capacity-building in research ethics by graduates from the University of Toronto’s Joint Centre for Bioethics MHSc in Bioethics, International Stream program funded by the Fogarty International Center for Advanced Study in the Health Sciences. Research ethics is a growing area of work and interest in India. Ethics review remains the weakest component in the mechanism of good clinical practice, and there is a severe dearth (...) of professionals trained in ethics who can provide leadership. Although the Indian Good Clinical Practice Guidelines, the Indian Medical Council Act, and the Drugs and Cosmetics Act require that the Indian Council of Medical Research’s ethical guidelines be followed as a mandatory requirement for physicians who conduct research, there is a pervasive lack of awareness of basic requirements guiding the ethical conduct of research. There is a great need to strengthen India’s research ethics capacity and regulatory framework for research. (shrink)

In this paper a new technique of dual image watermarking is proposed for protection of ownership rights which utilizes salient properties of homomorphic transform (HT), discrete wavelet transform (DWT), singular value decomposition (SVD) and Arnold transform (AT). In embedding algorithm host image is splitted into reflectance and illumination components using HT, DWT is further applied to the reflectance component resulting in frequency subbands (HL and LH) which are transformed by SVD. Two image watermarks are selected for embedding process whereas security (...) of proposed algorithm is strengthen by performing scrambling of second watermark through AT. Both watermarks are transformed with DWT and SVD. Singular values (SVs) of both transformed watermark are embedded into SVs of host image. Simulation results clearly signifies for high robustness and imperceptibility of proposed algorithm as it is examined under various attacks. Superiority of proposed technique is illustrated by comparing it with other reported methods. (shrink)

COVID-19 forced lockdown in India, leading to the loss of job, crisis of food, and other financial catastrophes that led to the exodus migration of internal migrant workers, operating in the private sector, back to their homes. Unavailability of transport facilities led to an inflicted need to walk back to homes barefooted without lack of any other crucial resources on the way. The woeful state of internal migrant workers walking back, with all their stuff on their back, holding their children, (...) was trending on social media worldwide. Their problem continued even after reaching home, including misbehavior of villagers, indifferent mannerism of family members toward them, inability to fulfill family responsibility, and financial crisis, which led to stress, fear, and trauma for these internal migrant workers. The present paper aimed to assess the idiosyncratic stressors of internal migrant workers throughout the pandemic era and their responses toward those problems, which helped them cope with it. In-depth semistructured telephonic interviews were conducted with 25 internal migrant workers who were working in different cities in India before lockdown. The analyses revealed that multiple stressors include financial crisis, unavailability of food, inability to continue education, inability to pay house rent, lack of support from neighbors and family, and other psychological stressors that affected them. However, they also tried multiple strategies to deal with the problems, including a cognitive appraisal of the problem and making oneself psychologically competent to deal with the situation. Social support of family and friends played a vital role in enhancing hardiness and increasing the level of happiness at scarce times. At the same time, some of them could not deal with stressors and opted for psychiatric help to manage the physical symptoms of stress. (shrink)

Religion of the Rabaris of the Rajasthan, India; a study.

. Software testing is a very important phase in the development of software. Testing includes the generation of test cases which, if done manually, is time consuming. To automate this process and generate optimal test cases, several meta-heuristic techniques have been developed. These approaches include genetic algorithm, cuckoo search, tabu search, intelligent water drop, etc. This paper presents an effective approach for test data generation using the cuckoo search and tabu search algorithms. It combines the cuckoo algorithm's strength of converging (...) to the solution in minimal time along with the tabu mechanism of backtracking from local optima by Lévy flight. The experimental results show that the algorithm is effective in generating test cases optimally and its performance is better than various earlier proposed approaches. (shrink)

Gluten ataxia is a rare immune-mediated neurological disorder caused by the ingestion of gluten. The diagnosis is not straightforward as antibodies are present in only up to 38% of patients, but often at lower titers. The symptoms of ataxia may be mild at the onset but lead to permanent damage if remain untreated. It is characterized by damage to the cerebellum however, the pathophysiology of the disease is not clearly understood. The present study investigated the neurochemical profile of vermis and (...) right cerebellum and structural changes in various brain regions of patients with gluten ataxia and compared it with healthy controls. Volumetric 3-D T1 and T1-weighted magnetic resonance imaging in the three planes of the whole brain and single-voxel 1H- magnetic resonance spectroscopy of the vermis and right cerebellum were acquired on 3 T human MR scanner. The metabolite concentrations were estimated using LC Model while brain volumes were estimated using the online tool volBrain pipeline and CERES and corrected for partial volumes. The levels of neuro-metabolites were found to be significantly lower in vermis, while N-acetyl aspartate + N-acetyl aspartate glutamate and glycerophosphocholine + phosphocholine was lower in cerebellum regions in the patients with gluten ataxia compared to healthy controls. A significant reduction in the white matter of ; reduction in the volumes of cerebellum lobe and thalamus while lateral ventricles were increased in the patients with gluten ataxia compared to healthy controls. The reduced neuronal metabolites along with structural changes in the brain suggested neuronal degeneration in the patients with gluten ataxia. Our preliminary findings may be useful in understanding the gluten-induced cerebral damage and indicated that MRI and MRS may serve as a non-invasive useful tool in the early diagnosis, thereby enabling better management of these patients. (shrink)

The archaeological record is very limited and its analysis has been contentious. Hence, molecular biologists have shifted their attention to molecular dating techniques. Recently on April 2013, the prestigious Cell Press Journal Current Biology published an article (Fu et al. 2013) entitled “A Revised Timescale for Human Evolution Based on Ancient Mitochondrial Genomes”. This paper has twenty authors and they are researchers from the world’s top institutes like Max Planck Institute, Harvard, etc. Respected authors of this paper have emphatically accepted (...) that the fossil record is inadequate and unreliable. These statements clearly substantiate that now biologists are agreeing that fossil records do not provide any significant evidence at all for conventional evolution theory. Despite the well-recorded fact of the continual grand propaganda of Darwinism based on fossil evidence for more than 150 years, in recent times biologists are surprisingly coming up with such statements, based on their confidence that evolution can be explained purely by the genealogical/genomic record provided by modern molecular biology. Still many respected journals (for example the article in Nature, Retallack, 2013) continue to publish articles on fossil evidence to support Darwinian evolution. These incoherently diverse claims prove that Darwinists are struggling with unscientific ideological approaches to explain biodiversity. Darwinian evolutionary theory is not only the basis of modern biology, but also acts as the guiding principle of science and intellectual reasoning for modern civilization. Hence, a scientific understanding of the breakdown of the Darwinian theory of objective evolution is very important for overcoming the traditional scientific temper of mechanistic intellectualism that characterizes this ideology. In my article “21st Century Biology Refutes Darwinian Abiology” (published in two parts in November and December 2012 issues of The Harmonizer: www.mahaprabhu.net/satsanga/harmonizer) it was noted that several recent findings challenge the credibility that random mutations and natural selection can provide a valid basis for justifying the naturalistic evolution of species. The present article summarizes the problems associated with the fossil record and dating techniques, and its implication on the neo-Darwinian mechanistic misconception of biological life as mere molecular chemistry or abiology. An alternative approach based on the Vedāntic view for explaining biodiversity in the light of 21st century biology is also discussed in the end of the article. (shrink)

How can we make moral progress on factory farming? Part of the answer lies in human moral psychology. Meat consumption remains high, despite increased awareness of its negative impact on animal welfare. Weakness of will is part of the explanation: acceptance of the ethical arguments doesn’t always motivate changes in dietary habits. However, we draw on scientific evidence to argue that many consumers aren’t fully convinced that they morally ought to reduce their meat consumption. We then identify two key psychological (...) mechanisms—motivated reasoning and social proof—that lead people to resist the ethical reasons. Finally, we show how to harness these psychological mechanisms to encourage reductions in meat consumption. A central lesson for moral progress generally is that durable social change requires socially-embedded reasoning. (shrink)

Formal principles governing best practices in classification and definition have for too long been neglected in the construction of biomedical ontologies, in ways which have important negative consequences for data integration and ontology alignment. We argue that the use of such principles in ontology construction can serve as a valuable tool in error-detection and also in supporting reliable manual curation. We argue also that such principles are a prerequisite for the successful application of advanced data integration techniques such as ontology-based (...) multi-database querying, automated ontology alignment and ontology-based text-mining. These theses are illustrated by means of a case study of the Gene Ontology, a project of increasing importance within the field of biomedical data integration. (shrink)

People draw subtle distinctions in the normative domain. But it remains unclear exactly what gives rise to such distinctions. On one prominent approach, emotion systems trigger non-utilitarian judgments. The main alternative, inspired by Chomskyan linguistics, suggests that moral distinctions derive from an innate moral grammar. In this article, we draw on Bayesian learning theory to develop a rational learning account. We argue that the ‘size principle’, which is implicated in word learning, can also explain how children would use scant and (...) equivocal evidence to interpret candidate rules as applying more narrowly than utilitarian rules. (shrink)

Existing research posits that decision makers use specific cognitive frames to manage tensions in sustainability. However, we know less about how the cognitive frames of individuals at different levels in organization interact and what these interactions imply for managing sustainability tensions, such as in Bottom of the Pyramid projects. To address this omission, we ask do organizational and project leaders differ in their understanding of tensions in a BOP project, and if so, how? We answer this question by drawing on (...) a 5-year study of a BOP project of a global pharmaceutical company in India. In line with the existing research, we found three kinds of frames—paradoxical, business case, and business—held differently across organizational levels and over time. We also found that the shift in frames of both project and organizational leaders was mediated by the decision-making horizon. The initial divergence across organizational levels, seen in paradoxical and business frames, was mediated by long-term decision-making horizon. However, there was an eventual convergence toward business frames associated with the shift from long- to shorter-term decision-making horizons and one that led to the project’s closure. We contribute by proposing a dynamic model of cognitive frames in sustainability, where the research has either alluded to top-down or bottom-up understanding. (shrink)

Brain, Mind and Consciousness are the research concerns of psychiatrists, psychologists, neurologists, cognitive neuroscientists and philosophers. All of them are working in different and important ways to understand the workings of the brain, the mysteries of the mind and to grasp that elusive concept called consciousness. Although they are all justified in forwarding their respective researches, it is also necessary to integrate these diverse appearing understandings and try and get a comprehensive perspective that is, hopefully, more than the sum of (...) their parts. There is also the need to understand what each one is doing, and by the other, to understand each other's basic and fundamental ideological and foundational underpinnings. This must be followed by a comprehensive and critical dialogue between the respective disciplines. Moreover, the concept of mind and consciousness in Indian thought needs careful delineation and critical/evidential enquiry to make it internationally relevant. The brain-mind dyad must be understood, with brain as the structural correlate of the mind, and mind as the functional correlate of the brain. To understand human experience, we need a triad of external environment, internal environment and a consciousness that makes sense of both. We need to evolve a consensus on the definition of consciousness, for which a working definition in the form of a Consciousness Tetrad of Default, Aware, Operational and Evolved Consciousness is presented. It is equally necessary to understand the connection between physical changes in the brain and mental operations, and thereby untangle and comprehend the lattice of mental operations. Interdisciplinary work and knowledge sharing, in an atmosphere of healthy give and take of ideas, and with a view to understand the significance of each other's work, and also to critically evaluate the present corpus of knowledge from these diverse appearing fields, and then carry forward from there in a spirit of cooperative but evidential and critical enquiry - this is the goal for this monograph, and the work to follow. (shrink)

Given the rapid growth and emerging trend of e-commerce have changed consumer preferences to buy online, this study analyzes the current Indian legal framework that protects online consumers’ interests. A thorough analysis of the two newly enacted laws, i.e., the Consumer Protection Act, 2019 and Consumer Protection Rules, 2020 and literature review support analysis of 290 online consumers answering the research questions and achieving research objectives. The significant findings are that a secure and reliable system is essential for e-business firms (...) to work successfully; cash on delivery is the priority option for online shopping; website information and effective customer care services build a customer's trust. The new regulations are arguably strong enough to protect and safeguard online consumers' rights and boost India’s e-commerce growth. Besides factors such as security, privacy, warranty, customer service, and website information, laws governing consumer rights protection in e-commerce influence customers’ trust. Growing e-commerce looks promising with a robust legal framework and consumer protection measures. The findings contribute to the body of knowledge on e-commerce and consumer rights protection by elucidating the key factors that affect customer trust and loyalty and offering an informative perspective on e-consumer protection in the Indian context with broader implications. (shrink)

Whistleblowing is the act of disclosing information from a public or private organization in order to reveal cases of corruption that are of immediate or potential danger to the public. Blowing the whistle involves personal risk, especially when legal protection is absent, and charges of betrayal, which often come in the form of legal prosecution under treason laws. In this article we argue that whistleblowing is justified when disclosures are made with the proper intent and fulfill specific communicative constraints in (...) addressing issues of public interest. Three communicative constraints of informativeness, truthfulness and evidence are discussed in this regard. We develop a ‘harm test’ to assess the intent for disclosures, concluding that it is not sufficient for justification. Along with the proper intent, a successful act of whistleblowing should provide information that serves the public interest. Taking cognizance of the varied conceptions of public interest, we present an account of public interest that fits the framework of whistleblowing disclosures. In particular, we argue that whistleblowing is justified inter alia when the information it conveys is of a presumptive interest for a public insofar as it reveals an instance of injustice or violation of a civil or political right done against and unbeknown to some members of a polity. (shrink)

Formalisms such as description logics (DL) are sometimes expected to help terminologies ensure compliance with sound ontological principles. The objective of this paper is to study the degree to which one DL-based biomedical terminology (SNOMED CT) complies with such principles. We defined seven ontological principles (for example: each class must have at least one parent, each class must differ from its parent) and examined the properties of SNOMED CT classes with respect to these principles. Our major results are: 31% of (...) the classes have a single child; 27% have multiple parents; 51% do not exhibit any differentiae between the description of the parent and that of the child. The applications of this study to quality assurance for ontologies are discussed and suggestions are made for dealing with multiple inheritance. (shrink)

These essays, by widely respected scholars in fields ranging from social and political theory to historical sociology and cultural studies, illuminate the significance of the public/private distinction for an increasingly wide range of ...

The problem of consciousness has become one of the biggest unsolved problem in philosophy from the last few decades. Qualia and intentionality are the two feature of consciousness. Qualia represents the conscious awareness, subjectivity or phenomenality whereas intentionality represents the understanding or object-directedness. These are the two major issues in the philosophy of mind while we address the problem of consciousness. The objective of this paper is to give an overview of these two features of consciousness namely intentionality and qualia. (...) Qualia is subjective in nature, whereas intentionality or object-directedness is objective in nature. This paper will focus on some major question regarding qualia and intentionality like, do qualia exist? What is the relationship between qualia and intentionality? Can qualia be reduced or to identify with intentionality or intentionality represent the qualia? Science by its nature objective whereas consciousness by its nature subjective so can there be a science of consciousness? And so on. My paper is divided into two parts, the first part will discuss the problem of qualia whereas the second part will focus on the intentionality and subjective-objective distinction both from the epistemological and ontological perspective. (shrink)

The automatic integration of information resources in the life sciences is one of the most challenging goals facing biomedical informatics today. Controlled vocabularies have played an important role in realizing this goal, by making it possible to draw together information from heterogeneous sources secure in the knowledge that the same terms will also represent the same entities on all occasions of use. One of the most impressive achievements in this regard is the Gene Ontology (GO), which is rapidly acquiring the (...) status of a de facto standard in the field of gene and gene product annotations, and whose methodology has been much intimated in attempts to develop controlled vocabularies for shared use in different domains of biology. The GO Consortium has recognized, however, that its controlled vocabulary as currently constituted is marked by several problematic features - features which are characteristic of much recent work in bioinformatics and which are destined to raise increasingly serious obstacles to the automatic integration of biomedical information in the future. Here, we survey some of these problematic features, focusing especially on issues of compositionality and syntactic regimentation. (shrink)

The integration of biomedical terminologies is indispensable to the process of information integration. When terminologies are linked merely through the alignment of their leaf terms, however, differences in context and ontological structure are ignored. Making use of the SNAP and SPAN ontologies, we show how three reference domain ontologies can be integrated at a higher level, through what we shall call the OBR framework (for: Ontology of Biomedical Reality). OBR is designed to facilitate inference across the boundaries of domain ontologies (...) in anatomy, physiology and pathology. (shrink)

Felicitas Goodman (1990) observed that naive participants experienced unique trance states, characterized by specific visionary content, when they assumed particular postures and listened to monotonous rattling. Students (n = 284), enrolled in various sections of the course Introduction to Psychology, experienced one of four conditions with their eyes closed: Sitting Quietly with and without Drumming, Standing (Feather Serpent) Posture plus Drumming with and without Suggested Experiences. Participants completed the Phenomenology of Consciousness Inventory (Pekala 1982, 1991c) and wrote narratives following their (...) respective stimulus conditions. Participants reported less imagery, joy, and absorption, but more internal dialogue, self‐awareness, and muscular tension in the posture, compared to the sitting quietly, conditions. Goodman's results of specific posture (content‐related) effects with naive participants were not replicated. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial and biological (...) schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds. The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference, Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of medicines (...) escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient. Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over 'me too' drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions. The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a corporate enterprise or remain a patient welfare centered profession. A third approach involves an eclectic resolution of the two. Such amount of patient welfare as also ensures profit, and such amount of profit as also ensures patient welfare is to be forwarded. For, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. According to this approach, medicine becomes a patient welfare centered professional enterprise. The various ramifications of each of these approaches are discussed in this monograph. (shrink)