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avoidable tragedy: spurious liquor
Avoidable Tragedy: Spurious Liquor


With more than half of all alcohol drinkers in India falling into the criteria for hazardous drinking, alcohol abuse is emerging as a major public-health problem in the country. The problem becomes more compounded especially where we find the urban poor and rural peasants flocking to the liquor shops with a 10 rupee note and buying death in a sachet as seen in the recent Calcutta tragedy India's reputation as a country with a culture of abstinence especially in matters regarding alcohol is underserved, say experts. The country, which has seen a rapid proliferation of city bars and nightclubs in recent years, is fast shedding its inhibitions about alcohol as a lifestyle choice.
This situation has led to fears of an undocumented rise in alcohol abuse not only among poorer classes but also in sections of society that were previously considered dry. The entire policy regarding the pricing and trading of state sponsored liquor outlets with singular aim of generating revenue needs to be questioned by concerned citizens. The increasing production, distribution, and promotion of alcohol have already seen drink-related problems emerging as a major public-health concern in India. Sales of alcohol have seen a growth rate of 8% in the past 3 years. Officially, Indians are still among the world's lowest consumers of alcohol—government statistics show only 21% of adult men and around 2% of women drink. But up to a fifth of this group—about 14 million people—are dependent drinkers requiring “help”.

The concern, say experts, is that there has been a rapid change in patterns and trends of alcohol use in India. Chief among them is people are beginning to drink at ever-younger ages. The percentage of the drinking population aged less than 21 years has increased from 2% to more than 14% in the past 15 years, according to studies in the southern state of Kerala by Alcohol and Drugs Information Centre India, a non-governmental organization (NGO). Alarmingly, the study found that the “average age of initiation” had dropped from 19 years to 13 years in the past two decades.
The centre points out that a “powerful international and domestic alcohol lobby” is purposely targeting young Indians. The local industry has introduced flavored alcohol drinks to attract previously non-drinking women and young men. Multinational companies have identified India with its vast unexploited markets as one of the worlds most sought after places for investment.
Many alcohol adverts now feature spirited groups of young people having a good time. Although alcohol advertising is banned in the electronic and print media, surrogate advertising is rife, “Drinking water and apple juice is packaged by alcohol companies. It's all about getting young people to start early and be life-long consumers. Bollywood films now glorify alcohol where the good guys drink.”
The shifting composition of Indian drinkers has seen a rise in the number of Indian women drinking regularly and heavily. One recent study in the southern state of Karnataka found young women consumed similar amounts of alcohol to young men on any typical drinking occasion.
What is of particular concern—and an important indicator of health risks—is that the signature pattern of alcohol consumption in India is frequent and heavy drinking. More than half of all drinkers fall into the criteria for hazardous drinking, which is characterized by bingeing and solitary consumption to the point of intoxication. Moreover, spirits account for 95% of the beverages drunk in India.
There is evidence even to suggest that the poor are beginning to drink more than they earn—a deadly spiral of alcohol and debt. Although the Indian constitution includes the prohibition of alcohol among its directive principles, alcohol policy is devolved to individual states—as is the levying of taxes on it. Since most states derive around a fifth of their revenue from alcohol taxation—the second largest source after sales tax—they are generally ambivalent towards stemming its flow. Moreover, there is a long history in India of a powerful alcohol lobby with industry figures influencing the political process, both in the form of party donations and as representatives. But experts argue that Indian society is losing considerably more than it gains.
According to a recent study by researchers from NIMHANS it is shocking to know that the direct and indirect costs attributable to alcohol addiction is more than triple the profits of alcohol taxation and several times more than the annual health budget of Karnataka. These included the tangible costs of health care, occupational, financial, social, and legal factors.
Indian Alcohol Policy Alliance, an NGO aiming to prevent alcohol-related harm through evidence-based policy intervention, says that the key is to break the stranglehold of state revenue departments who see increasing consumption of alcohol as a boon to treasury coffers.
In less than a week after more than 90 women, men, and children died in a calamitous fire at the AMRI hospital in Kolkata, illicit brew has claimed the lives of about 150 people, at Sangrampur in the South 24 Parganas district of West Bengal. The hooch was sold in sachets, priced between Rs.7 and Rs.20, virtually opposite a police post in the area. Starting with a couple of deaths early in the morning, the toll kept rising through the day and touched 80 by daybreak next day. Most of the victims complained of body pain, stomach cramps, vomiting, and a burning sensation. The recurrence of heart-rending tragedies caused by the killer brew only lends credence to the thinking among political parties and State governments that it might be better to introduce legal sale of licensed liquor than let addicts go for the illicit stuff. There is a demand from sections in government to suggest monopolizing sale of government controlled liquor as the Tamil Nadu Model .Of course the protagonist will feel that this step might be catastrophic. But the evidence from across India shows that prohibition just doesn't work; in fact, it brings on all sorts of ill effects, social as well as medical. Although States that still implement prohibition, full or partial, have set up separate wings in the police department to handle cases arising out of prohibition offences and illicit brewing, it is common knowledge that connivance between the brewers and sections of the police makes the hooch flow, particularly in festival season. Most, if not all, victims tend to be poor laborers, and the families end up paying a terrible price. Alcoholism is a social menace that needs to be tackled in a sensitive, intelligent, multi-pronged way. Driving it underground, to dangerous devices, is clearly not the way.


(Prof Gourishankar Patnaik is a senior Consultant in orthopedics based in Bhubaneswar. He can be contacted at drgsp66@yahoo.com)

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ETHICAL ISSUES IN STEM CELL RESEARCH
ETHICAL ISSUES IN STEM CELL RESEARCH

Give me a doctor partridge-plump,
short in the leg and broad in the rump,
an endomorph with gentle hands,
who’ll never make absurd demands,
that I abandon all my vices,
nor pull a long face in times of crisis,
but in a twinkle of his eyes,
will tell me that I have to die.[1]

No one who qualified as a doctor more than 20 years ago can be unaware of the change in the ethos of medicine since then. To tackle ethical issues in medicine, one would need to go retrospective and decide how we as doctors have changed. Simply speaking, it is useless to talk about such issues without knowing the foundations on which medicine is built on. Medicine has been an art thousands of years before the advent of systematic science, and it was then that many problems started plaguing doctors. True, science and technology has propelled medicine to perhaps one of the fastest changing field in any sense, making accurate and difficult diagnosis, offering treatment for diseases we would never even have dreamt of dealing with just short of a century ago. In 1950, the poet Auden gave a witty sketch of his ideal doctor (above). Auden’s physician is not too much concerned with resource allocation, prolonging life, achieving ideals in disease prevention, abortion or euthanasia. He is deeply rooted in a culture during which, physicians, bound deeply in the Hippocratic oath acted as almost ecclesiastical and autonomous being that held the patient’s trust in their hands from a paternalistic point of view. Most importantly, Auden’s doctor knew the patient close enough to be able to tell him with a twinkle in his eye that death is imminent and inevitable, without fear. In contrast, a generation of doctors have risen that knew not this pattern of confidence and privilege held by themselves, and so go on to strip themselves of the ethos that has been with medicine from the start. We have diluted medicine so much that it is nothing more than a business between the treating doctor and the knowing patient. The doctor no longer act autonomously in the benefit of the patient, but rather, the paternalistic relationship of trust and kindness has evolved into a business contract of agreement and fear. Lastly, instead of walking alongside the patient with care and support to death, we have scrambled in every direction trying to prolong and prevent the end of life which we now so fear and do not dare look in the eye. Harsh as it might sound, discounting the few physicians who still operate from the same ethos of the original Hippocratic oath [2], this is the general shift or ‘hollowing’ medicine has undergone. It is from this premise and background that the content of this article will proceed.


Definitions

Ethics, is a word that begs proper definition. To put it simply it is the correct way to do things. Ethical issues surrounding medicine have generally surrounded an epicenter which is “human dignity” or “the sacred human life”. All medicine and every decision made hinges upon the premise that human life is sacred and every human should live a dignified life. Every side of the debate on abortion, euthanasia, embryonic stem cell research claims they have human in their best interest, but one has to be correct. However, to talk about ethics without talking about moral values is as futile as talking about morality without bringing in God. I have to be radical here as I opine that the elimination of a transcendant being that rules with objective moral his mortal subjects will ultimately leave this discussion fruitless. Transcendence is the value that so powerfully dominates the Hippocratic Oath. Throughout history, men have seeked numerous ways to teach themselves morality, Hitler used himself, Darwin used nature, Pol Pot used power; and we later use consequence, conscience, authorities, feelings and lastly relative morality. It would be wrong for me to say that all these are wrong in themselves, but they certainly are not dependable and infallible. We have them to guide us, but what our lives and values are based on should be objective and unchangeable, someone I call God. Ethics is but the tip of the iceberg resting on a monstrous foundation of core beliefs, doing ethics ignoring all others is to float aimlessly in the sea and calling ourselves practitioners of evidence-based medicine.

The second word is stem cells, which means simply thecells from which all cells begin from. These cells have sparked endless interest, hope and debates because they possess the ability to differentiate into all the cell lines in the body, which amounts to more than two hundred. Stem cells are the reason an egg of two cells could transform into a human being with utmost complex functions. These stem cells give hope to millions who are stricken by degenerative diseases such as Alzheimer’s, osteoarthritis, patients with spinal cord trauma, diabetes mellitus, inborn errors of metabolisms, etc. Basically, researchers believe that if we can correctly stimulate the stem cells, it can transform into any tissues in the body which needs repair, a fibrillating heart, a thinning brain, a broken nerve, name it and stem cell transplant is the miracle answer. In fact, the body’s reparative mechanisms each day is a miracle in itself. Cells are dying and stem cells are metamorphosing into mature functioning cells every second in our body in every system, its regulation beautifully controlled by genes; any faster results in a cancer, any slower, in degeneration. Stem cells can be found in an adult body, in the skin, bones, heart, and more than sixty other sites identified by scientists. Embryonic stem cells are stem cells that formed after fertilization of an egg by a sperm, and it is this that give rise to ethical issues, not the adult one.

Adult vs Embryo

The complexity of the ethics surrounding this is far less compared to that in euthanasia and abortion. Proponents who are labeled ‘pro-life’ oppose only the embryonic stem cell research holding on to the premise that life begins at conception, that is when an ovum is fertilized by a sperm. To use stem cells from embryos even at this primitive stage of life is tantamount to destroying a sacred human life, which the institution of medicine seek so carefully to preserve. They have never had any case against adult stem cells research; in fact, they are themselves doing active research and enthusiastically promoting the use of adult stem cells for medical purposes. The exciting prospect and results currently surrounding stem cells have mostly been the result of research on adult stem cells. Encouraging results have enabled us to catch a glimpse into how to harvest and stimulate these cells to differentiate into the type that we desire.
Having said this, it is important to know that the stage of use of stem cells to treat diseases is still at its infancy, and the prospect of cure is still a long way off. We will then have to assess the impact that stem cell therapy have in the long run on its recipients and the risk of malignancies and a whole spectrum of other considerations before we can truly call this special cells as our miracle cure. The pro-life group therefore see no real meaning in embarking on the destruction of thousands of embryo which will yield results of cure that is so elusive and tread on moral grounds so dangerous and dark. They have not left this debate with their arms crossed snugly, but they have themselves proved in many ways that in the presence of adult stem cells, the use of embryo is truly redundant.

On the other side are those who feel no qualms in using embryos for stem cell research, for to them, the embryo is not truly alive yet. Another reason is that they believe that if the sacrifice of a few lives of much lower value could result in the saving of millions and alleviate the suffering of tens of millions, then the effort is truly justified. They are called consequentialists, and perhaps possess the most seemingly logical and most powerful voice in ethical issues, and is also the main logic used in parliaments in the United Kingdom regarding this debate. The question one would superficially ask is then, ‘Are embryonic stem cells better than adult stem cells?’ The striking advantage that embryonic stem cells have, as claimed by its proponents, is its ability to differentiate into all cell lines in the body whereas adult stem cells only possess limited ability to differentiate. Embryonic stem cells can be grown relatively easily in culture. Adult stem cells are rare in mature tissues, so isolating these cells from an adult tissue is challenging, and methods to expand their numbers in cell culture have not yet been worked out. This is an important distinction, as large numbers of cells are needed for stem cell replacement therapies.[3] The battle over stem cells intensified throughout 2004 becoming a major issue in the US election won by Republican George Bush on 4 November. Much of the controversy centred around different views on the status of the human embryo, and the fact that embryos have to be created and destroyed to produce stem cells. Bush's policy was to restrict federal funding to research on the 78 embryo stem cell lines in existence since 9 August 2001, banning both the use of all new human embryos and the creation of cloned human embryos through cell nuclear replacement. Democrat candidate John Kerry supported funding the use of embryo stem cells, cloned and otherwise, to develop treatments for heart disease, Alzheimer's, Diabetes and Parkinson's.[4]
The emotional intensity of the debate was raised considerably by the involvement of celebrities who threw their weight behind Kerry. Back to the Future star Michael J Fox, who has Parkinson's disease, made a television advert supporting Kerry's campaign in October.[5] Superman actor Christopher Reeves, who was paralysed in 1995 after falling from a horse, campaigned tirelessly for the Democrat candidate, believing that his only hope also lay with embryo stem cells. He died just before the election on 10 October.[6] Nancy Reagan claimed that the life of her husband former US president Ronald Reagan, who died in June from Alzheimer's, could have been saved by embryo stem cell research. The Washington Post hailed this 'Reagan-inspired tidal wave of enthusiasm' as 'an example of how easily a modest line of scientific inquiry can grow in the public mind to monumental proportions'. [7]Ironically Alzheimer's, in contrast to spinal injuries and Parkinson's, involves widespread diffuse neuronal and synaptic loss, and is most unlikely to benefit from stem cell treatment.
The scientific community on both sides of the Atlantic have not been quick to dispel the myths or counter the claims. In the UK, the British media and public have been consistently misled into seeing cloned embryos as a panacea for treating degenerative diseases through the Government's failure or unwillingness to highlight the dangers and to rectify misconceptions about the properties of the more ethical alternative of adult stem cells propagated in the now seriously dated 2000 Donaldson report Stem Cell Research. Such selective interpretation and presentation of scientific data is both irresponsible and dangerous because it falsely raises the hopes of vulnerable people. Honest and balanced reporting of the facts should always take precedence over the prestige and profit motives of the government and biotech industry.
Assessing the peer-reviewed evidence catalogued in great detail on the Christian Medical a Dental Association (CMDA) [8] they conclude that:
1. Embryonic stem cells have yielded only very limited and/or questionable success in animal models and no therapeutic application whatsoever in human beings:
• Human embryonic stem cells are difficult to obtain, develop and maintain and are unstable and mutate in culture.
• Differentiation protocols for many cell types have not been developed and cell types that have been differentiated often act abnormally.
• When embryonic-derived cells have been placed in animals, cancerous tumours have formed.
• Cloned cells, used to address the problem of immune rejection, are not normal.
• At a cost of over $200,000 per patient, only the very wealthy could afford the procedure.
2. Adult stem cells are ethically obtainable from multiple sources in human beings and research over the last three years has made great strides:
• 'Adult' (non-embryonic) stem cells have been found in cord blood, placenta, bone marrow, fat, teeth and other sources.
• Adult stem cells found in one type of tissue can repair damage in another tissue type and can be harvested from each patient, multiplied in culture and transplanted back into the patient.
• Since adult stem cells require limited, if any, manipulation, and are readily available from a number of sources, the cost for their clinical application will be far less.
• There are no ethical concerns in their use, making them acceptable to virtually all patients and healthcare providers.
• Adult stem cells are already providing cures in animals and clinical human trials.

A sampling list has shown the examples of breakthrough of adult stem cell research in various institutions
• Researchers at Harvard Medical School say adult stem cells may eliminate the need for embryonic ones. The researchers experienced a permanent reversal of Type 1 diabetes in mice by killing the cells responsible for the diabetes. The animals' adult stem cells took over and regenerated missing cells needed to produce insulin and eliminate the disease. The results hold promise for rheumatoid arthritis, multiple sclerosis, lupus and more than 50 other ailments.
• At the University of Texas MD Anderson Cancer Center in Houston, a man with a rare, potentially fatal skin disorder that was so severe that he could no longer eat, is now symptom-free after receiving a transplant of his own adult stem cells.
• Doctors at Northwestern Memorial Hospital in Chicago extracted the adult stem cells from the blood of two Crohn's patients and successfully used them to rebuild their faulty immune systems.
• Dr. Edward Holland of the Northern Kentucky Eye Laser Center in the greater Cincinnati metropolitan area, is using adult stem cell transplants as part of a treatment to dramatically improve the eyesight of his patients.
• New research in the UK on rats indicates that transplants of adult stem cells can help stroke victims regain movement, senses and understanding. They also show that the adult cells were more effective than cells from aborted babies.
• The Albert Einstein College of Medicine in New York came to similar conclusions.
• A study by the Institute for Stem Cell Research in Milan, Italy showed that certain cells from the brains of adult rats can be used to generate muscular tissue.
• Researchers at the University of South Florida in Tampa have found that adult stem cells from the umbilical cord blood may be able to help repair damaged brain tissue after a stroke.
• Scientists at the University of Medicine and Dentistry of NJ have found that bone marrow cells may be converted into replacement nerve cells, able to treat brain and nerve injuries. Dr. Ira Black and his team were able to convert 80% of the bone marrow cells into nerve cells.

From October to December 2004 three independent reports of patients showing recovery from spinal injuries after adult stem cell transplants surfaced in Russia [9] and later in Korea and Portugal; and a group in Innsbruck have reported success in using the same technology to treat stress incontinence. We will have to wait and see if these so-far small studies are confirmed; but it seems that Christopher Reeve's hope may have been misplaced. Either way we will get far more answers through following the wise injunction to 'enquire, probe and investigate'.
Hybrids
Just two years ago, a raging debate sparked in the United Kingdom medical ethics scene when scientists proposed the use of hybrid embryonic stem cells for research. Because of the lack of embryonic cells and difficulties in harvesting them, they try to push a bill that will enable them to use cytoplasmic human cells ‘fertilised’ with animal gametes. This is a whole new facet in which opponents of hybrids believe this to be a heinous crime against nature, and that God’s creation should not be tampered with in this manner. Last May, Prime Minister Gordon Brown welcomed animal-human hybrids as 'a profound opportunity to save and transform millions of lives' and expressed his commitment to this research as 'an inherently moral endeavour that can save and improve the lives of thousands and over time millions of people'. The measure was supported in a heavily whipped vote as part of the Human Fertilisation and Embryology Bill.
Now it appears, before the new Act has even come into force, that stem cells from animal-human hybrids are seen as a poor investment and almost certainly won't work. In January, the two leading UK researchers who had been granted licences for this work, Stephen Minger of Kings College London and Lyle Armstrong at Newcastle University Centre for Life, were denied funding by the Medical Research Council. The British Medical Journal [11] reported that the grant applications had been turned down because the reviewers considered that they were not competitive in the face of the lack of overall funding for medical research in the United Kingdom. Minger himself admitted that he believed the distribution of research funding should be competitive, based on assessment of scientific value and cost, and noted that induced pluripotent stem cells are cheaper to set up than human-animal hybrid stem cell research. No one it seemed wanted to invest money in the new research, given the low likelihood of it ever yielding results and the emergence of cheaper ethical alternatives.
Less than three weeks later, in a landmark paper in Cloning and Stem Cells, Robert Lanza and colleagues from Advanced Cell Technology, Massachusetts, demonstrated that animal oocytes lack the capacity to fully reprogramme and activate adult human cells, and specifically the pluripotency-associated genes needed for stem cell production. [12] The hybrid embryos from mouse, cow and rabbit eggs looked microscop-ically normal but were genetically flawed. Journal Editor Sir Ian Wilmut, the British cloning pioneer involved in the 1996 creation of Dolly the sheep, concluded that 'production of patient-specific stem cells by this means would (now) be impracticable'. [13]

Conclusion
Debate is good, but only when we know and truly believe the direction we are coming from and the direction we are heading towards. In the midst of heated arguments, it is easy to lose our heads proving and disproving that we forgot the core of the problem. The epicenter of the problem surrounding medicine is now, I believe, the loss of ‘Auden’s doctor’. With the paradigm shift and change in ethos, healthcare and medicine are now married, and with this marriage sprung numerous problems such as issues on life prolongation, government fundings, public concern, the greater good, etc. We cannot turn back time. But what we can in fact do is to remember that in the centre of good research going on to prolong a patient’s life and give a cure to their problems, it is much more precious and important for us to be able to cry with the patients, empathise with their suffering, hold their hands and walk with them when we know that no cure is in the near future, and finally to be beside them when they need courage most to face the ultimate enemy, death. Medicine is not about the cure, but about the person. We should not cease to embark on studies that will find answers to problems for our patients, but we must never neglect rooting ourselves so deeply in the humanity of medicine and be involved in our patients who are each of them sacred in the utmost sense.


References
1) Poem Hunter. Give Me a Doctor by WH Auden. http://www.poemhunter.com/poem/give-me-a-doctor-2/. Accessed 7/4/2010.
2) The Hippocratic Oath. The Hippocratic Oath (Original version). http://www.members.tripod.com/nktiuro/hippocra.htm. Accessed 7/4/2010.
3) Stem Cell Information. What is the similarities and differences between adult and embryonic stem cells?. http://stemcells.nih.gov/info/basics/basics5.asp. Accessed 6/4/2010.
4) Tanne JH. Slugging it out over healthcare, stem cells and abortion. BMJ 2004; 329:592 (11 September).
5) BBC News. Michael J. Fox Makes Advert news.bbc.co.uk/1/hi/entertainment/tv_and_radio/3724296.stm . Accessed 7/4/2010.
6) BBC News. Actor Christopher Reeve Dies news.bbc.co.uk/1/hi/entertainment/film/3732310.stm. Accessed 7/4/2010.
7) Weiss R. Stem Cells an unlikely therapy for Alzheimer's, say experts. Washington Post 2004; 10 June.
8) www.cmdahome.org/index.cgi?BISKIT=1471444487&CONTEXT =art&art=2702
9) Free Republic. Doctors in Russia Prove that Non-Embryonic Stem Cells can be Used in Treating Spinal Cord Injuries. http://www.freerepublic.com/focus/f-news/1295924/posts.
10) Life Issues Institute. Embryonic versus Adult Stem cells. http://www.lifeissues.org/cloningstemcell/bradsarticle.html. Accessed 7/4/2010.
11) Lack of Funds slows human-animal stem cell research despite legislation in favour.
BMJ 2009; 338 :194-5
12) Lanza R et al. - Reprogramming of Human Somatic Cells Using Human and Animal Oocytes.
Cloning and Stem Cells 2009; 11(2):1-11
13) Animal eggs not suitable substitutes to produce stem cells.
Genetic Engineering and Biotechnology News 2009; 2 February
www.genengnews.com

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Self Esteem: Key to a meaningful living
Self Esteem: Key to a meaningful living

Many times we get confronted with low self esteem. Many definitions, many explanations yet we find that every one of us seems to get bogged down with this problem. Introspection into this complex issue made me think of the problem and an analytical view is submitted herein .Self esteem is the major challenge of our era. It lies at the heart of many of the diverse issues and challenges we face in life.
The fact is precise that low self esteem does not seem to be the problem, that it is so very insidious. Many people who suffer from low self esteem attribute their life challenges to wholly different causes and very rightfully. It does not even occur to them to relate their problems to how they regard themselves at the deepest level. You ask them to trace the origin and the answers seems to be one of the many explanations like a mean boss, racial or sexual prejudice, a talent for choosing abusive love partners and so on. We try to externalize the problem trying to source the origin out of our existence. On the contrary it stems from deep within. However, doing this merely moves a person further away from the real problem, and consequently from the solution. Thus by disguising itself as some other more immediately visible issue, low self esteem is never tackled and overcome. It remains to rear its ugly head again.
How Low Self Esteem Arises
It is very strange to believe People with no apparent self esteem problems may still be susceptible at a subtle level. For example, failing to fulfill one’s dreams when one is young, and settling for a safe route to an unchallenging existence, can damage how well one regards himself. In later life, it could manifest in short temper, cynicism when others do try to better themselves, and even physical illness. However, it is difficult and sometimes impossible pinpoint the exact problem.
In other words, self esteem issues, often inherited from your parents, appeared at this early stage. There are many causes of low self esteem. We gain our predominant world-view by the age of five. In other words, whether you consider the world to be a safe or dangerous place, and whether you will react to events in a primarily positive or negative manner, is determined by this age. Parents are the prime shapers of our young psyches at this time. However, schools, society, and more importantly our peers also play an important role. Our later experiences in life merely reinforce the core impressions we gained at this very early age. Parents play a very significant role in shaping the psyche of the future child and more or less their actions can be reflected with their children’s self esteem. People say that I have taken full care of my children, provided them with every possible needs yet my child seems to have lost his sense of direction and has become wayward in terms of confidence etc. Spiritualist and even scientists believe that this care must begin whilst the child is still in the womb! Parents are too often far too casual about how they bring up their children. They unconsciously pass on their own limitations to them as a result.
The first thing is to understand the difference between self-esteem and self-image. Self-image forms as a result of comparisons you make between yourself and those around you. It is the judgment you make of yourself - the image you have of yourself. Sadly, it is often negative as you can usually find someone better than you at almost everything. Self-image in turn affects self-esteem. An easy way to understand this difference is to look at young children. They have perfect self-esteem because they have no self-image. They are not continually judging themselves against externals and falling short. As they grow older one can note the difference .
One need not work upon self-image. There lies the key. This is what many people try to do. However, working on self-esteem is the heart of creating radical change. One important issue is the all pervading issue of self talk. The key to improving your self-esteem is to take conscious control of your self-talk. Negative self-talk is the prime cause for creating and maintaining negative self esteem. The things you say to yourself in your mind, as well as the meaning you attribute to events in your life, combine to create the reality you end up live. A study has revealed that most people’s self-talk is roughly 95% negative. They see the worst in themselves and in everything that happens. Putting a stop to such self-destructive thinking is vital. It is our thoughts and expectations that shape and produce what we become. The quality of our lives is a direct result of them.
One excellent way to combat and overcome negative self-talk is through using positive affirmations. The principle behind them is that the brain cannot entertain two contradictory notions at the same time. Eventually one of the two contradictory notions must win out and cause the other to collapse completely. The belief that finally wins out is the one that you invest with the most emotional energy and constancy of thought. Putting all your emotional energy behind them gives the affirmations the power to destroy negative self-talk and low self esteem.
Recognition of the problem is the half way to the solution. The key to success in life is to recognize the existence of the problem in the first place! Therefore, consider where self esteem issues may be lurking in your life, but manifesting as apparently external problems. The key attitude for success in life is to take total responsibility for what happens to us. We must work upon ourselves continually in order to manifest what we want. To conclude creating high self esteem is one of the best things you can ever do to totally transform every aspect of your life. The results are time tested and reproducible.

Prof GSPATNAIK is a consultant orthopedic Surgeon and a social scientist based in Bhubaneswar. He can be contacted at www.drgspatnaik.com

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Spiritual Healing
Spirituality involves the recognition and acceptance of a God beyond our own intelligence and with whom we can have a relationship. This God can provide an experience of inspiration, joy, security, peace of mind, and guidance that goes beyond what is possible in the absence of the conviction that such a power exists.
Spiritual healing is when energy is transmitted to the person who needs it. The treatment works on the body, mind and spirit, which are seen as one unit that must harmonize for good health. If a separate healer is involved, the healer will place the hand on the person being treated to channel the energy from the Higher Source. The spiritual healing can help mental and emotional problems and physical conditions such as a frozen shoulder.
What is spiritual healing?
The channeling of healing energy from its spiritual source to someone who needs it is called spiritual healing. The channel is usually a person, whom we call a healer, and the healing energy is usually transferred to the patient through the healer's hands. The healing does not come from the healer, but through him. On the other hand, you don’t need a healer to take advantage of spiritual healing. You can pray. The word "spiritual" refers to the divine nature of the energy, which healers agree comes from one external, invisible intelligent source. The healing energy from this source is available to all. Healers see the body mind and spirit as one interdependent unit and believe all three must work in harmony to maintain positive health. Any problem - be it a broken leg or depression needs the power of healing to restore the balance of the whole person. It is felt that sickness often starts in the mind, or at the deeper level of the spirit, and it is often here that healing begins.
New Age and the Dawning of a New Era
New Age is a loose term that includes everything from self improvement programs to awareness of mind-body connections. The movement is growing by leaps and bounds. Time magazine reported that in 1996, about 44 million Americans identified with the healing movement. It is estimated that Americans alone spend about $1.5 billion annually on books about spirituality and religion. About 42 percent of Americans have sought out alternative health care. So, there is no doubt that the movement is catching on.
"There is a hunger for being connected with a divine force. The hunger is not just for philosophy, but for experience," says James Redfield, author of ‘Celestial Prophecy’. "The consciousness I am describing – the perception of synchronicity, mysterious coincidences – represent great opportunities to grow. That process works whether you are a brain surgeon or sacking groceries. Consciousness has the ability to break cycles of poverty."
Spirituality vs. Religion: Are they complimentary??
Spirituality can be seen as being distinct from religion. Different world religions have proposed various doctrines and belief systems about the nature of a God and humanity's relationship with it. Spirituality, on the other hand, refers to the common experience behind these various points of view. It is an experience involving an awareness of and relationship with something that transcends your personal self as well as the human order of things. This "something" has been given various names ("God" being the most popular in Western Society) and defined in ways that are too numerous to count. We call it simply as the God. You can choose to define what that means for yourself in whatever way feels most appropriate. Your own sense of a God can be as abstract as "cosmic consciousness" or as down-to-earth as the beauty of the ocean or mountains. Even if you regard yourself an agnostic or atheist, you may get a sense of inspiration from taking a walk in the forest or contemplating a beautiful sunset. Or a small child's smile may give you a special sense of joy.
Specific Benefits of Developing Your Spirituality
Safety and Security
Through developing a connection with God, you gain security through the conviction that you are not all alone in the universe, even at those times when you feel temporarily separated from other people. You feel increasingly safe as you come to believe that there is a source you can always turn to in times of difficulty. There is much security to be gained through the understanding that there is no problem or difficulty that cannot be resolved through the help of God.
Peace of Mind
Peace of mind is the result of feeling a deep, abiding sense of security and safety. The more reliance and trust you develop in God, the easier it becomes to deal without fear or worry with the inevitable challenges life brings. It is not that you give up yourself or your will to such a power; rather you simply learn that you can "let go" and turn to God when you feel stuck with a problem in living and don't know how to proceed. Learning how to let go when solutions to problems aren't immediately apparent can go a long way toward reducing worry and anxiety in your life. Peace of mind is what develops in the absence of such anxiety.
Self-Confidence
As you develop a relationship with God, you come to realize that he has created you and hence he has found something good in you. You are part of the universe. You're good, lovable, and worthy of respect just by virtue of the fact that you're God’s creation. This realization can improve the way you look at yourself and will help you to improve your ego and what you think of yourself. You are still inherently good and worthwhile. Your own judgments of yourself, however negative, do not ultimately count if you are a creation of the universe as much as everything else. As one person put it: "God doesn't make junk."
Guidance
Developing a relationship with God will provide you with guidance for making decisions and solving problems. God has a universal wisdom that goes beyond what you can accomplish through your own intellect. In traditional religions this has been referred to as the "divine intelligence." Through connecting with God, you can draw upon this greater wisdom to help you resolve all kinds of difficulties. By learning to ask God for guidance, you'll be surprised to find that every sincere request sooner or later is answered. And the quality of that answer generally exceeds what you could have figured out through your own conscious intellect or will. Here, God is like your co-pilot. God is always available in the instant of need to those who have made a habit of waiting quietly before Him for insight and guidance.


Prof GSPATNAIK is a consultant orthopedic Surgeon and a social scientist based in Bhubaneswar. He can be contacted at www.drgspatnaik.com

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When Doctor was God
When I was a child, the doctor was God. Like God, in exchange for respect and obedience—”doctor’s orders”—he guided us through the valley of the shadow, held out the hope of life eternal, and came when we summoned him, yea, even through snowstorms, to sit on the edge of our bed with his empowered doctors bag and lay his hand on our fevered brow. Often we treat doctors with a higher awe. Our parents were wise by definition but he was infallible by definition; “The doctor knows best” was an incantation you could lean on. We trusted him utterly. Like God, he was the safety net forever spread under our precarious lives. Like God, he was the powerful super parent standing backup behind our mortal parents, appearing as if by magic when our mother’s remedies failed, black bag in hand: “Well, well, what seems to be the trouble? Let’s have a look.”
In the days before the all-purpose antibiotic, it was important for the doctor to figure out what ailed you, and this he did, not in the lab, but sitting on your bed. It was an art form as much as a science and a clever diagnostician were much admired. He touched your skin and lifted your eyelids and peered down your throat; he flexed your knees and elbows and thumped your back. He unbuttoned your pajamas and listened to your heart and lungs. His interest was inexpressibly comforting and most people felt better almost at once. Even if his bedside manner was brusque and his voice tired and impatient, that couldn’t disguise the love he bore us. The love was implicit in his coming; why else would he be at our side? I’m sure I wasn’t the only child who wept upon learning that he charged money for his services, but even that didn’t shake my faith in his love. Often I used to wonder and quite painfully that he is taking my father’s hard earned five rupees fees yet my parents comforted me that he has a child like me and he too needs to go to school etc.
In nineteenth-century novels the heroine’s grave condition was underlined by the number of doctor’s visits per day. It’s never clear exactly what he was doing on these visits, but visit he did, and often the languishing lady cheered up, sipped a little lemon tea, and recovered. Back then, illness was a more personal matter. It was said that those with a “strong constitution” would pull through, while the naturally sickly and patients whose constitutions had been previously undermined would turn up their toes and die of a fever like Sweet Molly Malone. Even those who believed in germs didn’t give germs much credit; violent emotional scenes or fits of passion might throw a person into a fatal fever, at least in novels. The doctor stood by, lending the constitution moral support, shoring it up with a change of air, a change of scene, an ocean voyage.
If we transcend the history for the first half of the twentieth century, the doctor cured us with aspirin, orange juice, bed rest, and the laying-on of hands. If we worsened, he put us in a hospital where we stayed, complaining about the food, until he was quite satisfied with our condition. (Then he sent us bills, or sent them to our family if we perished, and the phrase “doctor’s bills” rang ominously, and the impecunious often took years to pay them off.). Medicine has made tremendous strides since then, and by rights we should worship our doctor more fervently than ever, but somehow we don’t. He never comes to see us anymore. Sometimes he doesn’t bother to discover personally exactly what the matter is by inspecting our ailing bodies; if for some reason he needs to touch us, he first puts on latex gloves and a mask. Then he writes a prescription that should cure whatever it is, and if that fails, he orders lab tests. He makes us to fill out daunting piles of paper that look like tax forms. Rumors circulate about his income, comparable to sports stars’; sometimes we think he might be healing us as much for money as for love. He’s a quitter, too, and when we seem really sick he thrusts us away from him, sends us off to a specialist we’ve never seen before. Indeed, we may never have seen our doctor himself—now called a health-care provider—before.
Since doctors no longer talk to us by phone presumably because of multitasking and their quest of earning only money offering advice and consolation and prescriptions free of charge, some conscientious providers have now gone on-line, so we can share our ailment with our computer. (“If temperature is elevated, click here.”) .It’s lonelier to be sick now and scarier than it used to be, and millions of us have turned our backs on the new doctors and searched out Chinese women with needles, massage therapists, manipulators of joints, chanters of mantras, and purveyors of roots and barks and herbs and essential unguents. They seem friendlier. The shamans and wiccans with cures from the woods and ditches are more reassuring than the doctor himself, who has turned so cold and uncaring and who may not be God after all.
In the great yellow fever epidemic in Philadelphia, in 1793, the famous Dr. Benjamin Rush saw well over a thousand patients, bearing the cure he’d invented and believed in passionately. His treatment consisted of ripping their guts out with mercury purges and draining off most of their blood. This savage remedy should have killed them all, even if they hadn’t been already sick, but an astonishing number survived and flourished. He had tremendous confidence and courage. He strode into their evil-smelling chambers and sat on their vomit-soaked beds and smiled and said, “You have nothing but a yellow fever.” Probably they trusted him. Probably they thought he was God, and loved them, and it would be ungrateful and impious of them to die.
More of us stay alive today under the tender care of the antibiotics that replaced the doctor. We must learn to feel the same respect and trust for our bottle of pills, and smile weakly but gratefully at it when it comes to our bedside. Press it to our fevered brow, this pharmaceutical father figure squeezed into a plastic tube, with two refills and possible side effects but comforting, powerful, and wise. And probably very soon now medical science will have the bottle programmed to murmur, when we take off the lid, “Well, well, what seems to be the trouble? Let’s have a look.”

Prof GSPATNAIK is a consultant orthopedic Surgeon and a social scientist based in Bhubaneswar. He can be contacted at www.drgspatnaik.com

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