“Doc, will my child be the next Sachin?” is the question many parents are apparently asking (a news article I recently read in a daily). This article was about a “Gene-testing lab” that has newly been set up in Mumbai, and the children being tested are apparently as young as 3. Of course, the test being non-invasive, simple and probably physically harmless, parents are unhesitatingly choosing to test their children in the hope that they can identify a sport that suits their child.

As a child I was keenly interested in Table Tennis, and played it myself, representing my school. With limited media coverage of sporting events, we still got some television coverage of international Table Tennis and I used to wonder what made the Chinese win at this game more than anyone else. In the last few years there has also been an on-going debate on why Jamaicans are champion sprinters and what makes Kenyans win marathons. Is sporting success dependant on genetics, socio-economic status, geographical region, race, colour, psychological make-up, specialised training, or the elusive “x-factor”? Can sporting success be predicted and skills honed from early years?

Sportsmen, as all of us, are a product of cellular and psycho-social genesis combined with a huge helping of providence. To take the example of Jamaican sprinters: scientists, doctors and coaches have come up with various factors for their success. Training on grass, the ACTN-3 RR gene, the toughness of mind and body, the national passion for track and field events: especially sprinting, the history of slavery and resultant pent-up anger, the ‘Trelawny Yam’ (a vegetable grown in Jamaica), and even as ridiculous as the athletes having “an extra-long ring finger”!! But though some or all these factors might be common to most Jamaicans, not all achieve the success that Bolt and Asafa did.

Testing and research shows that the impact of genes on identifying and achieving sporting excellence is exaggerated. Most elite athletes have chosen their sport after dabbling in other sports as children. E.g. Usain Bolt played football and cricket, Lance Armstrong began as a swimmer, soccer player Diego Forlan was a promising tennis player, etc. Physical, emotional, social development of children is enhanced by participation in various sports, and in fact participation in team sports teaches vital social skills for the future. Children who specialize in a single sport, especially those that are played individually, are deprived of several opportunities for all round development, time for free play, and time to make lasting friendships. Further, the psychological stresses of competition, gruelling practise sessions and competition schedules, overuse of certain joints and muscles are all potentially harmful. Is it not a fact that most talented world class athletes have risen to the top barely 4-5 years after they entered the sport? Sporting genius does not need several years of perfecting, and in fact children training for a single sport face the danger of early “burn-out” or game-threatening injuries before they shine.

The particular “sports gene” that is being tested is only a small part of the athletic make up. It can at the most give an indication of whether the child will be good at endurance sports or those that require speed. But genetics determine many other factors like mental make-up, liking and preferences, height and body type, talent and flair, etc. Some of these are changing throughout childhood, and in fact may be apparent only after adolescence. If a child is confined to a single sport due to the mistaken belief of the parent that it is his* “calling”, the child may never find out what his real interests are!! Different sports require different body types, and the body type of the child may not be obvious till full growth is complete!! What a pity it would be if it did not match the requirement of the sport after all!!

Success itself might mean different things to different people and cannot be defined. No milestones, no material items or objects can be the measure of success as long as you need more. The markers for success can be different to a parent than to a child, and one cannot decide for the other what his goals should be. In simple terms, success is whatever makes the individual happy. What right does a parent have then to choose a sporting career for the young child on the basis of a genetic test? In fact this test will potentially take away the child’s right to explore other sports, arts, hobbies and careers in his pursuit of happiness.

To conclude, the making of a champion is extremely complex and probably requires hundreds of factors to interact with each other, but if a champion is in the making, they all suddenly come together at the right time like pieces of a kaleidoscope making a beautiful picture. Wouldn’t it be gratifying to wait patiently and support your child with love and understanding while the pieces fall together on their own?

Your child may not be another Sachin (in fact there will probably never be another Sachin), but… the world might still reverberate with the name of YOUR child the way it does with HIS!!

(*Note: The pronoun “his” has been used to denote a child, for the sake of convenience, and should be treated as a substitute for a girl as well as boy child)

“Stair climbing for weight loss”, “Stair climbing builds strong legs”, “Climb stairs to climb the fitness ladder”, “Stair climbing can be done anywhere and anytime”, “Why do you need a gym membership? Just run up and down the steps in your building!”……

All true!!! But…..

Let’s talk about the benefits first: Walking is THE MOST natural activity for the human body, and an excellent cardio-vascular exercise. But walking burns a small amount of calories, and to burn enough calories for weight loss by walking alone, you need to have a lot of time on your hands! Now if you walk UP THE STAIRS though, you can triple the amount of calories you burn, effectively cutting the amount of time you need to spend by 1/3^rd!! Walking upwards will also require more work from your heart, and will bring you into the “Target heart rate zone” you need to be in for best benefits of exercise.

Walking up-stairs needs a lot of work from the Quadriceps (Front of thigh) muscle, the Gluteal (hip) muscles and the calf muscles. Obviously, climbing often will make these stronger building stronger legs. The single leg balance required to propel the body upwards, and the work of the trunk muscles to centre the body, also means a good “Core” workout. Besides this, the rhythm, repetitions, co-ordination and proprioceptive conditioning makes stair climbing a good all rounded functional training tool.

Unfortunately, there are some disadvantages!!

Stair Climbing (and descending) can destroy your knee!!!: The pull that the large and strong quadriceps muscle exerts on the front of the knee is completely centred on the tiny knee cap through the “Quadriceps tendon”. This strong force grinds the knee cap on the bone lying directly behind it (the “femoral condyles”) repeatedly, slowly eroding the soft protective cartilage covering. While Climbing DOWNSTAIRS, the work of the hip muscles reduces, and the whole act of descending is dependent on the slow release of a very strong Quadriceps contraction, leading to even stronger grinding forces behind the knee cap!! Further, the act of lifting your body weight upwards, also loads the main knee joint (Tibio-Femoral) 3-4 times more than while walking on a flat surface. If you are overweight and your knees are already groaning, this repeated action can be the last straw!!!

In fact, if you have a foot or ankle problem, a hip problem, or even back pain, stair climbing is not for you!! If you have a “Back problem”, or if because of knee pain your posture while climbing up is not perfect, you may develop back pain from stair climbing! Climbing up requires the muscles of the hip to work well. Tight or weak gluteal muscles will cause excessive movement in the lumbar spine and strain the Sacro-illiac joints. Also a forward bent posture to assist weak Quadriceps will cause low back pain and increase discomfort coming from “Sciatica”.

When we advocate an exercise for efficacy or convenience, we also have to evaluate it for safety. An exercise that can potentially cause damage or increase disability cannot be used as a means towards “fitness”. Any advice towards weight loss or fitness, should promote health. “Convenience” and “Cost” should be evaluated and projected for the long run. Conservation of tissues and joints is an important part of health and fitness, and should never be ignored. “One exercise fits all” concept is dangerous and delusionary!!

To conclude, if you are fit and healthy, have no lower body pain, do take the stairs often to keep fit; If you are a sportsman and extremely fit, do use stair climbing as a part of your fitness routine; If you are trying to lose weight and are a healthy, YOUNG individual, do use stair climbing SOMETIMES to replace your other exercise routines or to bring in variety. In fact, if you are fit, try taking two steps at a time instead of one: a longer stride will mean more work from both the hips, better “push-off” from the leg behind, and less load on the forward knee, making the same exercise more challenging, less injurious and ensuring better strength, balance and functional gains!

But if you are on the other side of thirty, overweight, unfit, and have various aches and pains, please DO NOT use stair climbing as a part of your exercise routine!

The other day a young (and affluent) patient asked me to recommend the “Best Possible” wheelchair as he wanted to present it to his father. Though my opinion on whether one is required was not sought, I couldn’t resist asking about what the present ambulatory status of his father was, and why the wheelchair was required. The answer was a shocker, and is the basis of this article…

It turns out that my patient wanted to gift this wheelchair to his father out of commendable but excessive, filial anxiety. The concerned parent was walking with a stick, albeit with an unsteady gait, and the son wanted to ease his father’s struggle with walking: An admirable, but slightly misplaced notion.

When a child learns to walk, he wobbles, falls down often, picks himself up again, concentrates on each step, takes support when he needs it, and quickly leaves it again as he regains balance. His gait may seem laboured, but is a part of his development, and he needs all the practise he can get while he learns to walk. When a sprinter tries to improve his speed, or a marathoner his stamina, both exert beyond their comfort zone to gain their target. What is it that makes us applaud all of these but distress over a parent’s laboured walking?

Exertion (or struggle as a loved one might see it), is essential to the human body’s growth, development, maintenance, and longevity. The challenges should certainly be achievable, and will definitely be different at different stages of life. But living a life without challenge is detrimental and can deteriorate function or retard growth.

In the elderly, ambulatory aides should be prescribed medically. A walking stick may be used to reduce forces on compromised knee joints, a walker may be used when balance is poor and there is a fear of falling, a wheelchair may be used to improve the quality of life of an otherwise bed ridden patient. But if an otherwise healthy individual walking well with a stick is given a wheelchair with the mistaken belief that it will benefit him, this is unwarranted and can actually be harmful.

As “cell-building” processes are slower than “cell-breaking” processes in the bodies of the elderly, deterioration sets in quickly, and dependence on whatever aides are offered is difficult to reverse. The effort of walking and the cerebral, cerebellar and musculo-skeletal challenges it generates helps to increase longevity and maintain physical and mental health.

Maintaining “ambulation” or “available mobility” in the elderly has several benefits. Walking maintains bone mass and prevents osteoporosis, improves cardio-respiratory health, regulates hormones and enzymes (Limits Diabetes etc.), Helps to maintain muscle strength and balance, Improves digestion and intestinal health, and brain functions. The very important psycho-social benefits of walking with minimum supports need no clarification!!

Our elderly need a supportive hand sometimes, and a lot of patience and understanding always, but when they need a wheelchair, you will know for sure!! Of course my patient left that day without any information on “The best-possible” wheelchair, but hopefully his father benefitted anyway!

From infinity are we born
Into the infinite do we return?
Or from an atom do we arise
And to the elements return?

The earth and its creatures
Share the same compounds
The “matter” that forms us
Exists in all… and around!!

If matter cannot be created
Nor is ever destroyed
And the chemicals that form us
Just change form and survive..

Then the body is invincible
Perpetual, eternal!!
The atoms just re-group,
Change structure and go on..

“Life” is the energy
That drives every cell
Vibrant and Pulsating
Our Spirit and essence

We exchange with the universe
This energy through life
Using it for bodily functions
Discharging it with each action

Energy is unending,
Only changing its form
Undying and timeless
The substance of us all..

There can be no death to body or soul
Each of us will live on in this timeless zone
Created from earth, to earth we belong
From infinity born, to infinity we belong..

What have we come to..
My country I ask…
Where are we going
And to whom do we belong?

For years we were looted
We thought it would end
At the stroke of mid-night
That far-gone week-end

Here we are again
Has anything changed?
Did we wipe any tears
Redeem any pain?

Did we grow-Did we rise
Do we share the same pride?
Can we call it “our” freedom
If we left most behind?

Let’s build us a nation
With plenty for all
Food, Water, Dignity,
Is that too much to ask?

When did money and power
Replace compassion and pride?
Did we not see us changing?
Or did none of us care?

Now it’s time to rise up
And learn from our past
Cos our destinies tie up
With this country of ours!!

In school and college I was told that Honesty is the best policy, and was taught, cajoled, admonished, and encouraged to be honest. I was deeply disappointed with myself for not being able to remain honest even in small ways, and often tried to turn a new leaf with resolutions every year!! In fact it is really difficult to remain completely honest throughout school, college and work life!!

As I grew up I realised that whether or not we decide to be honest to others, we will never find true happiness unless we are completely honest to ourselves. Thankfully, I have always been honest to myself, and in fact at times I have several conversations with myself through the day! I cannot (in all honesty) take credit for consciously choosing to be truthful to myself, it happened somewhere on the way while struggling with my (sometimes) untruthfulness towards others.

Honesty towards our self starts with the acknowledgement that our life is our own and that we are in every way responsible for the decisions we take. Yes, fate might decide the obstacles you face, parents and decision makers may interfere with the path you wish to take, calamities might land in your plate more often than in others’, but how you react to any of these will ultimately decide the shape of your life.

While people around you are influencing your life, remember that you, the family and society are influencing theirs. Some of their actions (obviously not all), towards you might be a reaction to what they observe in you. Whatever fate and people dole out to you, you do have an ability to create a positive influence on your life, and on those around you.

We are very easily influenced by powerful people around us: friends, peers, parents, teachers, icons, bosses, etc. Many times we lead ourselves to believe that their words are our words, their life is what we want ours to be, their goals and dreams can be ours. In fact their influence on our life might control small things we do like our words, actions, the clothes we wear etc., as well as larger aspects of our life like education, career, etc. This of course might make our life seem easy, because all we need to do is follow them and we find a path to walk on. But our life is our own, and its challenges and opportunities are also unique: somewhere on the road (sooner than later), there comes an obstacle or an opening made only for one person, the other goes on in another direction!

If decisions we make turn out to be wrong, we can make a positive change if we first accept that the decision was ours: We choose our path not only by selection, we also decide by choosing not to object. It also makes our life easy if we have someone (or something) else to blame for the decisions we made. But this does not lead to contentment. Standing by each small decision we make, and guiding our life with grace and strength gives a joy and fulfilment that is difficult to describe.

It is obviously difficult at times, as it involves standing up for yourself, disagreeing with others, and sometimes a little loneliness and fear. But the personal integrity that you develop ultimately leads to deep satisfaction. Making your own decisions of course need not be confused with defiance and obstinacy. It is OK to walk with others without necessarily choosing their path. But recognising that which is individual to you, and staying true to it, is the essence of honesty.

A lady was explaining to a man how a “kick-back” deal works and in her enthusiasm to explain with an example she made a case in point of doctors sending patients for blood work-ups to pathology labs and receiving an assured kick-back in return. It was partly the words that caught my attention, and partly how they were spoken: casually, carelessly, plainly. A distasteful fact, spoken easily without aversion or disgust, in fact with a hint of approval and used to validate some other deal she was trying to make.

In fact it was obvious that to her getting a monetary “kick-back” for a professional reference was a mundane fact, one that she accepted wholeheartedly, and did not deliberate over. Contrary to this view there are many who would find the concept of accepting a “Kick-back” improper and offensive; morally corrupt.

This overheard conversation got me thinking about two issues:

Morality, according to me is a set of personal values of an individual, or a code of conduct decided up on by an organisation or firm. It need not/ cannot be standardised to apply to a whole society, must not be policed or enforced, and need not be uniform in structure or content. However, one’s personal or organizational ethical boundaries cannot tread over the legal, social or ethical rights of another. In an industry/ profession where “service” or “opinion” is offered and dispensed, the morality of one is closely associated with the fundamental rights of another. In the Medical Profession if decision making, advising, or referring is directed by the smallest hint of financial or other gains for the consultant, the patient’s rights have immediately been violated.

But are medical professionals accepting “kick-backs” the only ones that violate a patient’s rights? Are all medical professionals who accept such remuneration equally guilty? Can anyone “Quantitatively” measure whether the “Quality” of advice given was most favourable/ most beneficial to the patient in those particular circumstances?

Here the medical profession becomes unique in its functioning, because two variables are interacting with each other and the probabilities in terms of outcomes become infinite. The education, knowledge, usable experience, comprehension of the problem at hand, and morality of the Doctor interacts with the condition, perception, expectations and psycho-social make up of the patient.

Healing a patient requires a many pronged approach; experienced and perceptive Doctors reach beyond their skills and sometimes use their sensitivity to diagnose and advise. I remember, a long while ago when I was just out of Medical school I had laughed at a simple rural patient, who while giving me her history, had very seriously told me that she was cured of stomach pain after the Doctor treating her did an “X-Ray”. Many years later, I now know that sometimes investigations that the patient can read, hold, and see, can and do work in healing, or in convincing the patient to follow medical advice. Simply put, investigations not only help the doctor to diagnose, they also give the patient tangible proof of illness or good health. Depending on the Doctor’s diagnostic skills (which are hard to define or measure) and perception, investigations that he/ she may ask for may differ. Furthermore, certain investigations like MRI or diagnostic USG may require human skills (specialised radiologists) to interpret results and modify ongoing scans. As interpretation and reporting is again “qualitative” or enhanced by experience, clinicians may have preferred choices of where to refer their patients for some investigations. Not all medical professional referring you for investigations and specifying where to go are accepting remuneration for reference.

Symptom and disease relationship is so diverse in the population that medical professionals/ consultants have to draw on vast knowledge, acquired wisdom and scientific application to diagnose, predict course of illness, cure and prevent disease processes. Delayed referrals, hasty procedures, ill-advised treatment choices and inadequate counselling for financial gains, or simply because of an indifferent attitude can all be labelled unfair and corrupt. In the medical profession, the sincerity and personal morals of the consultant can obstruct the right of the patient to obtain the best and most beneficial advice in the given circumstances. It is not possible to quantify the quality of medical advice that you received, and hence impossible to prove or refute inherent corruption.

A profession is a vocation founded upon specialized educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Quoted). Professions rise in status and power, they also sometimes decline and lose shine. In the medical profession, an unspoken hierarchy exists between Surgeons, Physicians, General Practitioners and allied professions. With the declining importance of some professions, unfortunately, the well educated doctor may also lose the ability to earn respectably. Sometimes giving or accepting a “Kick-back” may have nothing to do with compromised ethics, and may need a deeper social rethinking and aligning of work-compensation structure. The fact that your doctor gave or received a kick-back will not always compromise the quality of healthcare you receive and may not increase the cost of your treatment.

When we define the word “Profession” (as stated above) there seem to be four important parts to the definition:

1. Specialized educational training: I would like to say that academic education and wisdom gleaned from constructive experience, combined with an ability to use sensitivity and scientific deduction to arrive at a diagnosis should all be considered in this segment. A doctor not qualified in any one or more of these aspects should not offer an unsupervised opinion to a patient seeking his counsel.
2. Disinterested counsel to others: The ability to look at your patient as a “whole” person, to advise them on the basis of his/ her long term health and well-being, without considering your own speciality, interest and promotion. In short, while looking at the patient, the Doctor should have only the best overall interest of the patient in mind.
3. Direct and Definite compensation: Though it may seem in the patient’s best interest to have some externally fixed fee structure for different medical specialities, it may not actually be so. Within reasonable limits, the professional should be allowed to choose the compensation he/ she needs for their counsel, as this will minimise the chances of corrupt practice. The fees, especially for procedures advised should be fully and clearly stated, and the patient should be well-informed. The Doctor should be completely satisfied with the compensation received and the patient should be willing to pay the same.
4. No expectation of other business gain: Talking about compensation for referrals is the tip of the iceberg, and “Business gain” for doctors can come from various sources, like pharmaceutical companies, manufacturers of surgical instruments and implants, equipment manufacturers, etc. The Doctor should, of course only use commodities that will give the patient best results, and not use unnecessary procedures that do not ensure the patient’s long term well being.

This essay is not a comment on the morals of doctors who give or receive financial remuneration for referrals. Rather, it is an attempt to shed light on the complexity of the issue. It is important to remember here that the services offered have to be evaluated qualitatively, and the complexity of the matter is reflected here. The rights of the patient are supremely important, and a doctor who respects these rights and does not infringe on them for any kind of personal benefit is morally blameless.