Bharat Rakshak

Ranbaxy shares tumble after Lipitor ruling
Mon Dec 19, 2005 4:38 AM ET

By M.C. Govardhana Rangan

MUMBAI (Reuters) - Shares in Ranbaxy Laboratories Ltd. fell almost 9 percent on Monday after a U.S. judge ruled that India's top drug maker could not launch a copycat version of Pfizer Inc.'s $12 billion-a-year cholesterol drug, Lipitor.

The ruling comes as Ranbaxy (RANB.BO) is already fighting sharp price erosion in the crucial U.S. market amid intense competition, a slowdown in new product launches and higher research and development and litigation costs.

A U.S. federal judge on Friday upheld the validity of two of Pfizer's (PFE.N) U.S. patents on the cholesterol drug, blocking a generic version that Ranbaxy planned to introduce.

Ranbaxy has said it will appeal against the verdict.

One analyst said the ruling would boost the confidence of firms hesitant to spend money for research and development, but would not stop generic makers from challenging patents.

"The companies which believe in a high risk, high return strategy could continue to challenge patents," said Kavita Thomas, analyst at First Global Securities, adding that Israeli generics firm Teva (TEVA.TA) was still aggressive.

Drugs worth about $25-$30 billion are estimated to come off patent in 2006-07 and generic makers will have opportunities to grab six-month exclusivity deals before they become freely accessible, analysts said.

News of Pfizer's victory in the challenge that threatened the U.S. company's largest source of revenue had lifted its shares 10 percent in New York on Friday.

"This is the best-case outcome for Pfizer and the branded industry," said one dealer in London. "It should be a positive for the whole group and for Sanofi in particular."

Sanofi-Aventis SA (SASY.PA) is not directly involved in the cholesterol market but its shares were boosted by hopes the Lipitor ruling augured well for its own court fight over top-selling bloodthinner Plavix.

In Mumbai, Ranbaxy shares dropped to as low as 355.55 rupees, before edging back up to 366 rupees by 0926 GMT, still down 6.2 percent, while the benchmark BSE index was up 1 percent.

LOST OPPORTUNITY

Sanjeev Chiniwar, analyst at Anand Rathi Securities, said a Ranbaxy victory in the patent challenge would have been "a great opportunity" as the market had not really factored in potential earnings from a version of Lipitor.

He said he maintained a buy rating on Ranbaxy as earnings could improve in the coming quarters.

At Monday's low, Ranbaxy shares had fallen 43 percent in 2005, underperforming a 41 percent jump in the BSE index.

Ranbaxy President Malvinder Singh told Reuters on Saturday the U.S. ruling would have no impact on the company's business plans.

"If you look at the top line, bottom line, we have not factored anything on atorvastatin (Lipitor) into our business plan," he said.

Ranbaxy's net profit slumped 91 percent to 184 million rupees in the September quarter as competition in the U.S. generic market ate into its profit margins, though the company forecasts a much better 2006.

It plans to launch 15 products in the United States and has said sales will rise 18 percent, compared with a forecast of low single digits for 2005. It also sees an operating margin of more than 16 percent in 2006 against 8 percent expected for 2005.

Ranbaxy had lost its challenge of the basic patent on Lipitor in the UK in October, a ruling it is appealing.

"When you're running a marathon, you don't judge yourself at the 100-meter or 400-meter point, you have to look at running the full course," Ranbaxy's Singh said, adding he expected a final judgment in the fourth quarter of 2006.

Stem cells: Bio-insurance for your child
http://in.rediff.com/money/2006/feb/22spec3.htm
Shobha Warrier in Chennai | February 22, 2006

When Neha and Vivek Saxena decided to bank the cord blood cells of their baby more than a year ago as an 'insurance,' little did they realise that they would have to use it so soon.
Although their families did not have a history of any health problems, they decided to bank the stem cells of their baby.

"We did it for our child. But I took some time to be convinced mainly because it involved big money. I consulted my family doctor, my sister and father who are scientists, to know whether it was worth it. It is a kind of bio-insurance for our child," Neha explained the thoughts that went behind the decision.

Unfortunately, her son developed intolerance to milk from the fourth month onwards. "This has made him extremely vulnerable to diseases. My son is also anaemic, and is on antibiotics. I just hope and pray that some scientist would do some research on this area. I pray that the investment that we made will solve these issues. I feel this is the best insurance we have taken for our son."

Neha had post-delivery complications due to the negligence in the hospital, and a blood patch surgery on her back a week after the delivery has made the situation even worse. Now she has severe back pain, headache and many other health problems. "The only hope I have now for spinal injury is the stem cells of my son that we have banked. We are told a lot of research has gone into spinal injuries. What we had done for our child might come to use for me, I think. Strange!"

Stem cell bank

S.Abhaya Kumar, the founder and managing director of Shasun Drugs and Chemicals, is the man behind India's first private stem cell bank, LifeCell. Marketing guru Dr Jagdish Sheth one of the directors of Shasun helped set up this project as Dr.Sheth was also on the board of Cryo-cell International Inc. in Florida, USA. Set up in 1992, Cryo-Cell International is the world's first and largest cord blood stem cell bank.

"Dr Sheth was very interested in bringing the technology of preserving the stem cells from the (umbilical) cord blood for the family's future use. Since it had not come to India, we thought of this as a platform to do a lot of research," Abhaya Kumar said.

But he knew how difficult it would be to introduce something of this sort in India. "As I was aware of the mindset of the Indian doctors, I knew selling this concept to Indian public will be the most challenging job, more challenging than setting up a lab of international standards."

He went ahead with the idea and a lab was set up with an investment of Rs.12 crore (Rs 120 million) as per USFDA standards. He also set aside Rs 3 crore (Rs 30 million) for marketing the concept.

As his daughter-in-law was expecting her first child by November, they decided to race against time to set up the lab in just six months' time. On 14 November 2004, LifeCell, India's first cord blood cell banking was inaugurated. "We wanted my grandson to be our first customer! It was a massive effort, and we were happy that we could store my grandson's cord blood." The first enrolment happened on the 28th of November and the first collection on the 5th of December.

What are Stem cells?

Stem cells are master cells that act as the building blocks of our blood and immune systems. They can develop into white cells that fight infection, red cells that carry oxygen throughout the body and platelets that promote healing. This ability allows them to act as a repair system for the body, replenishing other cells throughout our lives. Stem cells are found in our bone marrow where they continue to regenerate cells.

What is cord blood?

It is the baby's blood that remains in the umbilical cord and placenta at the time of birth. Cord blood has a high concentration of stem cells. Stem cells in cord blood have a number of advantages over those from bone marrow. They are easier to obtain than stem cells from bone marrow. The collection of cord blood is a quick and painless procedure with no risk to the mother or the child. They also have the advantage of being available for transplant if ever needed as the they are stored in the labs.

More importantly, the cord blood stem cells are a perfect match for the child and his/her blood relations from whom it is collected, thus eliminating the difficult process of finding a matching donor and minimising the risks of rejection.

The Procedure

Once a pregnant woman enrolls herself with LifeCell paying an initial fee of Rs 27,000, she is given a kit. Post delivery, within ten minutes of cutting the umbilical cord of the baby, the blood is collected and stored in the bag provided in the kit. The kit is sealed and sent by courier to the stem cell storing facility in Chennai. Cord blood can be retained at room temperature for almost 36 hours.

Once it reaches the lab in Chennai, the cord blood is tested for all types of infectious diseases. Only if it is found to be safe, stem cells are processed from it. About 14 ml of stem cells are taken and stored at a temperature of -190 degrees. Every parent who has banked with LifeCell has to pay Rs 2900 every year for the safe keeping of the stem cells from cord blood. Though the stem cells belong to the child, the mother is the guardian of the stem cell till the child turns 21.

How successful are stem cells

So far, 6000 cases are reported globally where stem cell transplants have been successful. One of the first successes was the stem cell transplant in a woman paralysed by brain haemorrhage. Another successful case was of a South Korean woman paralysed for 20 years, walking again after scientists repaired her damaged spine using stem cells taken from cord blood.

In India, Adyar Cancer Institute and Apollo Speciality Hospital in Chennai, Tata Memorial Hospital in Mumbai, Apollo Speciality Hospitals, Global Hospitals, and NIIMS in Hyderabad, Christian Medical College in Vellore, Narayana Hrudayala in Bangalore, R&R Army Hospital and AIIMS in New Delhi, Inlaks Hospital and AFMC in Pune and Sanjay Gandhi PGIMS in Lucknow have stem cell therapy centres.

Ailments that stem cells can cure

Stem cells are already in use to cure ailments like acute leukaemia, chronic leukaemias, myelodysplatsic syndromes, stem cell disorders, myeloproliferative disorders, lymphoproliferative disorders, phagocyte disorders, inherited disorders like osteoporosis, B-Thalassemia, inherited metabolic disorders, inherited erythrocyte abnormalities like Beta Thalassemia mand Sickle cell disease, and other malignancies like multiple myeloma, plasma cell leukaemia, renal cell carcinoma and retinoblastoma.

Trials are on for cardiac diseases, diabetes, multiple sclerosis, muscular dystrophy, Parkinson's disease, spinal cord injury and stroke. Scientists are hopeful of stem cell applications in Alzheimer's disease, Lupus and rheumatoid arthritis in future.

Life Cell members

Life Cell has more than 1300 members. Some of the celebrity members are Raveena Tandon and Priya Dutt. So far, LifeCell has processed and stored around 1100 samples. Though it was expected that families with a history of cancer and other chronic ailments would enroll as members. Most of the 1300 members are using stem cell banking as an insurance for their child.

Dr. Prakash, who is a consultant psychiatrist with the Mahatma Gandhi Medical College and Research Institute in Pondicherry, decided to bank his first born's stem cells although no one in the family had any major illnesses. He and his wife had to think a lot before taking a decision, due to the high cost. As a doctor, I know the kind of unpredictability in everybody's life. I felt this will act like a buffer if something goes wrong not only for the child but others in the family too."

"We thought this would help not only the baby but the family as well. We felt this is an opportunity we are giving our child, which can help him in future," says Nilakandan and his wife Ameera.

The road ahead

Starting with one centre in Chennai, LifeCell plans to have centres in Gurgaon, Surat, Pune, Chnadigarh, Jallandar, Jaipur, Coimbatore, Nagpur and Vizag in India, and Dubai, Colombo, Kuala Lumpur, Singapore, Riyadh and Bangkok abroad, by the end of the year.

Abhaya Kumar does not want to restrict himself to cord blood banking alone. His plan is to have therapy centres also, and as a first step, LifeCell is collaborating with the Sri Ramachandra Medical Centre in Chennai to start a stem cell transplant centre. Initially, the hospital plans to have transplants in the cases related to haematology and oncology. "We plan to set up more transplant centres across the country in association with other reputed hospitals," said Abhaya Kumar.

LifeCell also intends to have application research and clinical trials with focus on spinal cord injuries and then move on to cardiac and other diseases. LifeCell has tied up with Saneron to bring in therapy for neurological disorders, to India.

"We are at par with the developed countries. I would say we are one step ahead in therapy, as in the US, there are restrictions they cannot use stem cells for all therapies. Approval takes a long time but in India, rules are more encouraging for research. So we would like to conduct of lot of clinical trials and establish procedures for therapy. Once we are successful in therapy, we can propagate all over the world," Abhaya Kumar said.

LifeCell plans to start a public cord blood banking facility. Every mother who supplies cord blood to the public banking has to give a declaration that the cells can be used for research or for third party use. This will be operational in another two months. If you want to take stem cells from a public bank, it will cost you Rs10 lakhs.

LifeCell gets 300 clients every month, and has a target to have 2000 clients every month. They plan to have 10,000 members by 2006-07 and 18,000 by 2007-08 and 30,000 by 2008-09.

The six AIIMS-type medical institutes would come up in Bihar, Orissa, Madhya Pradesh, Rajasthan, Utranchal and Chattisgarh, he said. Last year's budget had provided Rs 270 crore for this purpose.

The state government medical colleges or institutes that would be upgraded to AIIMS-level would be in Jammu and Kashmir, Tamil Nadu, Uttar Pradesh, Karnataka, Kerala, Maharashtra, Jharkand, Gujarat and West Bengal.

Let us analyze cocoanut oil's
Fats are more scientifically classified into three varieties based mainly on the number of carbon atoms they posses and the length of the chain-Short Chain having between C4-C6 carbon atoms, Medium Chain having between C6-C10 or so and Long Chain with C11-C24 atoms. The saturated, unsaturated classification is for the convenience of the fat lobby to sell their wares. Science is what scientists do. Science is only curiosity and, as such, could never be bad, but scientists could definitely be bad when the circumstances warranted. The problems for man would not cease as long as the present market economy lasts. God help mankind!

Little over 50% of cocoanut oil is medium chain fatty acid, Lauric acid and another 7-10% is a medium chain Capric acid. Lauric acid gets converted inside the human system into MonoLaurins. the best fat that mother's milk has.10 Other than mother's milk monolaurins are found only in cocoanut oil. New born babies and infants depend on the monolaurins for their immune system development and their capacity to withstand any infection.11 In addition, cocoanut oil can be digested by the salivary lipase, getting absorbed very fast to give energy like carbohydrates. All other fats need the pancreatic lipase for digestion that the infants do not have. The best alternative food fat for the infant when mother's milk is not available is cocoanut oil. (In baby foods). Other fats might be dangerous.12 Just this week there is a study published in the British Medical Journal showing the dangers of using Soya fat for babies. The article also warns adults to take Soya oils cautiously!13

Cocoanut oil is a low calorie fat and as such helps control body weight. In addition, cocoanut oil stimulates metabolism to get itself metabolized fast to supply quick energy unlike all other fats. This also helps control body weight. Changing the food fat to cocoanut oil could help reduce weight in obese individuals.14 It also helps to control blood fat levels in diabetics. Because most of cocoanut oil is medium chain fat it gets absorbed and metabolized so fast that it rarely gets transported to fat depots like other fats, altering the lipoprotein fractions of blood, another great boon. Cocoanut oil contains so many anti-oxidants that it resists oxidation even if it is preserved for as long as a year whereas all other fats would have been already oxidized and have become Trans fatty acids by the time they come on the food store shelves! Cocoanut oil resists oxidation even on boiling at 76 degree centigrade. So there are no Trans fats in cocoanut oil.15 While fried foods are not good for health, if fried in cocoanut oil, fried foods are not that bad, after all.

The monolaurins in the cocoanut oil have been found to be very powerful anti bacterial, antiviral and antifungal agents. Most viruses, including the retrovirus HIV, are sensitive to cocoanut oil. Cocoanut oil has been found to be an excellent moisturizer for dry skin conditions and is known to be even absorbed from the skin surface of preterm babies. A diet rich in coconut oil reduces diurnal postprandial variations in circulating tissue plasminogen activator antigen and fasting lipoprotein (a) compared with a diet rich in unsaturated fat in women.16 Cocoanut oil is said to penetrate hair roots to keep hair healthy and clean.17 They have even found some very interesting therapeutic values in cocoanut oil.18 A recent report shows how it could be used to treat aluminum oxide poisoning (agricultural pesticide content) for which there had never been any specific antidote so far.19 Cocoanut oil's regular use in diet would regularize blood fats and is known to increase the HDL cholesterol fraction while decreasing the LDL and triglycerides significantly; disproving the myth that cocoanut oil increases cholesterol and triglycerides.15, 20 Cocoanut oil has been now classified as a functional food. Functional food was defined as "food that provides health benefits over and above the basic nutrients." No other fat could claim that status except the Indian clarified butter-ghee, which according to Ayurveda is an excellent food for good health and strength. Even the west has now learnt a bitter lesson. After having realized the dangers of polyunsaturated fats in margarine they have coined a new slogan: "butter is better".

In conclusion, one could easily surmise that cocoanut oil that has been our staple food for thousands of years, could not have suddenly become so bad in the 1930s that it had to be thrown out of the window. Our thousands of years of observational research is any day more reliable compared to the short term cross sectional motivated research today. Although Aristotle did say that truth could only influence half a score of men in a Century, truth will have to triumph at the end. The sad state of the Polynesian migrants to the west coast of America is there for all to see. Prof. Castle's elegant studies did show the curse of acculturation of these long living sturdy people whose main food was cocoanut till they became American citizens. With modernity Polynesians were succumbing to all the degenerative diseases precociously. They never had atherosclerosis in their natural habitat what with 80% of their calories coming from cocoanut. Long live the cocoanut tree, the venerated kalpavriksha, for the common good of humankind.

BIBLIOGRAPHY.
Jacobs D, Blackburn H, Higgins M et. al. Report of a conference on low cholesterol and mortality association. Circulation 1992; 86: 1046-60.
Bleck J. Disease Inventors. 2000. (German)
Blackburn GL, Kater G, Mascioli EA, et. al. A reevaluation of coconut oil's effect on serum cholesterol and atherogenesis. J Philippine Med Assoc 1989;65:144-152
Hegde BM: "Angina- an Indian Disease" - Jr. Assoc. Physi. India 1999; 47:440-442
Stehbens WE. An appraisal of the epidemic rise of coronary heart disease and its decline. The Lancet 1987;182: 399-405.
Milloy S. Science without Sense. 1997. Cato Institute Washington DC.
Shepherd J, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet, Nov. 23, 2002; 360 (9346): 1623-30.
Forette B, et al. Cholesterol as risk factor for mortality in elderly women. Lancet, 1989; 1: 868-870.
Multiple Risk Factor Intervention Trial Research Group: Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA 1982; 248: 1465-1977
Halden VW, Lieb H. Influence of biologically improved cocoanut oil products on blood cholesterol levels in human volunteers. Nutr. Dieta. 1961; 3: 75-88
Hierholzer JC, Kabara JJ. In vitro effects of Monolaurins on enveloped RNA and DNA viruses. J. Food Safety 1982; 4: 1-12.
Hodgson JM, Wahlqvist ML, Boxall JA, and Balazs ND. Can linoleic acid contribute to coronary artery disease? American Journal of Clinical Nutrition 1993;58:228-234
Siegel-Itzkovich J. Health Committee warns of the potential dangers of soya. BMJ 2005; 331: 254.
Willett W. Editorial: Challenges for public health nutrition in the 1990s. American Journal of Public Health. 1990;80:1295-1298.
Nevin KG, RajMohan T. Beneficial effects of cocoanut oil in lipid parameters and in vitro LDL oxidation. Biochem 2004; 37: 830-835.
Muller H, Lindman AS, Blomfeldt A et. al. A diet rich in cocoanut oil reduces diurnal postprandial tissue plasminogen activator antigen and fasting lipoprotein A. J. Nutrition 2003; 133: 3422-3427.
Rele AS, Mohite RB. Effects of mineral oil, sunflower oil, and cocoanut oil on the prevention of hair damage. J Cosmet Sci. 2003; 54:175-92.
Nanji AA, Sadrzadeh SM, Yang EK, et. al. Dietary saturated fatty acids: a novel treatment for alcoholic liver disease. Gastroenterology 1995;109:547-554
Shadnia S, Rahimi M, Pajoumand A et.al. Successful treatment of acute aluminium phosphide poisoning: possible benefit of coconut oil. Hum Exptl Toxicol 2005; 24: 215-8.
Ravnskov U. Quotation bias in reviews of the diet-heart idea. Journal of Clinical Epidemiology 1995;48:713-719

While data from north India is still cause for worry, the Lancet study reports that prevalence of HIV-1 (the most common variant of the virus in India) prevalence fell in the southern states from 1.7% to 1.1%—a relative reduction of 35%.

UNAIDS, World Health Organisation and the Government of India all agree on an estimated 5.1 million people infected with HIV, 75% of them in the southern states.

“There have been many predictions, mostly based on guesswork, that India’s AIDS problem will explode—as it did in southern Africa—but we now have direct evidence of something positive,â€

I am in the waiting room of the Sitaram Bhartia Institute of Science and Research in New Delhi, one of the many world-class medical facilities all over India.

I am here because I heard that medical tourism is starting to take off in India. Last year around 100,000 people came for everything from knee replacements to nose jobs, compared to 10,000 five years ago.

Having been to India before, they also knew to stock up on cheap medicine, prescription glasses (she got two pairs, including prescription sunglasses, for $40 U.S.) and to see a dentist (he is contemplating nine teeth implants for $2,000 U.S.)

Finally it is all over for the day. I come back a few days later for follow-ups with a few of the doctors and a session with the dietician. End result: seven hours of tests, half a dozen doctor appointments, physio, a personalized diet plan, all my charts and scans to take back home, a nice lunch and a couple of slightly retracted eardrums. Total cost: $100 (U.S.)

The Bureau of Indian Standards (BIS) will now be looking at the National Accreditation Board for Hospitals & Healthcare Providers (NABH) standards as the basic framework for evolving standards for hospitals across the country.

At present, there are no acts governing the registration of hospitals on a national basis. But there are state Acts, like the Delhi Nursing Act, which healthcare industry experts say have become obsolete.

BIS itself had framed standards for 30 bed and 100 bed hospitals. But these standards also deal primarily with building specifications and not with other important areas like hospital infection control, management of medication, HR management, facility management and safety, patients rights and education.

NABH standards, on the other hand, focus on all these areas, and can be applicable to small, medium and large hospitals.

The industry has reacted positively to the step. CII said with BIS getting involved, the NABH standards will carry more weight as the BIS is a government institution. This will eventually drive away the poor quality operators.

The work on hospital accreditation structure had been initiated by Indian Healthcare Federation (IHCF), a CII affiliate. IHCF’s accreditation committee comprising of leading Indian healthcare majors like Fortis hospitals, Apollo hospitals, Wockhardt, etc was instrumental in framing the NABH standards along with the Quality Council of India

ICICI Venture invests Rs 35 cr in Metropolis Health Services

Private equity and venture capital management company ICICI Venture has invested Rs 35 crore in Metropolis Health Services, a chain of corporate diagnostic centres with presence in India and abroad. The investment was provided by India Advantage Fund-I, a fund managed by ICICI Venture. Metropolis would use the investment to fund its expansion plans of extending its geographical reach and entry into related areas of business.

The company is also looking at international acquisitions or joint ventures in countries like South Africa and South East Asia, investment in IT infrastructure development of new technologies and tests.

It would also continue with a spate of domestic acquisitions in cities such as Kolkata, Bangalore, Hyderabad and Delhi.

Metropolis has NABL and CAP accreditation in India. It has 17 laboratories, 200 franchisees and caters to over 3,000 small labs, nursing homes and hospitals.

The company has over 10,000 consultants across the globe and processes over 5 million samples a year.

Indian Ocean Tsunami Warning System Up And Running
by Staff Writers
Paris (AFP) Jun 28, 2006
A tsunami warning system for the entire Indian Ocean "is up and running as scheduled", the United Nations' Educational, Scientific and Cultural Organisation (UNESCO), which has been overseeing the scheme, announced on Wednesday.

A network of 26 national tsunami information centres have been set up in Indian Ocean countries, capable of receiving and distributing tsunami advisories around the clock, it said in a press release.

Twenty-five new seismographic stations have been created, providing data in real time to centres that analyse the location and depth of a quake and compute whether there is a risk of a tsunami.

The information is being supplemented by three deep-ocean sensors that detect and report tsunamis.

The system is being coordinated by UNESCO's Intergovernmental Oceanographic Commission (IOC).

UNESCO director general Koichiro Matsuura said countries could be "justly proud" of this achievement but stressed the need to beef up international coordination and for governments to work hard on grassroots preparedness.

"A timely, 100-percent accurate and precise warning will not provide any protecting if people do not know how to respond to the emergency," he said.

The warning system was set up after the December 26, 2004, tsunami, triggered by an earthquake just west of Indonesia. The wave killed some 220,000 people in a dozen countries.

A similar system has been in existence in the Pacific for more than four decades, and others are planned for the Atlantic, Mediterranean and the Caribbean.

Montek, Nair on public health board

Special Correspondent

Foundation to train health workers

# One-time grant of Rs. 65 crore for corpus
# Foundation's goal to open first school of public health
# To open five centres across the country

NEW DELHI: Montek Singh Ahluwalia, Deputy Chairman Planning Commission, and T.K.A. Nair, Principal Secretary to the Prime Minister, have joined the governing board of the Public Health Foundation of India (PHFI). Mr. Nair will be the ex-officio member.

At the second board meeting of the foundation here on Thursday, chairman Rajat Gupta said the Government had also approved the deputation of Prof. Srinath Reddy as PHFI president for a five-year term.

The Cabinet Committee on Economic Affairs has already announced a one-time grant of Rs. 65 crore towards the initial corpus of the foundation, which seeks tostrengthen the public health system by training health workers at various levels and reaching out to the remotest areas.

Its immediate goal is to open the first school of public health (Indian Institute of Public Health) by July 2008. The foundation has undertaken innovative measures to build a strong faculty pool, for which it has entered into academic partnerships with the Association of Schools of Public Health (U.S.) and the London School of Hygiene and Tropical Medicine. These will soon be extended to include partnerships with institutions in other parts, especially in developing countries.

Partnership

The partnership entails the sponsored candidates to undertake courses in Master's in Public Health and doctoral programmes. This will help in applying technical knowledge of these programmes to India-relevant issues. PHFI aspires to create over the next 3-5 years a group of 100 permanent faculty members with a deep understanding of India-relevant issues.

According to Prof. Reddy, biodata has been received from 130 experts across the world, who are interested in associating themselves with these institutes.

Development programme

The foundation has selected 14 candidates from multidisciplinary fields for faculty development programme. It intends opening open five centres across the country. Offers have been received from private institutions and State Governments including West Bengal, Andhra Pradesh, Karnataka, Gujarat, Tamil Nadu, Kerala, Delhi, Haryana, Uttar Pradesh, Tripura, Punjab and Jharkhand.

While the target is to strengthen the National Rural Health Mission (NRHM), the foundation aims at training 10,000 health workers every year for being sent to remote areas.

``We will try to train the people already working in these areas, instead of sending people against their wish, to ensure that they serve the purpose,'' Mr. Gupta said.

Acharya wrote:What is the implication of linking up with
Association of Schools of Public Health (U.S.) and the London School of Hygiene and Tropical Medicine.Will it give access to demographics and public health data such as aids to foriegn govts.

So we do need as much help as possible to get these depts running with faculty coming in from the US to train/develop future IIPH faculty.

CHENNAI, India There are many ways to understand diabetes in this choking city of automakers and software companies, where the disease seems as commonplace as saris.

One way is through the story of P. Ganam, 50, a proper woman reduced to fake gold.

Her husband, K. Palayam, had diabetes do its corrosive job on him: Ulcers bore into both feet and cost him a leg. To pay for his care in a country where health insurance is rare, P. Ganam sold all her cherished jewelry. Gold, as she saw it, swapped for life.

She was asked about the necklaces and bracelets she was now wearing.

They were, as it happened, worthless impostors.

"Diabetes," she said, "has the gold."

And now, Ganam, the scaffolding of her hard-won middle-class existence already undone, has diabetes too.

In its hushed but unrelenting manner, Type 2 diabetes is engulfing India, swallowing up the legs and jewels of those comfortable enough to put on weight in a country better known for famine.

Here, juxtaposed alongside the stick- thin poverty, the malaria and the AIDS, the number of diabetics now totals around 35 million, and counting.

The future looks only more ominous as India hurtles into the present, modernizing and urbanizing at blinding speed. Even more of its 1.1 billion people seem destined to become heavier and more vulnerable to Type 2 diabetes, a disease of high blood sugar brought on by obesity, inactivity and genes, often culminating in blindness, amputations and heart failure.

In 20 years, projections are that there may be a staggering 75 million Indian diabetics.

"Diabetes unfortunately is the price you pay for progress," said Dr. A. Ramachandran, the managing director of the M.V. Hospital for Diabetes in Madras.

For decades, Type 2 diabetes has been the "rich man's burden," a problem for industrialized countries to solve. But as the sugar disease, as it is often called, has penetrated the United States and other developed nations, it has also trespassed deep into the far more populous developing world.

In Italy or Germany or Japan, diabetes is on the rise. In Bahrain and Cambodia and Mexico - where industrialization and Western food habits have taken hold - it is rising even faster. For the world has now reached the point, according to the United Nations, where more people are overweight than undernourished.

Diabetes does not convey the ghastly despair of AIDS or other killers. But more people worldwide now die from chronic diseases like diabetes than from communicable diseases. And the World Health Organization expects that of the more than 350 million diabetics projected in 2025, three-fourths will inhabit the third world.

"I'm concerned for virtually every country where there's modernization going on, because of the diabetes that follows," said Dr. Paul Zimmet, the director of the International Diabetes Institute in Melbourne, Australia. "I'm fearful of the resources ever being available to address it."

India and China are already home to more diabetics than any other country. Prevalence among adults in India is estimated about 6 percent, two-thirds of that in the United States, but the illness is traveling faster, particularly in the country's large cities.

Throughout the world, Type 2 diabetes, once predominantly a disease of the old, has been striking younger people.

But because Indians have such a pronounced genetic vulnerability to the disease, they tend to contract it 10 years earlier than people in developed countries. It is because India is so youthful - half the population is under 25 - that the future of diabetes here is so chilling.

In this boiling city of 5 million perched on the Bay of Bengal, amid the bleating horns of the auto-rickshaws and the shriveled mendicants peddling combs on the dust-beaten streets, diabetes can be found everywhere.

The conventional way to see India is to inspect the want - the want for food, the want for money, the want for life. The 300 million who struggle below the poverty line. The debt-crippled farmers who kill themselves. The millions of children with too little to eat.

But there is another way to see it: Through its newfound excesses and expanding middle and upper classes. In a changing India, it seems to go this way: Make good money and get cars, get houses, get servants, get meals out, get diabetes.

In perverse fashion, obesity and diabetes stand almost as joint totems of success.

Last year, for instance, the MW fast- food and ice cream restaurant in this city proclaimed a special promotion: "Overweight? Congratulations."

The limited-time deal afforded diners savings equal to 50 percent of their weight in kilograms. The heaviest arrival lugged in 135 kilograms, or 297 pounds, and ate lustily at 67.5 percent off.

Too much food has pernicious implications for a people with a genetic susceptibility to diabetes, possibly the byproduct of ancestral genes developed to hoard fat during cycles of feast and famine. This vulnerability was first spotted decades ago when immigrant Indians settled in Western countries and in their retrofitted lifestyles got diabetes at levels dwarfing those in India.

Now westernization has come to India and is bringing the disease home.

Though 70 percent of the population remains rural, Indians are steadily forsaking paddy fields for a city lifestyle that entails less movement, more fattening foods and higher stress - a toxic brew for diabetes.

In Madras, about 16 percent of adults are thought to have the disease, one of India's highest concentrations, more than the soaring levels in New York, and triple the rate two decades ago. Three local hospitals, quaintly known as the sugar hospitals, are devoted to the illness.

The traditional Indian diet can itself be generous with calories.

But urban residents switch from ragi and fresh vegetables to fried fast food and processed goods. The pungent aromas of quick-food emporiums waft everywhere here: Sowbakiya Fast Food, Nic-Nac Fast Food and Pizza Hut. Coke and Pepsi are pervasive, but rarely their diet versions.

The country boasts a ravenous sweet tooth, hence the ubiquitous sweet shops, where customers eagerly lap up laddu and badam pista rolls. Sweets are obligatory at social occasions - birthdays, office parties, mourning observances for the dead - and during any visit to someone's home, a signal of how welcome the visitors are and that God is present.

"When you come to the office after getting a haircut, people say, 'So where are the sweets?'" said Dr. N. Murugesan, the project director at the M.V. Hospital for Diabetes.

The sovereignty of sweets can pose ticklish choices for a doctor.

Trying to set an example, Dr. V. Mohan, chairman of the Diabetes Specialities Centre, a local hospital, said he had omitted sweets at a business affair he arranged, and nearly incited a riot.

Last year, his daughter was married. Lesson learned, he laid out a spread of regular sweets on one side of the hall and on the other stationed a table laden with sugar-free treats. Everyone left smiling.

In the United States, an inverse correlation persists between income and diabetes. Since fattening food is cheap, the poor become heavier than the rich, and they exercise less and receive inferior health care. In India, the disease tends to directly track income.

"Jokingly in talks, I say you haven't made it in society until you get a touch of diabetes," Mohan said. He points out that people who once balanced water jugs and construction material on their heads now carry nothing heavier than a cellphone. At a four-star restaurant, it is not unusual to see a patron yank out his kit and give himself an insulin injection.

The very wealthy have begun to recoil at ballooning waistlines, and there has been a rise in slimming centers and stomach-shrinking operations. In high- end stores, one can find a CD, "Music for Diabetes," with raga selections chosen to dampen stress.

The rest of urban India, however, sits and eats.

In Madras, workers in the software industry rank among the envied elite. Doctors worry about their habits - tapping keys for exercise, ingesting junk food at the computer. Dr. C.R. Anand Moses, a local diabetologist, sees a steady parade of eager software professionals, devoured by diabetes.

"They work impossible hours sitting still," he said.

S. Venkatesh, 28, a thick-around-the- middle programmer, knows the diabetes narrative. Much of his work is for Western companies that operate during the Indian night. So he works in the dark, sleeps in the day.

"The software industry is full of pressure, because you are paid well," he said. "In India, if you work in software, your hours are the office."

His sole exercise is to sometimes climb the stairs. A year and a half ago, he found out he had diabetes.

So if you burn 500 cals with 30 mins of cardio...