Reflection on Emory Global Diabetes Research Center

 

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.”

 

When I joined Emory in August 2006 (naive to US academia, never having written a grant or supervised a doctoral student), I was suddenly a single member team with an office, and without the  national diabetes research operation (and security of a federal job) that I had just left behind. 

 

Going to my new office every morning at 7.00 am, I would sit and stare at a white board to chart ideas, and spent my first 3 months or more talking to people (at Emory and several other places) to get advice on what I might do and how.

 

I was very lucky to get some phenomenal and inspirational advice and support from the likes of Bill Foege, Jeff Koplan, Jim Curran, Rey Martorell. They simply gave me inspiration and none of them told me what to do or what not to do. 

 

My life was suddenly like an empty canvas on which I could draw anything. This was a very exhilarating feeling, and one that I long for! What a lovely idea - a vast landscape ahead, no restrictions, and one could do anything with the freedom to shape something and to fail or to succeed (on one's own terms).

 

Equally, in my various meetings, I met people ("experts", and "colleagues") who gave me advice (some unsolicited). Many of these was about barriers, challenges, and what I should and should not do.  I would prefer not attributing these items (although, I fully remember who said what and when). Some examples below:

 

 • “Getting global NCD (diabetes studies) funded is close to impossible. Gates is not interested. NIH won’t fund them. LMICs don’t have funds.”

• “Finding good fellows and faculty to work on global NCD will be hard; there is no career path for them.”

• “We don’t need research in Low and middle income countries (LMICs). We just need programs to implement all the science we have.”

. “Emory has no strength in diabetes, only one NIH-funded diabetes researcher. You should focus on other diseases”

• “Emory has no track-record in global NCDs.  You should join hands with the Harvard team and slowly grow your program.”

• “India is a very difficult country to work with. NIH has struggled. The country has too many restrictions, is proud and arrogant, and it is much easier to do work in other countries like China, countries in Africa, in other parts of Asia, or Latin America.”

• “All of diabetes is obesity-driven, and Indian populations are highly insulin resistant.”

• “Quality of care cannot be improved in LMICs until the governments invest in infrastructure.”

• “Interventions and quality improvement strategies that work in high income countries don’t work in LMICs.”

• “We should only focus on prevention of diabetes and NCD, as the LMICs don’t have the capacity to deal with care and will be overwhelmed.”

• “Only prevention that can work is societal and governmental action.”

• “Industries are the cause of NCDs, and public health should not collaborate with them”

• “We should only work with governments, not with private institutions”

• “Our focus in LMICs should be prioritized toward the poorest and least served areas, not big cities or strong institutions.”

• “Technology is the cause of health inequities, and public health should stop their growth.”

• “We should train large numbers of foot soldiers in LMICs, not doctoral and post-doctoral fellows or faculty researchers.”

• “Starting schools of public health in LMICs is risky. There wont be jobs for these people.”

• “Infectious diseases and undernutrition should be eliminated before we address NCDs in LMICs.”

• “Globalization and westernization are the “causes” of NCDs, and we should fight to stop them.”

 

Looking back, we seem to have turned every one of these barriers or negativisms (above) into opportunities!!  Of course, I was so lucky to be surrounded (in due course) by some amazing colleagues (faculty, fellows, students), and special thanks to all of them (only a handful of them are tagged; there are far too many to name them all).

 

 

Arthashastra

 

Written in the 4th century BC in India, the ideas in the extensive political treatise "Arthasastra" eerily anticipate Machiavelli’s "The Prince" by almost 2,000 years. Despite its harsh philosophy of the "end justifying the means" and of privileging power and control, the book is remarkably clear about the need for an impartial system of justice and of the importance of education. 

“for in the absence of a magistrate (Dandadharabhave), the strong will swallow the weak; but under his protection, the weak resist the strong.” 

― Kautilya, The Arthashastra 

“Education is the best friend. An educated person is respected everywhere. Education beats the beauty and the youth.”

― Kautilya, The Arthashastra

Prakash Shetty

 Was thinking about why Prakash Shetty touched me so much, and why I so fondly remember him. 

It was about the end of our first year, I got called by Kalyankar and Mr. Sharma, and they asked me why I was so disinterested and doing so poorly. I told them I could not put my heart into studies and was very bored. They made a “plan” for me. In that plan, they asked Anandappa to “help” me. 

A couple of days later Anandappa took his task seriously, and at the physiology lab decided to openly confront me about why I was not taking my work seriously. I showed irritation and pretty much appeared unhappy with his intrusive approach. Swarna in her own gentle way said “Maybe, he is is not using his potential…”. Anyway, Shetty appeared and saw me distraught. He calmed the situation. Next day he took me to coffee and spoke to me for over an hour. 

I really liked his approach. He tried to get to know me and asked what my interests were and why I was not motivated. I opened my bare chest to him. 

He then said “You are a very sensitive boy. You seem hurt. I am also seeing you want to be in a field that needs original thinking and is something different and not so rule-based. But you know training to be a doctor is very different from training to be a scientist. Try and focus on your studies as best as you can. But if being a scientist inspires you, come by and we can talk. I am always available. I live in the quarters and am also hostel warden. Don’t pick up fights with Dr. Anandappa. Don’t get hurt.” 

Almost 40 years later, Prakash, Anura, and I sat at the cafeteria at the research institute and discussed what it takes to train minds that are curious and into the science of medicine. 

When Shetty died, Anura and I exchanged a simple text: “A giant has fallen”. ‎

 

Reflections on "work-life balance"

 

As if one’s natural sloth is not enough, the absolute sloth of "vacation" beckons, although it just feels like slightly shifting gear from one vacation mode (very enjoyable work) to another mode (very enjoyable something else). 

I will be off until 5 August, travelling in the land of the Lapland, the Midnight Sun and the Northern Lights, and then onto a university town that has housed a place of great learning since 1096 AD. 

So, might you welcome not hearing from me or hearing from me less often?  Might you consider it rude or tardy if I don’t respond in time? 

It is fashionable to tout "work-life balance" as something that requires intentional separation of the compartments, or to place boundaries on work hours, or separation of weekdays from weekends, or a complete shut-down from work over holidays or during "vacation”. 

While I strongly enjoy leisure daily, as a part of daily living, and think I comfortably find that “work-life balance” in day-to-day life almost seamlessly, I for one reject any and every compartmentalization – which I believe violates the fundamental properties of any complex dynamic adaptive system – which is what defines the world and the universe we live in. 

I see life as multiple, almost infinite continuous variables, intersecting one another, and among them matters like work-family, work-leisure, work-vacation. 

So, I like to view all these as continuums, not as separate categories, and exercise my adaptive ability to shift gear from speed to slow in one dimension, while accelerating in another, but never stopping in any dimension altogether. 

A bit like wake-sleep cycles (where we don’t die when we sleep) or the systole-diastole cycle (where the heart does not go into asystole, and we don’t want it to) or any of numerous examples from complex systems. 

What all this means is that even while I am on vacation you will hear from me, but less often and my response may be much slower than when I am at work. That said, just like a sleeping animal preserves its adrenaline rush when required, should something emergent and urgent arise, I will find the way to kick into action from the slumbers of my slothful state – but sloth I will enjoy to the fullest. 

Wish you dynamism and peace always! 

Venkat

The future of globalization

 

(Written June 28, 2016)

 

The future of globalization

 

Brexit provoked a conversation on globalization, and my final position was as follows:

 

When it comes to globalization, I am uncharacteristically fatalistic!  The power, volume, and flow of information can no longer be controlled or contained, and whether it is good or bad (it is I think both good  and bad), globalization’s future is a relentless but a stuttered course forward.  

 

Self-interested systems that oppose it will lose their ability to oppose it and get weaker in the process. Do I think new self-interested systems will be more enlightened or more perfect?  No, not at all.  They too will be a  mixture of good  and bad, depending on context and perceived values.  Why would we want the blandness of a perfect or moral system? For one, it cannot exist or survive and secondly, life is imperfect and amoral – let us live it to the full with all its mixture.

 

Fast-forward modern globalization is here with us in our next journey as Sapiens!!  Where it will take us, I do not know nor want to know – but I am here to accept the  reality and the challenges, opportunities, dreams, and excitement that go with it.

 

Venkat

 

Optimistic Nihilism

 

Frankly, I think all humans and inevitably the civilizations that they construct are based on some illusive combination of lofty ideas and terrible flaws and fallibilities, and societies go through cyclical and ephemeral periods of wonderful renaissance and horrible decline. There is neither permanence nor linearity nor clear cut difference between progress and regress – everything is contextual, and we invent narratives to suit our sanity or insanity. 

Optimistic Nihilism is the only sensible frame-work to live through this anthropocentric menace that we call “civilization”. For all our creativity, we (Homo Sapiens) are a destructive and domineering species that wreaks havoc on all life and on the planet. I am sure our (Homo Sapiens’) path to extinction will be paved with “good” intentions.

Venkat

PS: My friend, Shivani, commented:  "Well put. The optimism can fuel us while on this earth, and the nihilism can keep us grounded. 

An afternoon in Oxford

 Enjoying my time visiting Sarayu at Oxford. She is in the midst of her essay, and asked I spend some hours by myself this afternoon. It turned out quite amazing. First, there are more book shops with each five minute walk in Oxford than with every five hours drive in Atlanta, and book shops are the ultimate refuge to any person lost in the whims of thought and exploration. One can spend hours in a book store and get into the minds of the writer and vicariously live in their worlds.

Beyond bookstores, Oxford has such a density of pubs, museums, colleges, old buildings, and history.  After spending an hour at a bookstore, delighted at the “Poetry corner”, I decided to search for the oldest pub in Oxford, and after some inquiring found “The Turtle” – only the second oldest pub and in existence since 1381. It is in the back of beyond, and a long walk through the cobbled streets into almost a cave-like location. It has an inviting entrance “Education in intoxication”!  Once discovered, is an anthropologist’s delight!  Sitting alone with half a pint of lager, one had only three options……stay to oneself, eavesdrop, or start conversations with strangers. The clientele was as diverse as Oxford itself.

My eavesdropping skills got me into the world of the young Oxford university students, diverse, and a group obviously majoring in Oxford’s reputed triple major in philosophy, political science, and economy. The conversation I overheard was incredible, diverse, beautifully logical, ranging from Plato’s “Republic” to Machiavelli’s “Prince” and also a smattering of Confucius, Sun Tzu, and Kautilya’s Arthashastra, and of course,  contemporary UK politics and Boris Johnson and Rishi Sunak.

While I admired this eloquence and thoughtfulness among the young, my ears also did not miss the rather rowdy and loud conversation in another table, occupied by older local non-university types. One stream of conversation made me realize how a section of old white male Brits is unhappy about their new prime minister. A guy ranted “Our nation is going down, imagine a fuckin Paki becoming our leader. His wife is supposed to be very rich, but she is obviously not shagging him enough” (ad verbatim) Then one of the woman on that table says “But you voted Tory” and this guy replies, “What choice did we have, this Paki shit or allowing Germans to take us over”. The woman persists “Rishi is not Paki, he is Indian-Brit”, and the guy goes “It does not matter, they are all the same”.

I turned left, and there was an Australian family, and I said hello to them, and this was a beautiful conversation. I learned about their roots seven generations ago, their forebears sent to Australia as convicts, and how the family is searching for true identity and empathizes with the Aborigines who have suffered colonization is ways more cruel than their own ancestors did. We ate a fabulous chocolate cake together, exchanged addresses and parted.

On the way back, I stopped at the Museum of Science, and this was a grand finale to a wonderful afternoon. The warden at the museum asks me my name and immediately tells me about “Venkat, the famous off spinner”, and takes me through four centuries of the progress of science, and we end up at the basement to read about Einstein, and as the museum closed at 5 PM, I leave promising to return tomorrow…………………and he has given me a quiz to guess his name……………..a five digit number, and his first name that of a Holocaust survivor. Above all, his parting remark, “science not religion, art not morality, humanity not tribalism” is our redemption…………………I look forward to seeing him again tomorrow.

 Venkat