Fiat: the service is the thing

In 2004 I bought my first car, a 1999 Fiat Uno that had done about 25000 km. I bought it for 1 lakh rupees, about half the price I'd have paid for a comparable used model from Hyundai or Maruti. I've more than doubled its mileage since then and it has served me well. If Tata's "Rs 1 lakh" car serves its customers equally well for five years, they should be happy. [sentence corrected - originally said Maruti's]

But the people who should take credit for its smooth running are not Fiat, but a garage near my house called Kittu Auto Works. I first went to them more or less randomly, but stayed for a while. The service was fast and excellent, which cannot be said of the official Fiat channels. The reason for the low price I originally paid was, in fact, precisely Fiat's terrible reputation for after-sales service (plus the fact that the Uno was no longer being manufactured.) At that time, it was Sundaram motors who were tied up with Fiat for sales and service; based on their reputation, I did not even venture to try them.

As the years went by, Fiat started turning itself around internationally, based on some extremely successful launches like the Fiat 500 and the Grande Punto, and on some aggressive costcutting and optimisation by a new CEO. In India, Fiat continued to struggle, but made changes too, notably scrapping their agreement with Sundaram and tieing up instead with Tata Motors (who were interested in Fiat's technology and overseas reach).

So I tried giving the new official Fiat service centre, Concorde Motors, a try. No luck. The guy told me frankly that the waiting time for Uno parts is typically 3 weeks. I said that my mechanic gets all parts the same day so far. He said "local guys can get it locally, but we have to go through the official channels." Given how many Unos are still on the road (I'd guess that, at least in Chennai, it's the most common car not still in production), I find it inexcusable.

So I stuck with Kittu. But I was growing a bit dissatisfied: the car, as it gets older, was showing more severe problems and it seemed like he was band-aiding them rather than fixing them. Also, every time he returned the car, it seemed a new problem would crop up.

Finally, after a repeated failed attempt to fix a radiator leak (he had fitted a new pipe, but placed it too close to the radiator body, and a sharp edge had cut into the pipe), I lost patience and decided to explore another mechanic. This was a new shop called Ignite, run by a young, articulate man called Raghav who had quit his software-industry job to pursue his first love, fixing cars. After a stint with Hyundai he had decided to set out on his own.

So far I am entirely satisfied with Ignite (and recommend them to anyone in Chennai who may be reading this). I find Raghav responsive, quick to understand the problem, and thorough in fixing it. Two examples: a persistent gearbox oil leak, that Kittu kept claiming was due to the driveshaft seal, was identified by Raghav as coming from deeper inside, and he fixed it. And a cold start problem, that had been around since the time I got the car but had been getting worse, was identified as a carburettor problem; he replaced the idle jet and the car has been as good as new since. He was also upfront in telling me what he did not fix and why not (basically, difficulty in getting parts plus lack of immediate severity of the problem); if it gets worse, he would do it, fabricating parts if necessary.

Thanks first to Kittu and then to Ignite/Raghav, I have been happy with my Uno. As for Fiat India, I am grateful to them for building good cars, but also, in a way, for their horrendous after-sales service that enabled me to buy a used car at a great price.

[UPDATE 05/02/2010: I really must update the above. A little after I wrote all that, the car developed a persistent problem in the ignition system that Raghav, after changing the spark plugs, wires, ignition coil, distributor cap and rotor, and much else -- all of which needed changing, except the ignition coil -- decided he did not know how to fix. I returned to Kittu, who immediately identified the problem as the distributor -- not the cap or rotor, but the timing mechanism -- and fixed it. Moreover, a couple of parts replaced by Raghav developed problems within a few months and had to be replaced again by Kittu. So I am back to Kittu, for the lifetime of this car. The guy knows his stuff and I highly recommend him to anyone who lives in or near Kottivakkam, Chennai. He has a tendency to minimise costs, but usually that's not a bad thing. I notice he even gets lots of Hyundai cars to repair, even though there is an official repair shop about 300 metres away. As for Raghav/Ignite, he's probably good too, but hasn't seen thousands of cars yet: he'll probably get there...]

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Though I am not on the market for a new car, I have been following Fiat India's recent doings with interest. They have launched three cars this year. First, the Fiat 500 (Cinquecento), a super-small car (comparable with the Volkswagen Beetle), which is exorbitantly priced partly because, as a fully-imported car, it attracts 100% import duties. I believe sales have been in the low single digits. Second, the Fiat Linea, a very nice looking sedan whose sales have reportedly been very encouraging. I see quite a few of those on the road now. Third and most recently, the Fiat Grande Punto, a hatchback meant to compete with the likes of the Maruti Swift or Ritz, or the Hyundai Getz or i20.

The Linea and the Punto have been very competitively priced, and both are visually outstanding -- the best-looking in their category on the market, in my opinion. Reviews for both have been excellent, too. But looks and build quality have never been Fiat's problem: it's their after-sales service.

Yesterday I saw a Punto, clearly a demo vehicle, parked in front of my car as I was returning to it from a shop. Seeing my interest, the lady inside smiled at me; I asked if she worked for Fiat, and she said yes.

"Very nice car", I said.

"Thanks," she said.

"But the problem with Fiat is not the car quality: I have a Fiat Uno, parked behind [gesturing], and am happy with it. The problem is the service."

"Yes sir, for Uno and Palio there is problem with parts, but for Linea and Punto there will be no problem".

I had been preparing to argue that it was not nice to dump Uno customers after ceasing manufacture of the Uno, but this took me aback.

"Wait a minute -- the Palio is a current car! Are you saying there are problems with parts for it?"

"For petrol Palio there are problems sir, but no problems for diesel Palio."

"But then why should customers believe that servicing for the Punto is good? Maybe you have it in place now, but will you dump your Punto customers after a few years?"

"No sir, for Punto and Linea there will be no problem."

"See, the problem for Fiat has not been the cars, it has been the after-sales service. If you can't even service the Palio you have a problem. You need to make sure the service set-up for the Punto and Linea are good."

"Yes, sir, I agree. Thank you."

I will watch with interest. Apart from anything else, there seems to be a conflict of interest with Tata: the Palio and Punto compete directly with Tata's Indica, and the Linea competes with Tata's Indigo. One hopes that this does not affect their sales network.

The point is, parts are available even now for the Uno -- just not with Fiat. Due to high localisation, most parts are not actually made by Fiat, and even if Fiat doesn't warehouse them, others do. As the localisation levels of the Linea and Punto increase, I expect that the same will be true of those models too. Even if Fiat leaves customers of those cars in the lurch, third parties will step in.

I don't expect to buy a new Fiat car (or a new car of any sort) any time in the near future. But if they don't improve their after-sales service, a used Fiat could continue to be a very cheap and tempting option.

Is 377 now 404?

I've been going slow on blogging for a while. Yesterday's news of the Delhi High Court's ruling on Section 377 of the IPC is the biggest civil-rights news in India that I can remember: perhaps the biggest since untouchability was abolished. Just like untouchability, homophobia will persist in our society, but apparently it is no longer blessed by the law. But given the complexity of the situation, I wanted to spend some time absorbing the news before blogging. It is now over 24 hours and I'm not sure I'm much the wiser.

There is no ambiguity in the Delhi High Court's ruling: it is clear, and it is common sense. Outlawing consensual homosexual acts among adults is clearly discriminatory and violative of fundamental rights. (One should note that 377 does not outlaw gay sex specifically, but "carnal intercourse against the order of nature", which could be interpreted to mean anything. For example, it could outlaw any form of sex other than penile-vaginal penetration; on the other hand, given that homosexual behaviour is widespread in the natural world, one could argue that gay sex is not "against the order of nature" and not outlawed. But any interpretation of article 377 as outlawing consensual adult gay sex has been struck down, rightly, by the court.)

What I was wondering was, is this the end of the story? First of all, does the Delhi High Court's writ run across India? I am not a lawyer, but from what I gather on the net, the answer is yes -- unless the Supreme Court overrules it, which they would consider doing only if the Union Government challenges the HC ruling. But what if another High Court upholds 377? One assumes that the SC will then have to step in.

And what if the SC does step in? I am not pessimistic: after the Delhi High Court originally dismissed the Naz Foundation's petition in 2004, on the grounds that it was not of public interest, it was the Supreme Court that asked the HC to reconsider the case. I think it is not likely that the SC will rule differently, if asked to do so. Articles 21, 14 and 15 of the Constitution, cited by the High Court, surely overrule any colonial-era laws that have lingered on in our books.

Our religious leaders are, predictably, having fits -- this is one issue that unites all religions and religious leaders. Some, like the Catholic Bishops Conference of India, are relatively temperate in their response, saying they are "not opposed to" decriminalising homosexuality. One must be grateful for small mercies.

What is most amusing is this harping on "Indian culture" (a phrase used by nearly all religious leaders): our epics feature such stories as Vishnu turning himself into a woman to seduce Shiva, while the law in question is a legacy of the British and represents Victorian English culture (the same culture that imprisoned Oscar Wilde), not Indian culture at all.

Huge news from Iran, thanks to The Hindu

I refer to this article (hat-tip: Rahul Basu).

In response, I just sent the following e-mail to the Readers' Editor at The Hindu:

Date: Thu, 25 Jun 2009 14:34:41 +0530
From: Rahul Siddharthan
To: readerseditor@thehindu.co.in
Subject: The Hindu: information that nobody else carries

Dear Sir,

Old-timers in Chennai have always counted on The Hindu for information and enlightenment, and this morning you did not disappoint. I was amazed to know, thanks to your editorial pages and specifically to our former foreign minister, K. Natwar Singh, that the former Supreme Leader of Iran, Ayatollah Ruhollah Khomeini, and the current Supreme Leader, Ayatollah Ali Khamenei, are in fact one and the same person, whom Mr Singh refers to (twice) as "Ayatollah Ali Khomeini" (and also as "supreme leader", "great man" and numerous other flattering epithets).

So Ayatollah Ruhollah Khomeini did not die in 1989, as widely reported, but merely changed the spelling of his name and continues in power to this day. (One assumes that a person as eminent as Mr Singh, and a newspaper as prestigious as The Hindu, will not misinform the public on such grave matters.)

I believe this news is significant in today's context and should be more widely known: it could have grave international implications. I request you to carry it prominently on your front page, and disseminate it as widely as possible.

With best regards,

Rahul Siddharthan

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UPDATE: The Hindu has a correction/clarification today, and I sent the following in response.

Date: Fri, 26 Jun 2009 10:50:20 +0530
From: Rahul Siddharthan
To: readerseditor@thehindu.co.in
Subject: Today's correction Re: The Hindu: information that nobody else
carries

Dear Sir,

(Ref: my mail yesterday, quoted below)

I am disappointed that the conflation of the two "supreme leaders" in Mr Natwar Singh's article yesterday was a simple error. However, the explanation that he was referring only to Ayatollah Khomeini and not to Ayatollah Khamenei is rather puzzling.

Mr Natwar Singh, as you observe, uses present tense throughout for Ayatollah Khomeini; and this is not a general habit with him in referring to deceased people, for he uses the past tense in referring to Mr Rajiv Gandhi. ("Ayatollah Ali Khomeini has a magnetic personality. If one is eye to eye, you blink first... Rajiv Gandhi too had uncommon charisma.")

Later, he writes:

"The Ayatollah is still the supreme leader. The West and Israel would be unwise to take him on.

"I have related this memorable episode to highlight the fact that the Iranian leader is no run-of-the-mill leader...."

But Ayatollah Khomeini is not still the supreme leader. The memorable episode, according to your clarification, features a man who died in 1989 and it is not relevant today whether or not he was a run-of-the-mill leader. This is similar arguing for caution in dealing with Gordon Brown because Margaret Thatcher was no
run-of-the-mill leader.

Here is the alternative explanation that I had thought of before your clarification: today, international conferences are attended by Iran's President, not the Supreme Leader. So the person whom Mr Natwar Singh met at the NAM summit was probably the President, who at the time was Ali Khamenei. Perhaps his 1982 anecdote also refers to Ayatollah Khamenei (who was the president throughout the 1980s). He was not the supreme leader then, but he was an important man; and if Mr Natwar Singh was referring throughout to Ayatollah Khamenei and not to Ayatollah Khomeini, and the error was due to his own mistyping or due to sub-editing errors, his article makes much more sense. (It is still doubtful whether there is any useful content in the article, and whether it is worthy on its merits of being published, but this is a separate topic.)

But your clarification, I'm afraid, raises more questions than it answers. If what you say is true, on what basis was this article published? Perhaps Mr Natwar Singh's advanced years are to blame in what he sent you, and one should not be too harsh on him, but how could such flagrant errors pass your editorial desk?

Sorry if I seem to be belabouring the point, but I think this case is symptomatic of a large number of problems I see in The Hindu lately.

With best regards,

Rahul Siddharthan

The long route to Microsoft

Sometimes I surprise myself. I have no Microsoft software installed on my office computer. I have Microsoft Windows Vista on my laptop, because it was pre-installed, but it is in a separate small partition that I almost ever use. I detest Windows, and have detested it since it was a separate program that one used by typing "win" on an MS-DOS computer. (Actually, I have rarely used it since those days.)

But a couple of days ago, I set the default search engine on my Firefox search box to Microsoft Bing.

I've been going back-and-forth between Bing and Google for a while, and not only does Bing look nicer and show up a useful mouse-over preview of search results, but the results look mostly more relevant. Most of my searches are academic-related. I still have the Google toolbar installed, with its own search box, so I can easily go back and forth. When searching for scholarly articles, I use either Google Scholar or PubMed -- so far there seems to be no Microsoft equivalent of those, but I won't be surprised if it's on its way.

I used to be a free software idealist, but the question is somewhat moot with online services. Besides, I have figured out now that what I really want is customisability. (This is also the reason I was never very tempted by Apple.)

Linux is almost infinitely customisable, but the days when I would build my own kernel and compile much of my software from source are long over. Nowadays it's just a question of selecting from the options in Ubuntu's software repository -- and, in rare cases, enabling an external repository.

Now, suppose my next computer is pre-installed with Windows 7, and it turns out that I can configure it to a unix/X-like interface with my own key bindings and can install most of my favourite open-source software, pre-built, with a few clicks (as I can in Ubuntu): would I consider going with it, and not repartitioning and installing some form of Linux? Till recently, I would have laughed at the idea of Microsoft becoming so open-source friendly: but the world is becoming a strange place now.

What if I can't look angry anymore?

I've had a problem with psoriasis on my foot for years. Recently it became rather bad, and I visited a well-known dermatologist in Kilpauk (who also practices at one of Chennai's best-known hospitals).

I have a mistrust of new doctors, so I cross-checked all items on the prescription. They all looked standard stuff for psoriasis; the ointment, in particular, was similar to something I've been prescribed once before (a different preparation of betamethasone, a corticosteroid). So I went ahead with the treatment and the problem cleared up within a week, as it had before.

I then told the doctor that the problem tends to recur after I stop the treatment (even if I keep the area moisturised). She said there is another tablet that she would consider prescribing, but wanted some blood tests done first to be sure it is safe to take it.

Today I went there, blood tests in hand. And while I was waiting, two people got up to the reception to speak. One guy introduced himself as from the company that makes Botox, and he said the young woman next to him will be sitting in the doctor's clinic assisting her; meanwhile they wanted to inform and educate us about this treatment.

I promptly announced that I am cancelling my appointment, scratched my name, wrote the doctor a brief note, and walked out.

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I had already been disturbed, on my first visit, at the sight of Botox advertisements in the doctor's clinic, telling patients how they could keep the wrinkles away and stay looking young; but I ignored it because I had strong recommendations to this doctor. (And, for all I know, she is indeed very good.)

There was a time when doctors would not prescribe medicines that were advertised to the public. For example, if you needed an aspirin, they would prescribe not Aspro (advertised in the glossies of the time, and on TV) but Disprin (not advertised). I know times have changed, and I have even seen a few Disprin ads. I can also understand a doctor prescribing Botox for someone who needs it (I first heard of it, years ago, in the context of treating writer's cramp).

But cosmetic Botox is another matter. And direct-selling it to patients, in a doctor's clinic? I find that utterly unconscionable. I mean -- the thing is a neurotoxin, derived from bacteria that cause a deadly form of food poisoning (botulism). Its therapeutic use is in paralysing muscles -- which is sometimes good (alleviating writers cramp), but sometimes surely unnecessary (paralysing facial muscles, which allegedly cause wrinkles not to form). At best, it should be suggested by a doctor after carefully explaining the pros and cons of the treatment -- not direct-marketed by a pharma company on her premises!

And if the doctor indulges in this sort of practice, how can I be sure that the pill that she was going to prescribe me was in my interest and not in the interest of some pharma company or the other?

I've heard it said that the reason for the wooden appearance of several Hollywood celebrities (think Nicole Kidman) is their excessive use of Botox; one quote that sticks in my mind (I forget where I saw it) is, "few actresses are able to look angry any more". [UPDATE: found it.] Well, sometimes I do want to look angry. For example, right now.

Good news

Dr Binayak Sen has been granted bail. About time.

The story is not over yet. I'm sure the state government will do what it can to get him behind bars.

The (relatively) good guys won

A recent US president said of the opposition: "They misunderestimated me." Manmohan Singh could well have said the same, only in correct English.

In 1991, this soft-spoken gentleman, who had been both an academic and a bureaucrat, was invited by Prime Minister P V Narasimha Rao to be finance minister in his cabinet. He embarked on a programme of economic liberalisation that sparked a boom, which continued through several administrations until the global meltdown of the past year. Nonetheless, liberalisation was not politically popular; Rao lost the next election, in 1996.

In 2004, he was sprung on the public at the last minute, after Sonia Gandhi declined prime ministership despite having led the Congress-led coalition to an unexpected victory. She did not want to court controversy over her citizenship; she believed Singh to be a capable leader; and, very likely, she thought he would be the better prime minister.

In 2009, he was promoted from the start of the Congress campaign as their candidate for prime minister. The public was asked, effectively, to choose between him and L. K. Advani. This is no longer 1996. The public chose Singh, overwhelmingly.

Because of his soft-spoken nature he has attracted charges of being weak, a puppet of Sonia Gandhi, and a temporary substitute for Rahul Gandhi. L K Advani attacked him viciously during the 2009 campaign, but it seems to have backfired. In fact, during his tenure, Singh pushed through the Right to Information Act, which he saw as one of the most important ways to improve transparency; he broke ranks with the Left to push through the nuclear cooperation deal with the US, and personally intervened with other parties (including some quite unsavoury politicians) to ensure that his government continued to have the support to last its full term; and, meanwhile, he let the Gandhis, Sonia and Rahul, focus on rebuilding the Congress party from the grassroots.

Here's a recent article by his former media advisor Sanjaya Baru, who reveals how often Manmohan Singh quietly got his way and how rarely he took credit for it: even in the case of the nuclear deal, he was willing to let the Left take credit for amendments if they supported it! As things turned out, Prakash Karat was obdurate and Singh (with the party's support) decided that the Left's support was dispensable.

The strategy of letting Singh govern the country and Sonia and Rahul Gandhi govern the party has paid off handsomely. Rahul's go-it-alone strategy has revitalised the Congress party in the north; troublesome allies and opponents have been marginalised, the Left is in tatters, and the BJP is on the back foot and unsure of what ideology to present the public. A new youthful generation of Congress leaders seems to be emerging to take over from the next election. And the public has marked their approval of the Congress's governance over the past five years.

Now that the ruling coalition has earned this "political capital", as the Americans call it, they must spend it wisely. Much needs to be reformed, in our economy, our bureaucracy, our educational system, and especially our judiciary. I don't expect miracles but I do expect an effort, especially now that the obstructionist Left are sidelined. And the rewards, for the Congress, could well be an even greater mandate in 2014.

Worrying about vaccines

Being the parent of a toddler means, among other things, giving the kid immunisation shots against various diseases at regular intervals. Understandably, this is not something kids enjoy. Moreover, some vaccines cause temporary reactions, that in rare cases can be quite severe. And while some vaccines are universally administered, others are very much at the discretion of paediatrician (and, in theory, the parents). So one tries to keep well informed.

So I read with interest a recent blog post where Dan Summers, a paediatrician, takes apart the anti-vaccine crowd, and in particular, this article by Jim Carrey.

The anti-vaccine movement is primarily driven by claims that vaccines are linked with childhood autism-spectrum disorders. There are at least two versions of this claim: first, that the MMR (measles-mumps-rubella) combined vaccine is linked with autism (a claim that caused particular scare in the UK); second, that thimerosal, a now-discontinued mercury-based preservative, is linked to autism (a continuing source of scare in the US). Both these are supported, at best, by anecdotal evidence. There are also claims that combined vaccines increase the shock to an immature immune system, leading to possibly undesirable side-effects.

Lots of peer-reviewed studies have, supposedly, refuted links between either MMR or thimerosal, and autism. This article reviews the situation. And only a few fringe loonies would argue that we would be better off without vaccines. It is wonderful to be in a world without smallpox, and to look forward to one without polio. Various once-common childhood killer diseases have now become rarities. Dr Summers says he has never even seen a single case of measles, still a common (if rarely fatal) disease in India. What's not to like about vaccines?

Dr Summers also exposes the bogus nature of Jim Carrey's "supporting" links. Like most conspiracy theorists, Carrey does not link to actual scientific literature, only to paranoid-sounding sites like "Generation Rescue".

---

Here's the problem though: I find Dr Summers unconvincing not for the things he refutes and exposes, but for the things he ignores in Carrey's article. And if I, a strong skeptic on most "alternative medicine" views, am unconvinced, I am sure millions of others will be even less persuaded.

First of all, Dr Summers says, "Indeed, I have never seen a single case of smallpox, polio, tetanus, measles or a handful of other once-common childhood illnesses..." But Carrey entirely agrees with the need to vaccinate against "the most serious threats including measles and polio"; I'm sure he would agree that tetanus is more serious than measles, and nobody vaccinates against smallpox anymore. So this is a strawman at the outset.

Dr Summers says "the advent of vaccinations has been as close to an unalloyed good as is likely ever to occur." If he merely refers to the eradication of smallpox, the near-eradication of polio, and the success against several other serious diseases, few should argue. But his article suggests something stronger: every approved vaccine is close to an unalloyed good. I think few doctors would agree with that (and he himself does not quite say it, only implies it).

Carrey says that there are 36 vaccines in the current US immunisation schedule; the version I saw only included 15 (as I discuss below), but perhaps he includes optional approved vaccines. He continues that there have been "no tests for cumulative effect or vaccine interaction" of all these vaccines, let alone the 100 or so in development. If there is such a test, Dr Summers doesn't supply a link to one.

Carrey claims that "American children are being given twice as many vaccines on average, compared to the top 30 first world countries". I don't know the true numbers, but Dr Summers doesn't refute this. I will return to this topic below.

Carrey says that "Paul Offit, the vaccine advocate and profiteer, who helped invent a Rotavirus vaccine is said to have paved the way for his own multi-million dollar windfall while serving on the very council that eventually voted his Rotavirus vaccine onto our children's schedule", and quotes strong words on this topic from a Congressional committee. Dr Summers does not address this.

Carrey says that "Veterinarians found out years ago that in many cases they were over-immunizing our pets, a syndrome they call Vaccinosis. It overwhelmed the immune system of the animals, causing myriad physical and neurological disorders." He also says veterinarians removed thimerosal from animal vaccines in 1992, and wonders why human vaccines lagged behind. Summers does not address this (or refute these claims).

Carrey admits that vaccines are good and bad, but says "One thing is certain. We don't know enough to announce that all vaccines are safe!" Summers, and the CDC in the US, seem to be announcing precisely that.

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Now, here's the main bothersome issue that Summers entirely ignores: if vaccines were such an "unalloyed good", why do US children reportedly receive twice as many vaccines as children in other developed countries?

In my developing country, India, the National Immunisation Schedule lists the following vaccines up until 6 years: BCG (tuberculosis), OPV (polio), DTP (diphtheria, tetanus, pertussis), Hepatitis B, Hib (Haemophilus influenzae B), Measles, MMR (measles, mumps, rubella), and various boosters for these. That's seven vaccines for ten diseases. (Source: IAP Guidebook on Immunisation, 2009, available here.)

The US schedule that I can find for children below 6, here, lists vaccines for a total of 15 diseases: in addition to the above, there are rotavirus, pneumococcal, influenza, varicella, hepatitis A, and meningococcal (while BCG is missing). The UK schedule lacks several of the US vaccines: namely, rotavirus, influenza, varicella, hepatitis A and B are missing.

Many children in India receive more vaccines than the immunisation schedule recommends, and the same may be true in the developed world. The Indian Academy of Paediatrics recommends typhoid in addition to the ones in the immunisation schedule, and also suggests that pneumococcal, rotaviral, Hepatitis-A and Varicella "can be given after discussion with parents". Needless to say, such discussion rarely occurs.

But why does no country include all 36 vaccines in its schedule, and why are other countries omitting so many vaccines included in the US schedule? Are other countries being perverse and regressive in ignoring the "unalloyed good" provided by all those US vaccines? Or are there other factors to consider?

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What are the possible drawbacks of vaccines? One is obvious: cost. This is relevant not only in India but very much also in the US, whose health coverage leaves much to be desired. It is the reason DTaP (the newer form of DPT, with an acellular pertussis vaccine that has milder side-effects) is not yet officially favoured in India. (Vaccines in India's National Immunisation Schedule are delivered free of cost via the public health system.)

Another is side-effects. Most vaccines have side effects; for the smallpox vaccine, one in a thousand have severe rashes, and about one in a hundred thousand had more severe, life-threatening complications. The risk was acceptable compared to the dangers of contracting smallpox when it was widespread. But as smallpox got effectively eradicated, the risk was judged unacceptable and the vaccine is no longer administered.

A third is an unknown and controversial factor: the effect of administering many vaccines simultaneously. More and more frequently, vaccines are "bundled" with five or more often administered in a single shot. Skeptics argue that the effects of this sort of "shock" on an immature and developing immune system are at best questionable. Defenders think there is little danger and an infant, of whatever age, is exposed to many more antigens and possible pathogens every day than what are administered in a vaccine. But few doctors or immunologists, I think would assert that there is no danger whatever.

Unfortunately medical science is not an exact science: despite the most exhaustive clinical trials, certain side-effects, interactions and allergic reactions from drugs can take years or decades to discover.

Unfortunately, also, patient mistrust of doctors and medicine seems to be rising all over the world, and not only are "alternative medicine" therapies of various levels of dubiousness rising, but proven medical therapies and treatments are being ignored by patients who read scare-mongering half-truths. Vaccines are an example: today's young parents have never encountered smallpox, polio, diphtheria, tetanus or many other dangerous diseases, but do encounter the reactions to the vaccines and read frightening but unsubstantiated stories on the internet; therefore many reject vaccines.

But how to tackle this? I think Dr Summers' approach is not the answer.

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I know many committed, sincere doctors who are concerned with nothing except the welfare of the patient. I believe this is true of the majority of doctors, around the world (though perhaps not the majority of high-profile, headline-grabbing doctors.) They are aware of the limitations of medical science, are willing to prescribe alternative methods (ayurveda, yoga, acupuncture) when appropriate, but prescribe powerful drugs when required. It is a pity when patients do not trust such advice, and assume that all antibiotics must be bad regardless of circumstance -- or that vaccines for certain diseases are not required because you don't run into those diseases any more.

But patient mistrust is not limited to the doctors: it extends to the pharmaceutical companies. And, here, I think the mistrust is merited.

Carrey cited the example of the rotavirus vaccine, included -- allegedly under the pressure of the developer -- in the US schedule but not in most other countries. But this is only one of their many crimes.

Pharmaceutical firms are routinely accused of focussing their efforts on "lifestyle drugs" that are directly marketed to the public, with minimal consideration of side-effects. See, for example, this article in Nature Medicine.

Infant formula makers used to claim that their products are superior to breastfeeding; when such advertising was banned in most countries, they resorted to more indirect claims that planted the same impression in the minds of the public. (See this article by George Monbiot, for example.)

Dr Summers talks about the importance of peer-reviewed research, and challenges skeptics on vaccines to publish their work in peer-reviewed journals. Unfortunately, pharmaceutical companies have done their best to pervert the scientific peer-review process too. It is mandatory for scientists to disclose sources of funding and potential conflicts of interest in their manuscripts, but this is not always kept above board. In a recent spectacular case of fraud, an anaesthesiologist who had built a significant international reputation turned out to have faked his clinical trials for over 10 years; his research was funded by pharmaceutical companies who produce many of the drugs that his papers promoted. And even more egregiously, Elsevier Science -- publisher of many leading journals in every discipline -- was found to have published fake journals, at the behest of pharmaceutical companies (in particular, Merck), that had every appearance of containing peer-reviewed research but in fact contained in-house research from the pharma giant presented in academic form.

I think this sort of thing hurts medicine and public health much more than a few conspiracy theorists ever do, because it undermines confidence in the entire medical system, and indeed, the scientific peer-review system.

Dr Summers writes that "Carrey wrote his post and appears as a spokesperson for Generation Rescue while affecting the posture of an informed and enlightened ambassador for truth." But when large swathes of peer-reviewed research is guilty of precisely the same crime, why should Carrey seem less credible? How are we to trust published research when it is so easily perverted by big money?

I tend to believe the published "basic research" that I read, because it is unlikely that the authors have hidden agendas. But in order to verify the claims that there is no statistical link between autism and MMR or thimerosal, I will not only have to read those papers, but verify that none of those authors had a conflict of interest in writing those papers. This is rather hard to do sitting at my desktop on the other side of the world. (I may also have to verify the statistics used: see this article on hypothesis-testing in the medical literature.)

So while I do not believe vaccines are bad, I am suspicious of mercury-based preservatives in vaccines, unwilling to believe disclaimers from the CDC, and unwilling to accept that every vaccine included in the US schedule (or being pushed on my son by a corporate hospital in Chennai despite its absence from the Indian schedule) is being considered on its merits alone. Take the hepatitis A vaccine: the WHO's recommendations say that large-scale childhood vaccinations should be "considered" only in regions of intermediate endemicity; but it is included in the US schedule (a low-endemicity country) and was recommended by our paediatrician in India (a high-endemicity country).

And I would like to see a lot more research on vaccine interactions, before administering five or more bundled vaccines in one shot to an infant.

And industry-funded research is unlikely to persuade me that my worries are unfounded.

RIP

Dr N S Murali, a well-known surgeon, a key figure in the Voluntary Health Services hospital in Chennai, the founder of the Seethapathy Clinic and Hospital in Chennai, and my uncle, died suddenly while on a break in Coventry today. He was 73. His wife had died, equally unexpectedly, a month ago.

The phrase "a towering figure" is over-used, but he was one. The shock is palpable. But his work will survive: both directly (his son and daughter both work in his hospital) and indirectly (he influenced many, many people in the city, and probably outside too). RIP.

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[UPDATE 06/05/09: Obituary in The Hindu.]

More Indus thoughts and links

[UPDATE 17 Sep 2010: The story continues here.]

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I am an expert neither on archaeology and history, nor on computational linguistics (though some of my interests come close to the latter). My previous post attracted 56 comments, and I eventually closed comments because it seemed that nothing productive was going to occur, and meanwhile certain individuals seemed to be using the space to redo arguments that had already been hashed out elsewhere years ago.

I would like to view the problem as a Bayesian one: given two or more hypotheses, each with prior probabilities, and a set of data, calculate the posterior probabilities of the hypotheses. This is essentially what we all do in "learning from experience". By "prior probability" is meant how likely we consider the hypothesis in the absence of data. By "posterior probability" is meant how likely the hypothesis should seem after we have seen the data. These posteriors will become priors when we see a new set of data. When we try to answer questions such as "Given that it is cloudy and humid, will it rain?" we base our answers on years of accumulated experience.

Bayes' Theorem states, basically, that given a set of mutually exclusive hypotheses H_i, with prior probabilities P(H_i), and given some previously unknown data that pertains to these hypotheses, the "posterior probabilities" of the hypothesis P(H_i|D) are proportional to P(H_i)P(D|H_i) where P(D|H_i) is the "likelihood" of the data given the hypothesis. That is, the posterior probability is proportional to both the prior probability of the hypothesis, and the probability of seeing the data given the hypothesis. To ensure that the posteriors sum to 1, there is also a "normalisation factor" that is the sum of all posteriors.

An example may make it clearer: Suppose a patient is being tested for a particular kind of cancer. In people of that age group, this particular cancer occurs in 0.1% of the population (one in a thousand people). The test correctly reports cancer 99% of the time in patients with cancer (it gives a "false negative" 1% of the time). However, in patients without cancer, the test incorrectly reports cancer 5% of the time. In this case, the test is positive. What is the probability that the patient has cancer?

There are two hypotheses: H₁ = the patient has cancer, H₂ = the patient does not have cancer. Their prior probabilities are, respectively, 0.001 and 0.999. If the patient has cancer, the probability of seeing the data (the positive test) is P(D|H₁) = 0.99. If the patient does not have cancer, the probability of seeing the data is P(D|H₂) = 0.05. Then Bayes' theorem tells us that the posterior probabilities of H₁ and H₂ are, respectively, proportional to 0.001 times 0.99 and 0.999 times 0.05, or respectively, 0.00099 and 0.04995. After normalising, the probabilities are roughly 0.02 for "the patient has cancer" and 0.98 for "the patient does not have cancer" -- the information given by the tests is insufficient to overcome our prior information about the likeliness of cancer.

Bayes' Theorem can be readily proved in the "frequentist" interpretation of probability theory, which until recently was the only widely accepted interpretation. In this interpretation, a probability of an outcome is the fraction of times, in a large number of "trials", that the outcome can be observed. If one has N identical situations, and P of them yield positive outcomes, the probability of a positive outcome is P/N. (Think of coin tosses: if you toss an unbiased coin a thousand times, you will get heads in roughly 500 of them.) In the cancer example, the rate of occurrence of the cancer in a general population and the success rate of the test can be quantified via frequentist methods.

Where Bayesian methods were controversial is when the frequentist picture does not apply -- one does not have access to a large number of trials. For example (to get ahead of our story): "What is the probability that the Indus script represents a written language?" A frequentist would call the question meaningless, unless there is a large number N of Indus-like civilisations, each with similar scripts, and it was known that for P of those civilisations the script represented a language: then P/N is the prior probability of the language hypothesis. But in our case, N=1 and P is not known. Similarly, in the above medical example, if it were known that the cancer is a genetic condition and the patient has a family history of it, that would affect the prior probabilities, but it would be hard to calculate the correct priors. A good doctor, however, would certainly take the information into account in some way, and not dismiss the question as meaningless. And a Bayesian would say that a "gut feeling" assignment of the prior probabilities is better than no assignment at all.

If any useful observation came out of my previous post and the comments therein, it is this: we need to calculate P(D|H), that is, the probability of seeing the data shown by Rao et al. given the language hypothesis (H_L) and given the non-language hypothesis (H_NL); and the prior probabilities for each of those hypotheses. If we could actually do these, then we could assign a fairly confident posterior probability for each hypothesis.

Given the data for other languages in the Rao et al. paper, I would estimate P(D|H_L) to be close to 1. That is, if the Indus script is a language, I would think it very likely that conditional entropies would closely resemble the data that Rao et al. show in their figure 1A. In comments to my previous post, I estimated P(D|H_NL) as about 0.1: that is, if the script is not a language, the chance that it looks so much like a language is about 0.1. This was based on a crude argument: a generic sequence-generating process could lie anywhere between the "type 1" (fully random) and "type 2" (fully correlated) lines in figure 1A. Languages occupy a very narrow band in this region, that accounts for about 10% of the area (or 10% of the height at any given number of tokens). The probability of hitting that narrow band by chance is then about 10%. Of course, one can quibble with this: perhaps there is a large class of non-linguistic sequence-generating algorithms that will give conditional entropies in this band, but I think the burden is on those who protest to demonstrate that such classes of algorithms (a) exist and (b) are likely to have been used.

Estimating the prior probabilities is a whole other problem. Someone who professes complete ignorance would assign a prior of 0.5 to each hypothesis. With my favoured likelihoods of the data, above, this yields a posteior probability of about 0.91 for the language hypothesis, and 0.09 for the non-language hypothesis.

But we are not completely ignorant: we do know quite a lot about the Indus civilisation. So how do we assign a prior to the two hypotheses?

For Steve Farmer, Richard Sproat and Michael Witzel, the answer is: there is zero probability that the Indus civilization was literate. Their arguments are in this 39-page paper, but Farmer summarises it here in one sentence:

"Not one ancient literate civilization is known — including those that wrote routinely on perishable materials — that didn't also leave long texts behind on durable materials."

To this we can add one more claim from their longer paper: the statistical distribution of Indus symbols, including the large number of "singletons", that is, signs that occur only once, is proof that it could not be a language. (The word "proof" actually occurs twice in their paper, and the title is " The Collapse of the Indus-Script Thesis: The Myth of a Literate Harappan Civilization". In other words, there is not much room for doubt -- at least, according to these scholars.

But the one-sentence summary of Farmer is easily refuted: only three other equally ancient advanced civilisations are known (Babylon, Sumer, Indus), and the Indus was by far the largest and most advanced of the these. Farmer's sentence loses its impact somewhat when one realises that "Not one ancient literate civilisation is known..." means "Not one of the three that are over 4000 years old".

Iravatham Mahadevan writes an excellent article in the Hindu demolishing the Farmer thesis on archaeological and historical grounds. I think his arguments can be summarised, Farmer-style, in the following sentence:

Not one civilisation is known, at any time in history, that was mainly urban, lived in planned cities with water supply and sanitation, had extensive trade networks, accurate measurement systems, and occupied an area of over a million square kilometres, but were illiterate.

Here we are not comparing with just three ancient civilisations, but with hundreds more between that time and ours. Many would say that we don't need to compare: the absurdity of the hypothesis that such a civilisation would be illiterate is self-evident.

As for the statistical arguments and the singleton count, Ronojoy Adhikari points me to this page containing data from Bryan Wells showing sign distributions from Proto-Sumerian, Proto-Elamite, and Uruk. Perhaps Farmer et al. will now argue that these were not scripts either.

Here is my feeling on what has happened here: Before 2004, the Rao et al. paper would not have gathered any attention. (Of course the Indus system is a language script! Why are you discussing it?) But that year, Steve Farmer managed to persuade two others -- one of whom, Michael Witzel, is a well-respected authority in the field -- to add their names to his thesis that it is not a language. The resulting manuscript was absurdly and unprofessionally bombastic in its language, while containing essentially nothing convincing. Regardless of the work of Rao et al, their hypothesis would have died a natural death -- but Rao et al do have Farmer et al to thank for enabling them to publish their work, with its obvious conclusions, in a prestigious journal like Science. Farmer et al are so rattled that they promptly post an incoherent, shrill, content-free, ad hominem rant on Farmer's website. Sproat even shows up on my previous post, leaving a chain of comments that reveal that he has neither understood, nor cares to understand, the argument. All those who dissent from their 2004 paper are Dravidian nationalists.

So that leaves the question: how do we assign prior probabilities for the two hypotheses? I think the opinions of Farmer, Sproat and Witzel can be discounted. If we instead asked: "Given that every other urban civilization with water supply and sanitation was literate, how likely is it that the Indus civilisation was illiterate?" I think the answer would be: "Extremely unlikely."

If we assign a prior of 0.9 for language (based on the above, I'd put it higher) and 0.1 for non-language, and retained my likelihoods as above, the posteriors are: 0.99 language, 0.01 non-language.

I expect it to get more convincing. Some actual (non-rhetorical) evidence to the contrary would, however, be very interesting.