Bonds for PG Seats: Arm-twisting Doctors

Reproduced from: http://www.indialegallive.com/viewpoint/bonds-for-pg-seats-arm-twisting-doctors-71170, published August 25, 2019

Odisha has proposed a penalty of about Rs 1.5 crore on MBBS students in state-run colleges who don’t sign a bond with it. Is this reasonable and does it not infringe the Constitution?

Dr KK Aggarwal

Anything done under coercion is hardly likely to get the desired results. And if involving doctors, it is very sad, for they are the ones who save lives. An adequate means of livelihood cannot be secured by taking away without any reason the means of livelihood.

And that is precisely what the government of Odisha has done. Its health minister, Naba Kisore Das, announced the state government’s decision to hike the rates of the bond policy for postgraduate and super-specialty medical students in state-run medical colleges in an effort to retain doctors. The move has been met with criticism from the association of government doctors. As per the government, a penalty will be imposed on qualified doctors who do not serve in the state for two years after completing their degrees. Odisha is said to have more than 2,400 vacancies against 6,500-plus sanctioned posts of doctors. But can a bond be the answer for the deficiency? Surely not.

Singapore too has a bond policy but it is valid only if education is made free by the government or if one takes a tuition grant from it. Also, once such students finish their studies, they are assured of a job on a par with other jobs. In India too, if the government ensured a two-year job on a par with any other job in the country, the move could have been justified. But any job which exploits doctors, pays them less than in other parts of the country and makes them work in an area with no infrastructure does not make sense. Poor pay and bad working conditions will make doctors move to the private sector for education or to other states or countries.

To add salt to wounds, the penalty amounts in Odisha for such “transgressions” are to the tune of Rs 1.5 crore or Rs 2 crore. This is a prohibitive amount and under no circumstances can most postgraduates cough up that kind of money and will end up in jail if they are unable to pay up. This will also restrict poor students from taking such PG courses and make it affordable only for the rich who will take the PG and later pay the bond and get out of it. This amounts to getting a PG seat at a premium capitation of Rs 2 crore.

Earlier attempts by other state governments to tie down medical students have been challenged in courts. In March 2019, the Bombay High Court allowed 45 students to appear for the counselling round of admissions to PG medical courses in Maharashtra despite not serving their one-year internship bonds. The petitioners had challenged the validity of the government resolution of October 12, 2017, that made it mandatory for medical students to serve the bond before seeking PG admission in the state. From 2008, medical students in Maharashtra were required to compulsorily serve a one-year internship in a state-run, civic or military hospital after completing their MBBS course or pay Rs 10 lakh if they failed to do so.

On April 12, 2019, in Shitanshu­shekhar Manoharlal vs State Of Gujarat in the Gujarat High Court, Additional Advocate General PK Jani argued that Gujarat was spending huge money on medical education and therefore, it was the duty of the students to reciprocate by serving in rural areas. The Court said that this argument was difficult to accept.

It is true that as per the Directive Principles contained in Article 47 of the Constitution, it is the primary duty of the State to improve public health. Nonetheless, the Right to Education is also a right concomitant with the Fundamental Rights enshrined in the Constitution. The expenditure incurred by the State on medical education cannot be permitted to be recovered from a class of students who got admission in PG courses on their own merit on the ground that they had not served in rural areas.

The bench of Justice Bela M Trivedi further said that in the wake of the above, the earlier instructions regarding the PG students were unreasonable, unjust, unconscionable and infringed on Article 12 of the Constitution, and deserved to be quashed and set aside. Accordingly, the Court quashed and set aside the impugned government resolution (GR) and said that the bond/surety furnished by the petitioners, if any, pursuant to the said GR shall not be acted upon by the respondent authorities.

In another case related to the bargaining power of parties, the Supreme Court in Central Inland Water Transport Corporation Ltd & Anr vs Brojo Nath Ganguly in 1986 said that if a condition was incorporated in a contract which was found unconscionable, unfair and unreasonable, and was entered into by the party with the superior bargaining power with a large number of persons who have far less bargaining power or no bargaining power at all, then it ought to be adjudged void.

As for the definition of “State” in Article 12, the State must not only act in conformity with the Fundamental Rights guaranteed by Part III but also in accordance with the Directive Principles of State Policy prescribed by Part IV. Clause (a) of Article 39 clearly provides that the State shall, in particular, direct its policy towards securing that citizens, men and women, equally have the right to adequate means of livelihood. It is also true that Article 41 requires the State, within the limits of its economic capacity and development, to “make effective provision for securing the right to work”. But the Court further said that these situations would amount to a violation of Article 14 and were contrary to the Directive Principles contained in Clause (a) of Article 39 and Article 41.

In a Supreme Court verdict in 2011, rendered in Rajanikanth vs Director of Medical Education, Tamil Nadu, it was said that a government does not have the right to force any doctor to sign a “service bond in return” for admission to a post-graduate course in a state-run institute.

Arm-twisting tactics don’t always work.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

A ‘Harm Reduction’ Approach to Bolster Public Health in India

Reproduced from: http://bwhealthcareworld.businessworld.in/article/A-Harm-Reduction-Approach-to-Bolster-Public-Health-in-India/22-08-2019-175123/, published 22 August, 2019

By Dr. KK Aggarwal, Dr. Anoop Misra

Serving the world’s second-largest population, the Indian healthcare system has faced a myriad of challenges. Over the years, the development of the healthcare sector has become a political commitment. Since the launch of Ayushman Bharat, the world’s largest healthcare scheme, in 2018, over 12 lakh people have been treated and 14,856 hospitals have been empanelled. The Government-initiated National Health Protection Mission aims to provide health protection to 10.74 crores poor, deprived rural families and certain occupational categories of urban workers’ families. Further, the Union Government has also increased the allocation for the healthcare scheme to Rs 6,400 crore for 2019-2020. By 2025, the Government is also planning to increase public health spending to 2.5% of India’s Gross Domestic Product by 2025. But this raises a number of questions: Is this adequate? Do we have a better healthcare environment? And, are we moving in the right direction?

There is a substantial scope to enhance the healthcare system exponentially across the country. Our ultimate goal needs to be developing a well-functioning healthcare system for 1.3 billion people (and increasing) in India. In order to create a strong backbone for a better healthcare industry, the Government, civil society and doctors along with public health specialists ought to have a comprehensive strategy to address the challenges of public health.

While access to affordable treatment options is undeniably the most important tenet of public health, a robust public health system also endeavours to prevent illness in the first place. In this context, the National Health Policy 2017 rightly emphasizes preventive health as a policy thrust area. Emphasis on prevention can reduce the burden on the public health system, and through judicious use of precious healthcare resources, can lower overall public health expenditure and improve quality of care.

India bears a particularly high non-communicable disease (NCD) burden. As per WHO estimates (September 2017), nearly 61% of all deaths in India can be attributed to NCDs, including heart diseases, cancer and diabetes. Cancer continues to be the second most common disease, and the largest cause of fatality, with cancer-led deaths accounting for over 8% of overall mortality across the world. Lung cancer is one of the most common types of cancer in India and accounts for 5.9% of all new cancer cases diagnosed in the country. Increase in cancer is directly correlated with unhealthy lifestyles, including tobacco consumption, alcohol intake and obesity. Tobacco consumption is a major contributory factor in nearly 95% of lung cancer cases and causes other serious health complications. Studies by the American Cancer Society have conclusively proven that combustible tobacco products are the single largest cause of cancer.

As per a study by the WHO and the US National Cancer Institute, global tobacco-led deaths are estimated to increase from 6 million to nearly 8 million annually by 2030. India is the second-largest consumer of tobacco in the world (Source) and in 2018, around 28.6% of adults and 15% of children consumed tobacco in India, according to the WHO, and over 1.35 million people die of tobacco-related illness in the country each year. Needless to say, refraining from tobacco consumption can be a significant action to reduce the risk of cancer.

People should be sensitized about the harmful effects of tobacco consumption and encouraged to abstain from the use of cigarettes and other forms of tobacco. In the case of long-term smokers, where there is a dependency on nicotine and quitting is not always a viable option, harm reduction alternatives can be explored. Various progressive nations such as the United Kingdom, New Zealand, Norway and Canada are offering lesser harmful alternatives to smoking, to reduce the harm caused by consuming tobacco.

In India, the immediate need is to follow a harm reduction strategy to reduce the incidence of diseases such as cancer. Medical health practitioners should advise patients to quit smoking with the support of approved nicotine replacement therapy products and if smokers are unable to quit the habit completely, they should be advised to shift to less harmful alternatives that may support their transition. Electronic Nicotine Delivery Systems or ENDS provide an alternative source of nicotine and reduces the user’s exposure to tar, carcinogens and toxins that are found in cigarette smoke. There is mounting evidence to show that ENDS are substantially less harmful than cigarettes. A report by Public Health England has stated that vaping is at least 95% less harmful than tobacco and has the potential to help smokers quit smoking. Another study published in the New England Journal of Medicine shows that vaping can be a viable alternative to help smokers transition and helps them stay away from combustible cigarettes. A group of 80 medical practitioners had recently written to the Prime Minister of India seeking regulations for ENDS, with the objective of ensuring that adult smokers have access to these reduced harm alternatives, while at the same time, restricting the use of these products by non-smokers.

The concept of ‘harm reduction’ acknowledges that safeguarding public health often requires significant behavioural and lifestyle changes on part of the patient, and sometimes inculcating these – especially in cases of dependency to an addictant - requires more than mere will power. Offering reduced harm alternatives to adult smokers gives them a third alternative besides quitting or dying.

NITI Aayog’s recent strategy document for a New India @ 75 recognizes that a sound public health system emphasizes on prevention of NCDs. To achieve this vision, we have for a better, healthier India, existing efforts such as upgradation of health infrastructure, strengthening healthcare manpower, and providing universal access to healthcare might not be sufficient. These need to be greatly supplemented with practices and technologies that have been successfully used in other countries to reduce the health and economic burden of tobacco, in order to ensure better public health outcomes for the people of this country.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Mera Bharat Mahan 11: The path of Chariot

Dr KK Aggarwal

The Katha Upanishad is the legendary story of a little boy, Nachiketa (the son of Sage Vajasravasa, who meets Yama (the Hindu deity of death) and their conversation, which is a discussion of the nature of man, knowledge, Atman (Soul, Self) and moksha (liberation). It has six sections (Vallis).

The third Valli of Katha Upanishad presents the analogy of the chariot, to highlight how Soul or Atman, body, mind, senses relate to a human being.

As per the Upanishad, one should know the Atman soul as the rider, the body as the chariot, the intellect as the charioteer, the mind as the reins, the senses as the five horses and the roads as the samsara representing the objects of the senses or the desires.

The path of Katha Upanishad therefore is to control your desires through control of the senses by tightening the reins of the mind using the power of discrimination or the intellect with soul as the observer.

The common Vedic teaching directs one a control from Bahi Karan or outward direct senses (five gross elements, five Karmendriyas and five Gnanendriyas) to Antar Karan (Mind, intellect cum ego, Chitta or consciousness).

So, one should use the power of discrimination or Viveka to take all the decisions in life with soul as the observer.

But in Bhagavad Gita we see a difference. Here, Arjuna is the rider in the Chariot and Krishna the Charioteer.

Before understanding this, we must know the difference between the teachings of Yoga Vasishta and Bhagavad Gita. In the first Rama got a preventive teaching from Sage Vasishta as to how to live life and prevent anxieties. And in Bhagavad Gita, Arjuna takes on-field guidance from Krishna in an anxiety state and gets guided for the battle.

So, there are two paths. The preventive path of Chariot Katha Upanishad and the treatment path of Krishna Arjuna chariot; hence, the difference.

·                     The path of Katha Upanishad: Take intellect-guided decisions with soul as observer

·                     The path of Gita: Take soul-guided decisions

The Shlokas

Know that the Atman is the rider in the chariot, and the body is the chariot,
Know that the Buddhi (intelligence, ability to reason) is the charioteer, and Manas (mind) is the reins. (1.3.3)

The senses are called the horses,
the objects of the senses are their paths,
Formed out of the union of the Atman, the senses and the mind,
him they call the "enjoyer". (1.3.4)

Katha Upanishad

1.3.3

आत्मानँ रथितं विद्धि शरीरँ रथमेव तु।
बुद्धिं तु सारथिं विद्धि मनःप्रग्रहमेव च॥

ātmānam̐ rathitaṃ viddhi śarīram̐ rathameva tu |
buddhiṃ tu sārathiṃ viddhi manaḥ pragrahameva ca

1.3.4

इन्द्रियाणि हयानाहुर्विषयाँ स्तेषु गोचरान्।
आत्मेन्द्रियमनोयुक्तं भोक्तेत्याहुर्मनीषिणः

indriyāṇi hayānāhurviṣayām̐ steṣu gocarān।
ātmendriyamanoyuktaṃ bhoktetyāhurmanīṣiṇaḥ

यस्त्वविज्ञानवान्भवत्ययुक्तेन मनसा सदा।
तस्येन्द्रियाण्यवश्यानि दुष्टाश्वा इव सारथेः॥

Yastvavijñānavānbhavatyayuktena manasā sadā |
tasyendriyāṇyavaśyāni duṣṭāśvā iva sāratheḥ ||

5. But of him who is not possessed of discrimination, and whose mind is always uncontrolled, the senses are not controllable as vicious horses of a driver.

यस्तु विज्ञानवान्भवति युक्तेन मनसा सदा ।
तस्येन्द्रियाणि वश्यानि सदश्वा इव सारथेः ॥

yastu vijñānavānbhavati yuktena manasā sadā |
tasyendriyāṇi vaśyāni sadaśvā iva sāratheḥ ||

6. But of him who knows and has a mind always controlled, the senses are always controllable as the good horses of the driver.

यस्त्वविज्ञानवान्भवत्यमनस्कः सदाऽशुचिः ।
न स तत्पदमाप्नोति सँ सारं चाधिगच्छति ॥

yastvavijñānavānbhavatyamanaskaḥ sadā'śuciḥ ।
na sa tatpadamāpnoti sam̐ sāraṃ cādhigacchati ॥ 7 ॥

7. But he, whose intellect has no discrimination and whose thind is not under control and who is always unclean, does not reach that goal and falls into Samsâra.

यस्तु विज्ञानवान्भवति समनस्कः सदा शुचिः ।
स तु तत्पदमाप्नोति यस्माद्भूयो न जायते ॥ ८ ॥

yastu vijñānavānbhavati samanaskaḥ sadā śuciḥ |
sa tu tatpadamāpnoti yasmādbhūyo na jāyate || 8 ||

8. But he, who knows, who has his mind always under control and who is clean, reaches that goal from which he is not born again.

विज्ञानसारथिर्यस्तु मनःप्रग्रहवान्नरः ।
सोऽध्वनः पारमाप्नोति तद्विष्णोः परमं पदम् ॥ ९ ॥

vijñānasārathiryastu manaḥpragrahavānnaraḥ |
so'dhvanaḥ pāramāpnoti tadviṣṇoḥ paramaṃ padam || 9 ||

9. But the man who has a discriminating intellect for the driver and a controlling mind for the reins, reaches the end of the road, i.e., that highest place of Vishnu.

इन्द्रियेभ्यः परा ह्यर्था अर्थेभ्यश्च परं मनः ।
मनसस्तु परा बुद्धिर्बुद्धेरात्मा महान्परः ॥ १० ॥

indriyebhyaḥ parā hyarthā arthebhyaśca paraṃ manaḥ |
manasastu parā buddhirbuddherātmā mahānparaḥ || 10 ||

10. Beyond the senses, are the rudiments of its objects; beyond these rudiments is the mind; beyond the mind is âtman known as Mahat (great).

महतः परमव्यक्तमव्यक्तात्पुरुषः परः ।
पुरुषान्न परं किंचित्सा काष्ठा सा परा गतिः ॥ ११ ॥

mahataḥ paramavyaktamavyaktātpuruṣaḥ paraḥ |
puruṣānna paraṃ kiṃcitsā kāṣṭhā sā parā gatiḥ || 11 ||

Beyond the great Ātman is the Unmanifested; beyond the Unmanifested is the Puruṣa (the Cosmic Soul); beyond the Puruṣa there is nothing. That is the end that is the final goal.

एष सर्वेषु भूतेषु गूढोऽऽत्मा न प्रकाशते ।
दृश्यते त्वग्र्यया बुद्ध्या सूक्श्मया सूक्श्मदर्शिभिः ॥ १२ ॥

eṣa sarveṣu bhūteṣu gūḍho''tmā na prakāśate |
dṛśyate tvagryayā buddhyā sūkśmayā sūkśmadarśibhiḥ || 12 ||

12. This Ātman (Self), hidden in all beings, does not shine forth; but It is seen by subtle seers through keen and subtle understanding

यच्छेद्वाङ्मनसी प्राज्ञस्तद्यच्छेज्ज्ञान आत्मनि ।
ज्ञानमात्मनि महति नियच्छेत्तद्यच्छेच्छान्त आत्मनि ॥ १३ ॥

yacchedvāṅmanasī prājñastadyacchejjñāna ātmani |
jñānamātmani mahati niyacchettadyacchecchānta ātmani || 13 ||

13. Let the intelligent man sink speech into mind, sink that into intelligence and intelligence into the great âtman and sink that into the peaceful âtman.

उत्तिष्ठतजाग्रतप्राप्यवरान्निबोधत।
क्शुरस्यधारानिशितादुरत्ययादुर्गंपथस्तत्कवयोवदन्ति॥१४॥

uttiṣṭhatajāgrataprāpyavarānnibodhata |
kśurasyadhārāniśitāduratyayādurgaṃpathastatkavayovadanti || 14 ||

उत्तिष्ठत जाग्रत प्राप्य वरान्निबोधत ।
क्शुरस्य धारा निशिता दुरत्यया दुर्गं पथस्तत्कवयो वदन्ति ॥ १४ ॥

uttiṣṭhata jāgrata prāpya varānnibodhata |
kśurasya dhārā niśitā duratyayā durgaṃ pathastatkavayo vadanti || 14

14. Arise, awake; having reached the great, learn; the edge of a razor is sharp and impassable; that path, the intelligent say, is hard to go by.

अशब्दमस्पर्शमरूपमव्ययं तथाऽरसन्नित्यमगन्धवच्च यत् ।
अनाद्यनन्तं महतः परं ध्रुवं निचाय्य तन्मृत्युमुखात्प्रमुच्यते ॥ १५ ॥

aśabdamasparśamarūpamavyayaṃ tathā'rasannityamagandhavacca yat |
anādyanantaṃ mahataḥ paraṃ dhruvaṃ nicāyya tanmṛtyumukhātpramucyate || 15 ||

15. Which is soundless, touchless, formless, undecaying, so tasteless, eternal and scentless, beginningless, endless, beyond the Mahat, and constant, knowing that, man escapes from the mouth of death?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

FICCI-ELICIT Action Plan for end-of-life care and decision-making for patients

Dr KK Aggarwal

Federation of Indian Chamber of Commerce and Industry (FICCI) and End of Life Care in India Taskforce (ELICIT) have also released an information guide to improve and facilitate execution of end-of-life decisions for patients and their families, in addition to their guide for doctors and hospital administrators

Here are excerpts from the “Action Plan for end-of-life care and decision-making” for patients.

“Plan in Advance: Self-awareness is the beginning of any journey. Think about how and where you would like to die.

Do not be afraid to bring up the subject of death if you feel it is relevant to you: Senior citizens or those with serious or life limiting illness should proactively assume the responsibility of discussing their future medical care preferences with family and loved ones and their treating doctors.

Ask your treating doctor and medical team about various options available to you and the advantages and disadvantages associated with each of them: It is important to remember that you cannot be forced to accept life-sustaining treatment against your wishes. Your treating doctor and medical team have an ethical and legal obligation to respect your wishes if you refuse any offered treatment, after understanding the consequences of such refusal.

To prepare for situations when you may not be in a position to express your wishes, make an Advance Medical Directive (AMD): An Advance Medical Directive has two components:

1.     The Living Will, which expresses your wishes for care clearly so that doctors can understand and follow them

2.     The appointment of a healthcare proxy, through a power-of-attorney, who can speak for you when you are no longer capable of doing so. Your healthcare proxy could be a member of your family or a friend, but should not be your treating doctor. This saves the family the agony of taking decisions on your behalf without any guidance or without knowing your wishes

Discuss your directive with your family and/or healthcare proxy and make sure that they accept the appointment. It is advisable to make the directive in the presence of two witnesses, who will attest to the fact that you have made the directive with a sound mind. This directive can be revoked verbally/in writing. Although at present the Supreme Court has mandated a rather cumbersome process for using these directives, rationalization of the process is being advocated for.

Take charge and accept death as part of life: If a serious or terminal illness is diagnosed, prepare to take charge of the last days of your life. Use all sources medical, social, psychological and spiritual, to live well till the end. Do not resist the natural course of death. Discuss your needs and expectations now and in the future with family members, doctors and trained counsellors. If you realize that you would rather not know or engage with such matters, appoint a trusted surrogate decision maker.”

(Source: FICCI-ELICIT Improving end-of-life care & decision-making information guide to facilitate execution of end-of-life decisions - for patients and their families)

See related link:

FICCI-ELICIT guide to improving end-of-life care & decision-making

https://www.emedinexus.com/post/13471/ficci-elicit-guide-to-improving-end-of-life-care-&-decision-making

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Mera Bharat Mahan 10: Neti Neti (Not This, Not This)

The main principle of knowing the truth

Dr KK Aggarwal

Sage Yajnavalkya, the greatest of Upanishadic philosophers, taught the great doctrine of “neti-neti”, the view that truth can be found only through the negation of all thoughts about it (Brihadaranyaka Upanishad 2.3.6).

तस्य हैतस्य पुरुषस्य रूपम्।यथा माहारजनं वासः, यथा पाण्ड्वाविकम्, यथेन्द्रगोपः, यथाग्न्यर्चिः, यथापुण्डरीकम्, यथा सकृद्विद्युत्तम्; सकृद्विद्युत्तेव ह वा अस्य श्रीर्भवति य एवं वेद; अथात आदेशः—नेति नेति, न ह्येतस्मादिति नेत्यन्यत्परमस्ति; अथ नामधेयम्—सत्यस्य सत्यमिति; प्राणा वै सत्यम्, तेषामेष सत्यम्॥

Tasya haitasya puruṣasya rūpam | yathā māhārajanaṃ vāsaḥ, yathā pāṇḍvāvikam, yathendragopaḥ, yathāgnyarciḥ, yathā puṇḍarīkam, yathā sakṛdvidyuttam; sakṛdvidyutteva ha vā asya śrīrbhavati ya evaṃ veda; athāta ādeśaḥ—neti neti, na hyetasmāditi netyanyatparamasti; atha nāmadheyam—satyasya satyamiti; prāṇā vai satyam, teṣāmeṣa satyam ||

The form of that ‘being’ is as follows: Like a cloth dyed with turmeric, or like grey sheep’s wool, or like the (scarlet) insect called Indragopa, or like a tongue of fire, or like a white lotus, or like a flash of lightning. He who knows it as such attains splendour like a flash of lightning. Now therefore the description (of Brahman): ‘Not this, not this.’ Because there is no other and more appropriate description than this ‘Not this.’ Now Its name: ‘The Truth of truth.’ The vital force is truth, and It is the Truth of that.

Sage Yajnavalkya’s dialogues with his wife, Maitreyi are featured in the Muni Kanda or Yajnavalkya Kanda. 

The doctrine of “Neti, Neti” in this Upanishad suggests it is possible to describe Brahman as what ‘It’ is not but not as to what ‘It’ is. 

The three cardinal virtues of self-restraint (DAmana), alms giving (DAna) and compassion (DAya) are also mentioned here (the three ‘DA’s).

Atman is “neither this, nor this” (“Neti, neti”). The Self cannot be described in any way. “Na-iti” - that is “Neti”.

It is through this process of “Neti, neti” that you give up everything - the cosmos, the body, the mind and everything - to realise the Self.

After knowing the Atman in this manner, you will develop the attitude that the phenomenal world and all its creatures are made up of the same essence of bliss.

Brahman is infinite, amorphous, colorless, characterless and formless Universal Spirit which is omnipresent and omnipotent, and like cosmic energy, it is pervasive, unseen and indescribable.

Avadhuta Gita 1.25

तत्त्वमस्यादिवाक्येन स्वात्मा हि प्रतिपादितः।

नेति नेति श्रुतिर्ब्रूयाद अनृतं पाञ्चभौतिकम्।।२५।।

Tattvamasyādivākyena svātmā hi pratipāditaḥ /

neti neti śrutirbrūyād anṛtaṁ pāñcabhautikam //25//

By such sentences as "That thou art," our own Self is affirmed. Of that which is untrue and composed of the five elements - the Sruti (scripture) says, "Not this, not this."

Anupalabdi (अनुपलब्धि) is one of the six Vedic Pramans. It means non-perception, negative/cognitive proof.

Indian scholars refined Anupalabdi to four types: non-perception of the cause, non-perception of the effect, non-perception of object and non-perception of contradiction.

Only two schools of Hinduism accepted and developed the concept "non-perception" as a pramana. The schools that endorsed Anupalabdi affirmed that it is valid and useful when the other five pramanas fail in one's pursuit of knowledge and truth. Only Mimamsa and Advaita Vedanta schools of Hindu Philosophy agree with this as a Praman. Naya Sutras do not accept it as a valid method of proof.

Guru Arjan Dev: Shloka Sehshritee on page 1359 of the Granth Sahib.

·                     न संखं न चक्रं न गदा न सिआमं॥ God has no conch-shell, no religious mark, no paraphernalia; he does not have blue skin.

·                     अस्चरज रूपं रहंत जनमं॥His Form is Wondrous and Amazing. He is beyond incarnation.

·                     नेत नेत कथंति बेदा॥ The Vedas say that He is not this, and not that.

·                     ऊच मूच अपार गोबिंदह॥ The Lord of the Universe is Lofty and High, Great and Infinite.

                                                         

·                     बसंति साध रिदयं अचुत बुझंति नानक बडभागी अह॥५७॥ The Imperishable Lord abides in the hearts of the Holy. He is understood, O Nanak, by those who are very fortunate. ||57||

Neti-Neti meditation: The principle of Neti-Neti has been used in meditation involving Gnana yoga. Whenever a thought or feeling, which is not the goal of the meditation or is not the soul or the inner self comes to the mind, the meditator simply has to say, “Not this, not this,” and dismiss the thought, image, concept, sound, or sense distraction. Any thought, any feeling, is discarded, patiently discarded, again and again if necessary, until the mind is clear and the soul/or the self is revealed.

Neti-Neti and the mind: When you get into the habit of “neti-neti,” you can 

also discard thoughts of worry, doubt, or fear, and become established in the light of your inner self. You can then look back at worries and fears with deep insight and handle them.

Neti-Neti and the medical profession: A basic medical teaching is to diagnose a condition by way of excluding other similar conditions. This is called differential diagnosis. This is the only scientific way of knowing the truth.

Neti-neti and multiple-choice questions: The principle of Neti- Neti also applies to any modern day examination, which uses the multiple choice questions (MCQs) format. In this, each question has about four nearly similar answers and the student must choose the correct one. He can do this only by the principle of negation; Neti-Neti, not this, not this.

Neti-Neti and police investigations: This principle is also used by the police during a criminal investigation. Many people are suspected of having committing the crime and the investigating tem starts eliminating them one by one.

The opposite of Neti-Neti is “All this is Brahman” - Sarvamkhalvidam brahma

Chandogya Upanishad 3.14.1 

सर्वं खल्विदं ब्रह्म तज्जलानिति शान्त उपासीत। अथ खलु क्रतुमयः पुरुषो यथाक्रतुरस्मिँल्लोके पुरुषो भवति तथेतः प्रेत्य भवति स क्रतुं कुर्वीत॥

sarvaṃ khalvidaṃ brahma tajjalāniti śānta upāsīta | atha khalu kratumayaḥ puruṣo yathākraturasmim̐lloke puruṣo bhavati tathetaḥ pretya bhavati sa kratuṃ kurvīta || 3.14.1 ||

All this is Brahman. Everything comes from Brahman, everything goes back to Brahman, and everything is sustained by Brahman. One should therefore quietly meditate on Brahman. Each person has a mind of his own.

What a person wills in his present life, he becomes when he leaves this world. One should bear this in mind and meditate accordingly.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA