SPAN: November/December 2000 by SPAN Hindi

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SPAN

Into the Zone By Jay Tolson

Meeting the Challenge of HIV/AIDS By Lea Terhune

Publisher James Callahan

The War Against AIDS By Carol Bellamy

Editor-in-Chief John Burgess

The Doctor Is in the House By Gunjan Sinha

Editor Lea Terhune

The Power of Knowing Our Genes An Interview witb Rick Wilson by Christopher Miller

Associate Editor A. Venkara Narayana Copy Editor Dipesh K. Saraparhy Editorial Assistant K. Muthukumar Art Director Suhas imbalkar Deputy Art Director Hemant Bhamagar

Virtual Healing By Gunjan Sinha

Medical Waste Disposal In Indio By Ravi Agarwal

The New Disposal Industry By Dipesh Satapathy

The Great Outdoors By Marc Gunther

Production/CirculationManager Rakesh Agrawal

Avoid Online Viruses by Vaccinating Your Computer

Research Services AIRC Documentation Services, American Information Resource Center

By Janet Rae-Dupree

On the Lighter Side Seven Ways to Save Sports Front cover: President Bill Clinton warmly welcomes Prime Minister Atal Bihari Vajpayee on the White House lawn during the larter's official visit. The President and the Prime Minister stand at attention while the national anthem is being played. See story on page 51. Photograph by John Wicart, U.S. Department of State.

By Leigh Steinberg

The Eroded Self By Jeffrey Rosen

The Code That Can't Be Broken By James Glanz

Note: SPAN does not accept unsolicited manuscripts and materials and does not assume responsibility for them. QuelY letters are accepted. Published by the Public Affairs Section, American Center, 24 Kasturba Gandhi Marg, New Delhi 110001 (phone: 3316841), on behalf of the American Embassy, ew Delhi. Printed at Thomson Press (India) Limited, Faridabad, Haryana. The opinions expressed in this magazine do not necessarily reflect the views or policies of the U.S. Government. No part of this magazine may be reproduced without the prior permission of the Editor. For permission write to the Editor. Price of magazine, one year subscription (6 issues) Rs. 125; single copy, Rs. 30.

Indio and America: The Knowledge Partners By Pramit Pal Chaudhuri

Ambassador Richard F. Celeste on Prime Minister Vajpayee's Official Visit to the United States

Spotlight-Anand By K. Muthukumar

Lal Shimpi

LETTERS

FROM

he year 2000 was a landmark

THE

for the US. Mission

EDITOR in

New Delhi for many reasons. The US. President visited India, the Indian Prime l\1inister visited Washington. And in the past few months

many new faces have come

on the

scene as key people migrated to new positions elsewhere. In this final issue of the year we introduce three new members of the Public Affairs office and the SPAN family: Country Public Affairs

Officer

and SPA

Publisher

Jim Callahan,

who replaces Francis B. Ward, and Information

Officer and

SPAN Editor-in-Chief John Burgess, who replaces Kiki Munshi. The third new face at SPAN is Dipesh Satapathy, who has come on board as copy editor.

the

Holy

Cross

and

Georgetown

University. John Burgess also has considerable experience in Asia and Africa, and has served in London, Panama, Damascus, Cairo, Dhahran and Tunis. Most recently he was Callahan,

in Washington.

He,

is Massachusetts-born

extensive experience publications.

like Jim and has

in advertising

and John Burgess

We welcome them and look forward to working together to continue SPAN's tradition of excellence into the new millennium.

Besides

a cover

feature

on Prime

Minister

Jim Callahan has had a distinguished career during which he spent largely in

Vajpayee' s visit to tl1e United States, tl1is issue has a special

Asia and Africa. His fIrst posting was in Beirut in 1973 and he subsequently

focus on health, particularly the HIV / AIDS. We hope you enjoy it.

served Manila,

Jim Callahan

& PUBLISHER

challenges

raised

in Amman, Tunisia, San'a, the Gulf of Baghdad and

Pretoria,

besides a tour in Washington,

coming

to Delhi from Lagos. He hails

from Boston,

and studied

at College

tis with pleasure and anticipation that I take up this posting in India. The relationship between India and tl1e United States is a dynamic and fertile one, a fact that Pramit Pal Chaudhuri analyzes in his tover story, "India and America: The Knowledge Partners." After a successful exchange of visits between the leaders of our two countries, the momentum can only grow, and it is exciting to be a part of this continuing interaction. One issue that is of paramount concern around the world is the containment and prevention of the HIV / AIDS epidemic. In "Meeting d1e Challenge of HIV / AIDS," Lea Terhune looks at the efforts in India by the government, NGOs and donors such as USAID, who are working toged1er to control the spread of this deadly disease. A component of prevention of any epidemic is effective medical was te disposal. Ravi Agarwal discusses what options India has in "Medical Waste Disposal in India." In a companion piece Dipesh Satapathy looks at Indo-US. collaborations that bring in new technologies for waste disposal. Rounding out the package are three articles about new developments in medicine: "Virtual Healing" by Gunjan Sinha tells of how the Internet is bringing far-flung doctors together in consultation to save lives; "The Doctor Is in the House," by Gunjan Sinha, describes new technology that will soon allow us to take our own physical at home; and in an interview Rick Wilson, one of tl1e most prolific researchers on gene sequences, talks about "The Power of Knowing Our Genes." Rising above the physical, superathletes like Tiger Woods credit their success to mind-honing: "Focus. Control. Flow. In

tl1e zone. Think of any other synonym for mental mastery, and it applies to the level of play that Woods achieved in the Open," writes Jay Tolson, who explores tl1e techniques that bring mind and body to peak performances in "Into the Zone." And "Seven Ways to Save Sports," by Leigh Steinberg, looks at sports from its flawed side, offering suggestions to improve its tarnished image with fans. More of us are spending more time in cyberspace, but what are the pitfalls? The issue of invasion of privacy has stirred much debate recently, and "The Eroded Self," by Jeffrey Rosen, examines how the unwary might be compromised and what to do about it. Along the same lines of cyber-protection is "Avoid Online Viruses by Vaccinating Your Computer," by Janet Rae-Dupree. A photo essay, "The Great Outdoors," by Marc Gunther, reports on an old enterprise that has been given new life by new technology: tl1e billboard. Regular features "Consular Focus" and "Spotlight," a new addition, complete this last issue of the year 2000. Much of the content is about cooperation, and as we end this year and enter the new century, our dedication to seeing that SPAN "links India to America" remains as strong, if not stronger, than ever before. \X!hat a wonderful time to be here!

one ometimes you have to kill the things you love. Pop-psych 10I ? To be sure. But Tiger Woods' Shermanesque march through the 2000 U.S. Open at Pebble Beach gave new force and meaning to the phrase. It's not just that Woods mowed down some of his nearest and dearest competitors, though that he certainly did. Nor is it only that he brought one of his favorite courses-and one of golf's hardest-to its knees. He also seemed to subdue the game itself: to beat it into submission. "Kill them," Kultida Woods used to say when her young son went off to face the competition. [t was oddly predatory counsel coming from a Thai-born mother who at other times imparted Buddhist wisdom about inner peace. But if Woods was ever confused by these seemingly dissonant messages, he didn't show it at the Open. He killed 'em, everyone, with almost transcendent calm, posting the biggest margin of victory in the history of golf's four "major" annual tournaments. "He's so focused every time," said an amazed Ernie Els, who tied for a distant second place. "That hunger for winning a major championship, it's like 110 percent. To be honest with you, I don't feel like that every week when I'm playing. He's just different. ['m not sure there's a lot of players out here like that." Focus. Control. Flow. In the zone. Think of any other synonym for mental mastery, and it applies to the level of play that Woods achieved in the Open. And while this state of internal calm and power has different names, it boils down to this: When the body is brought to peak condition and the mind is completely focused, even unaware of what it's doing, an indi-

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vidual can achieve the extraordinary. But this is not a game of chance. Psychologists and physiologists say ordinary people can achieve this state by inducing changes in physiology, including brainwave patterns and even heart rates, through focusing and relaxation techniques. These might include breathing exercises or using verbal cues or developing rituals (bouncing the ball exactly three times before you take the foul shot). It also might involve visualizing successful outcomes before you make the swing or jump shot, without thinking about the mechanics of the action. The "stay in the present" focus that enables Woods to sink almost routinely those deadly 8- and lO-foot putts for par came in part from what his father, Earl Woods-his best personal sports psychologist-taught him about having a mental picture of the ball rolling into the hole. Today, Americans of all stripes are using mental conditioning not just as a means to a better golf swing but also to make them better corporate competitors, more creative artists, and, some argue, better human beings. "When you're in the zone, it's so quiet, it's so peaceful," says Harriet Ross, a potter from Hartsdale, New York, who uses the lessons of Zen to relax and focus. Julio Bocca, who has been a ballet prodigy since he was four years old in Argentina, worried about a decline as his thirties approached. Instead, he has been dancing to acclaim around the world-an achievement reached, he believes, through mental focus. Winning a high-speed car race or coming out on top in a corporate takeover isn't just a matter of skill; it's also about how people handle pressure. The intangible

Hungarian-American psychologist Mihaly Csikszentmihalyi. He began his careerlong interest in the early 1960s studying a group of artists for his thesis on creati vity. Struck by how so many became oblivious to their surroundings while they worked, he went on to investigate whether other activities and even jobs produced such absorption, such flow. What he found was that any pursuit was an "autotelic activity" if the doing, and not the goal, was the end in itself and if it involved such things as intense concentration, clarity of goals, quick feedback, and a fine balance of skills and challenges. Which is what works for Bocca. "When I do a solothat's the moment you have to be 100 percent there-my mind is just in the character. I've been doing this for so many years, 1don't have to think about what to do with my body. 1 don't think 'now is my pirouette, now is my jump.'" ractitioners of Zen, yoga and many Eastern forms of martial arts have experienced the truth behind these principles without having had them explained scientifically, as Csikszentmihalyi and other proponents of flow-andpeak states well realize. Indeed, the scientists have learned a great deal from those and other pre-modern disciplines. Folklore about the mental dimension of sport is as old as the games themselves, but the scientific study of that dimension did not begin until the late 19th century, primarily in Germany and France. Throughout most of the first half of the 20th century, researchers concentrated on the description of the character types and personalities of athletes and paid almost no attention to performance. A rare' exception was German psychiatrist Johannes Heinrich Schultz (1884-1970), who developed "autogenic training," a form of self-hypnosis that was supposed to boost relaxation. Yet not even Schultz believed that his research into the links between emotional and bodily states should serve to enhance athletic performance. The coaches of the East bloc nations, including East Germany, are often credited with being the first to use psychology

factor, not knowing who's going to buckle or who's going to hit the last-second field goal, is what makes these pursuits exciting-or terrifying. The same week that Woods breezed through the Open, for example, Yankee second baseman Chuck Knoblauch, who has become phobic about routine throws, made three errors in a single game. Golfer John Daly, whose physical gifts nearly match Woods', took 14 strokes on Pebble Beach's 18th hole and quit the Open after the first round. Many athletes speak of choking as a failure to be "in the zone." That state is not unlike the "flow" defined by the

to supercharge their athletes. (Sports historian John Hoberman contends this is largely a Cold War myth, based partly on a desire of Western observers to see athletes from communist countries as programmed robots.) The perception that psychology lay behind the success of East bloc athletes prompted curiosity in the West-and even, according to some leading American sports psychologists, a desire to venture into the field themselves. uch was at least partly the case with Jim Loehr. Founder of a leading sports and motivational training center, LGE Performance Systems, in Orlando, Florida, Loehr began his career in the early 1970s as the head of a me~tal health center in southern Colorado. But the experience of successfully treating two professional athletes-albeit "under the cover of darkness"-changed his plans. It was not long before he decided to launch his own sports psychology practice in Denver, a decision greeted by derision from his peers.

Holy Grail. Some of the challenges he faced continue to plague the field. Prominent among them was Americans' tendency to associate psychology with the treatment of weakness or disorders, even though Loehr was concerned with improving performance, not in administering therapy. Undaunted, Loehr developed his own version of the peak performance state that has come to be the Holy Grail of the larger American sports psychology industry-the "ideal performance state" (IPS), he prefers to call it, or "mental toughness." "The mind and the body are one," says Loehr. "Mental toughness is not just something you can sit in a room and visualize and all of a sudden you're mentally tough. The ability to handle physical stress takes us right into the ability to handle mental and emotional stress." The center that he founded in Orlando in the early 1990s quickly became a mecca for a wide assortment of people who have one thing in common: the desire to be the (Continued on page 35)

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ine "peer educators" sat in a circle in Director Bimal Charles' office at the AIDS Prevention and Control (APAC) headquarters in Chennai. There, also, were Dr. Lakshmi Bai, APAC program associate, and A.L. Mahendran, a male liaison worker from Community Health Education Society (CHES). The nine women are sex workers, called "women in prostitution" by the NGOs, in an attempt to distance them from the stigma of their work. The women are reticent at first, but soon a lively discussion starts. As they share their experiences and argue emotionally about the difficulties of organizing a women's sangam to address their concerns, it is the women who stand out here, rather than their profession. Lakshmi Bai encourages them to raise their issues. These women are like gold to APAC. They are the principal means for disseminating information about HIV /AIDS in Tamil Nadu. They are the peer educators who tell their clients and other sex workers about safe sex practices and the dangers of carelessness. The more women in prostitution I encountered in Chennai and surrounding areas, the clearer it became that the line between them and other "respectable" women is very thin, indeed. Most of these women have families, with several children. They are burdened with husbands who exploit them or who have deserted them. They are from lower income groups and are therefore poorly educated and unequipped to get good jobs. They found in prostitution a way to support their families that is more lucrative than day laborer jobs, the only jobs for which they are qualified. In Above right: Dr. Sampat Kumar, APAC specialist in training NGOs and their support workers for intervention with high-risk groups, at a workshop with peer educators. Right: ICWO counselor Pallavi at the drop-in-counseling center in Mahabalipuram s main tourist area. In the foreground is the "talking condom, " an attention-getter that broadcasts information about safe sex to passers-by.

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many cases their families don't know what they actually do for a living. They keep up a fiction about their work, though as one of them said ruefully, "A person who steals for many days will be caught." Because of their desire to keep their respectability, they are receptive to learning and teaching others about HIV IAIDS and safe sex. South Indian society is extremely conservative when it comes to intimate sexual matters, legal or illegal. Not even in its urban centers do you find the type of red-light districts that other cities have. Here the sex trade is particularly clandestine. Instead of establishments run by madams who employ five to ten prostitutes, "brothels" consist of a pimp and members of his family who keep one girl at a time, passing her off as a relative. These setups are moved to new locations every few months to evade the police, unless, of course, the police hierarchy is paid off. Into this climate, with the threat of HIVIAIDS in India growing ever more serious, the AIDS Prevention and Control Project was born in 1995. Getting started 10 years after HlV/AIDS was officially identified in India made the aim of reducing sexual transmission

group is augmented by freelance consultants according to need. They rely largely on the network of community NGOs with which they have built strong, constructive relationships. "We isolate locations for intervention and train peer educators there," says Dr. Bimal Charles, adding that they have trained about 600 to date with the help of select NGOs who work closely with people on the site. Training modules have been developed by APAC- VHS specific to medical professionals, community health care workers and chemists. There are training programs for NGOs, as well, particularly on social marketing-how to sell condoms, safe sex and the psychology of behavior change. The booklet "Win Customers for Life" informs shopkeepers, in a few pages, about sexually transmitted diseases: how HIV/AIDS differs from other STDs because it is incurable, and how it is spread. The question is raised: "What will happen if this continues?" Many potential customers will die, is the short answer. Recommendations on the best quality condoms with manufacturers' names and suggestions on how to deal with customers who are shy about condom "

ofHlV infection in Tamil Nadu daunting for APAC, to say the least. The few statistics available-unreliable as they were-showed a deadly trend. But the APAC founders were determined. Today APAC is a model for HlV/AIDS education and prevention, doing effective work that is unsurpassed elsewhere in India. APAC functions under the auspices of the Voluntary Health Service (VHS) of Chennai, which provides office space and other assistance. It is funded by the United States Agency for International Development (USAID) through the National AIDS Control Organisation (NACO). Its work is to contact people in the community who can get the word out about sexually transmitted diseases: sex workers, medical and public health professionals, chemists, and even quacks. The staff is impressively small, given their reach in Tamil Nadu. Most of the original staff are still there. There are eight professionals, six technicians, two administrative people, and 12 support staff. This permanent

purchase helps the shopkeepers to preserve and retain their clientele, literally. Gauging the inroads ofthe mv IAIDS epidemic in India is not easy with the limited testing facilities and the reluctance of peo-' pIe to be tested. Myths about the disease can make life a living hell for mY-positive individuals, and why risk it if the prohibitively expensive drugs are not available, anyway? APAC- VHS has tried to fill this information gap with annual behavioral surveillance surveys, done in collaboration with data-gathering firm AC Nielsen. These studies follow trends on high-risk behavior among selected populations: truckers, sex workers, tourists and slum dwellers, among others. Findings in the most recent surveys have been encouraging, with an increase in the knowledge level of prevention of the disease corresponding to the increase in partner fidelity and condom usage among key groups. A. Siban, program assistant, communications, acted as guide

for my first field VISIt, a noisy truck stop on the ChennaiBangalore highway. There social worker A. Ezhil Pari from the Santhoshi Social Sciences Research and Welfare Center conducts a vigorous education campaign among truckers, sex workers, petrol pump operators, mechanics and local shopkeepers. Instruction on HIV /AIDS prevention is included in roadside counseling offered for sexually transmitted diseases at several Santhoshi booths along the highway. These are identified by signs mounted in truck tires. On the front of the office is a signboard featuring a man holding a towel over his middle and the question: "Do you have a problem there?" Pari comes out to greet us as we pull up. Inside, a group of women are seated around a table. Ten of them are sex workers who make their living at the truck stops. Several of them are "aunties" who have moved from active prostitution to running houses in which they rent rooms to sex workers for a few hours or the night. Others are counselors, and include Dr. Rashmi ,!nd a few men. All of the women in prostitution are peer educators. Most of them live in nearby villages and ply their trade in the evenings. Some told us \ - y

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they refuse sex without a condom, and that their clients are becoming more responsive to this demand. Pancha says she has developed a special technique that turns condom use into a pleasurable Unique Selling Point, something she later demonstrated on the plastic model used for condom instruction. After giving an hour of their time to share their experiences, it is time for them to go to work. After they leave, Pari takes us to the booking office, where booking agent K.N. Naggappar's husky voice dominates the room. He is one of the senior peer educators at this location. He and two truckers talk about mY/AIDS. "We take it seriously," says Maharaj, who is waiting for a booking. "I know people who have died of AIDS." Kumar, the other trucker, agrees, and they recall the story of one of their colleagues, who went from being hale and hearty to skeletal before he died. Truckers, perhaps more than any other community, have learned to live with

HIV /AIDS. So many of their members have been stricken with it. They tell me about a town populated by truckers, where the residents have moved beyond demonizing HIV/AIDS sufferers and treat them normally and with compassion. "Though relatives from outside the town, who do not know about HIV/AIDS, don't like to visit," notes Kumar. The two truckers, it turns out, are also peer educators. Two steps away from the booking office, the proprietor of a "fancy store" gives prominence to his display of condoms. A few years ago these would have been hidden away. "Sales are increasing all the time," he says. During our long ride through the horrendous Chennai traffic, Siban fills me in on some of his pet projects, such as street theater, a very effective educational tool in both urban and rural areas. APAC provides scripts to NGOs who do street theater. This is to ensure that accurate information is consistently relayed, and that the improvisation does not extend too far. APAC also places slogans in strategic spots facing the passenger in autorickshaws, instilling such ideas as "faithful partnerships are the best way to prevent HIV/AIDS." Siban, like all of his colleagues, knows too well the unimaginable tsunami of HIV /AIDS infection that is breaking over India. "It needs to be politicized. Until there is more political will to fight the epidemic on a national scale, not much progress will be made," he says. In this he echoes the sentiments of Siddharth Dube in his recent, excellent book, Sex, Lies and AIDS-a book which deserves to be widely readin which he writes, "Political leadership is an essential prerequisite to true HIV/ AIDS prevention. This is obvious from the experience of the few developing countries that have succeeded in prevention. It is also apparent from the relative success of Tamil Nadu-where prevention has been led by the chief minister and senior bureaucrats." He goes on to point out that most states have so far failed to mobilize sufficient support. Bimal Charles credits much of the success of APAC to the strong patronage they have received from the Tamil Nadu state government and its administration. Another field trip. The road to Mahabalipuram leads to many pleasures, among them illicit sex. So early on AJ. Hariharan, secretary of the Indian Community Welfare Organisation (ICWO), began to target the tourists in this seaside temple town and the women in prostitution who work there. As he, Dr. Sampat Kumar from APAC, and I ride through the lush, tropical landscape, Hariharan talks about the kinds of operations in Mahabalipuram: lodges with one or more sex workers who service clients; hotel referral; streetwalkers; and the more upmarket mobile phone call girl operations, where a car serves as an office. One of the things that he is excited about-and which sets Mahabalipuram apart from many other places-is the women's credit and savings society. But that is just one of the enterprises ICWO has going here. The main ICWO office is by the beach. Attached to the building is a free condom dispenser, where people can pick up condoms

Backbone o/the APAC staff (left to right): Santhya, administration officer; A. Siban, program associate, communications; Arvind Kumm; program associate, industrial intervention; Dlc ZaFullah, assistant director, STD; Dlc Bimal Charles, director; D,: Sampat KumG/; program associate, intervention; D,: Lakshmi Bai, program associate, Women in Prostitution and Information Evaluation Systems. Right: Thubamaram inFont o/his barbershop in Mahabalipuram. He is an entlntsiastic proponent o/HIVIAIDS prevention, and keeps afree condom box in his shop. Barbers are among the most important peer educators in the fight against HIVIAIDS.

24 hours a day. During working hours one or more counselors are present to advise about STD and HTV/AIDS. Counselors Ravi and Shashi Kumar meet us there, and we begin our walking tour. "Do you want to see a lodge?" Hariharan asks, as we thread our way through the lanes of the town. We stop in front ofa seedy-looking hostel. He disappears for a minute, then he takes us inside to where a caretaker sits. The caretaker is a "volunteer," someone who is not a trained peer educator, but who agrees to pass on information, display literature, advertisements for the ICWO counseling center, or assist counselors in contacting new sex workers. He shows us a row of dirty, box-like rooms. Coincidentally, Shanti, a sex worker who has been connected to the lodge for a few days, shows up. We sit on a stained mattress in one of the dingy rooms to talk. Her story is a sad one, but a common one among women in the sex trade. A widow, she must support her children. She had only been in Mahabalipuram for a few days, and, she says, the other night some men broke in, beat her and robbed her of her money. She had just made contact with an ICWO counselor. Ravi and Shashi Kumar stay in touch with all the lodges for this purpose, to find sex workers who need a support group and who need to be educated about safe sex. Leaving the lodge we went on to the modest shop of Thubamaram, the barber. A free condom box sits at eye level next to the mirror, where it can't be missed. Thubamaram explains, "The box gets people talking about HIV/AIDS, and that is a chance to share information." He is a peer educator, and

happy to be one. "HIV /AIDS is a serious disease, and it is important that people know about it. This is something I can do to help people, to prevent it from spreading," he says. Madhip, cutting hair in a larger shop further down the street, talks to us while he cuts. He also says people respond to the condom box he has set up. Barbers are effective peer educators, because of the nature of the trade. "Everyone talks to the barber, and barbers are talkative, too," says Hariharan. The barbershop is a hub of gossip and information-sharing. What better place to advertise safe sex? On the way to meet the ICWO women we pass an autorickshaw stand. One of the drivers standing around comes forward when he sees Hariharan. He is another peer educator and heads the local drivers' association. Since taxi and autorickshaw drivers are contacts for prostitutes and sometimes work with pimps, . getting the safe sex message to them is a good way to get it across to others. Like Thubamaram, he feels he has a social obligation to spread the word, and likes doing it. ICWO counselors also work with vendors, from pan-wallahs to shopkeepers at "fancy goods" stores, encouraging them to sell condoms, display them prominently, and instruct people in proper condom use. A shopkeeper with an eye-catching condom display tells me that in a few years his condom sales business has gone from nothing to selling a few dozen a week. He, too, mentions that the public service aspect of selling condoms appeals to him. Not far from his shop was the tourist counseling center, with the "talking condom" display and the "Know About AIDS

and Win a Gold Coin" contest. Pallavi, the ICWO counselor, is The women in this group were very aware about STD and discussed with their husbands. Condoms not only spare them on duty at this office in the tourist bazaar. Back at the ICWO office, the women peer educators are waiting. unwanted pregnancies but protect them from diseases. Ganesan, 31, is a peer educator 1 met at the clinic. His interEmpowered by their organization, they were among the most confident and upbeat of the women in prostitution I had met. Their est in public health led him to work with Seva Nilayam and pooled savings account gives them a fund from which they may take APAC as a counselor on STD education. He works with men low-interest loans to tide them over in emergencies or when they who have questions but are reluctant to go to doctors for explaneed help with children's school fees. They were enthusiastic, and spoke with conviction about their commitment to spreading the word about HIV /AIDS prevention. Aundapatti, near Madurai, is the site of an NGO Approximately 33 million people are HIV-infected that uses a different approach to AIDS education in worldwide a conservative rural environment. The Seva Nilayam Society was founded in 1963 by British expatriate 95 percent do not know they are infected Dora Scarlett, now 97 years old. The focus of the Estimated 4.5 million Indians HIV-infected organization is to provide health care and education Five to six million are infected annually, worldwide to the poor. A big concern currently is curbing Not just a problem of high-risk groups (eg. more than 2.5 percent female infanticide that is widespread in the region. A of women at antenatal clinic in Maharashtra are affected) baby basket at the entrance is a poignant reminder of this problem. Over it hangs a banner giving facts In India, main transmission routes: about safe sex. Counseling about STD and 75 percent sexual HIY/AIDS is increasingly important here. 7 percent intravenous drug use A. Vijayaraman is the director of Seva Nilayam, 7 percent blood/blood products and he explains how the approach to AIDS education HIV/AIDS is incurable in South Indian villages is necessarily indirect, done mainly through antenatal care. Public condom demonstrations are not tolerated, though private ones, with husband and wife are accepted. Condoms are stigmatized nations. "There are a lot of deaths in other parts of the country throughout South India, but in rural areas especially so. Not only is and so there are concerns in the villages if an HIV-positive perthe man unwilling to sacrifice pleasure, but is afraid that by using a son is discovered. They are afraid they will contract HIV/AIDS, condom he might arouse suspicions in his wife that he is having but we explain and lessen the fear. Originally they isolated such extramarital affairs. As in other places, STD treatment offers an people, but now they treat them more kindly," he says. One of occasion for HIV/AIDS education. Contacts are made through the Ganesan's roles is stage manager for the street theater perfor40 counselors and social workers who fan out to the surrounding vil- mances, which, he says, "help people understand very quickly." lages giving advice and referrals to a doctor when necessary. They When we emerge from the women's meeting, we find Ganesan also collect field data, although HIV infection rates are hard to has been busy. Over the loudspeaker in the village center is a call assess because there is no provision for voluntary testing. Lack of for people to come an impromptu performance. Dr. Chandra confidentiality for HIV-positive individuals is another hurdle that Sekaran, resident medical officer at Seva Nilayam, who accomdiscourages testing. Often those who are HIV-positive are ostra- panied us to the village, has another avocation: an accomplished cized, though eradicating superstition through education is a goal of actor. Within minutes about a hundred people gather to watch. counselors. Attitudes are gradually changing, they say. Social workers engaged in this work agree that street theater is The village of Sittarpatti is about five kilometers from the the most effective way to reach the people, particularly the illitSeva Nilayam dispensary. It is one of the sites for the weekly erate. Soon the magician in the skit has placed his subject under antenatal clinic. One of the women there, Kasturba, is a peer edua spell and is asking him questions about sexually transmitted cator who became involved after being infected herself with an diseases. It is done humorously, and the audience responds with STD. She is part of the Mutaraman Sangha, a women's group laughter and applause. "It is a tribute to the confidence Seva which focuses on concerns including health and hygiene. Nilayam has built here that people would get together in the midAlthough it is not their scheduled meeting day, about 20 women dle of the day for non-scheduled meetings or street theater at from this group assembled to speak with Dr. Zafrullah, APAC short notice," Dr. Zafrullah observes. That kind of confidenceassistant director, and myself. They, too, have a microfinancing building dedication appears to be the only effective way to get scheme which allows them to get loans for small-scale industrithis life-saving message to the people who need to hear it. al projects. A subscription fee of one rupee and a Rs. 30 contriBack in Madurai, there are other NGOs to visit. Meenakshi bution per month are required. The scheme has 20 subscribers. Mission Hospital and Research Centre (MMHRC) is first on the

HIV/AIDS FACTS

The War Against AIDS Teach the Young Safe Sex By CAROL

ist disturbing that we still must make this point: HIV/AIDS is the gravest crisis facing humanity today. The epidemic is a tyrmlliy as intolerable and ruthless as any kind in history. With people dying from AIDS at a monumental and escalating rate, we should be beyond describing the danger in earnest speeches, grand meetings and, yes, even essays such as this one. Yet, sadly, our exhortations are still needed. Stunning statistics about the spread of HIV released by the UN joint task force on the epidemic, UNAIDS, tells us why. Globally, six people under age 25 contract HIV every minute. They account for 40 percent of all new infections. In some HIV-ravaged countries, half of all people aged 15 could die from AIDS in the coming years. As adults continue to delay facing up to this disease, children are dying. Yet none of these victims were sexually active when the world first learned that HIV is primarily transmitted through unsafe sex. Most were not even born. That they are the main group contracting the virus today, after all we know, is more than just a disaster. It is complete moral bankruptcy and is emblematic of the world's failure to protect its children. As all parents know, children come into this world ignorant. Our job as adults is to educate them, and we must

BELLAMY

tell them that the best way to avoid AIDS is to avoid unsafe sex. Otherwise, we adults are complicit in the deaths of millions of innocents. Consider the levels of ignorance among girls, who in some countries are three times more likely than boys to get infected. In Mozambique, where HIV prevalence is 13 percent, three-fourths of girls between ages 15 and 19 do not know how to protect themselves against the virus. In eight countries where AIDS has reached epidemic levels, about half of adolescent girls believe that they face no risk of contracting the disease. In countries across Africa, the majority of girls in the same age range do not know that a healthylooking person could have AIDS. In the face of such grim findings, we need nothing less than a "war of liberation" against the epidemic. While medical researchers race for a vaccine and cure, our weapon is education. We cannot wait for the scientists to win their battle, for, right now, with 34 million people already infected and 2.6 million dead ill 1999 alone, we are losing the war. Stronger cam paigns are urgently needed to debunk myths about the disease and to provide youth with the knowledge to protect themselves. In the developing world, home to 90 percent of the victims of the epidemic, the core ofthe prevention campaign can be summed up in two words: safe sex.

list. It was founded in 1990 by Dr. N. Sethuraman with the vision that "No man is too poor to afford first grade medical treatment" and the goal of providing "world class care within your reach." Since then this public charitable hospital has developed into a 500-bed, multi-specialty hospital and research center where nearly half the patients are given free care. Since 1998, MMHRC has collaborated with APAC and offers training to health professionals and SUppOti workers. It also has a free ward for HIV /AIDS patients. It maintains a regional resource and information center, created with APAC assistance, where doctors, patients and scholars can access information on the Internet and

Yet only a fraction of money going into the fight against HIV /AIDS is earmarked for disseminating that message and the variety of skills needed to practice it. Children, while extremely vulnerable, are also our greatest chance for victory. Often they are the best communicators, telling their peers how to protect themselves in ways most effective for their age range and culture. Uganda has adopted such an educational program, and its infection rate, while still high, has dropped dranlatically. A peer-to-peer project in notihern Thai land has helped cut the rates of transmission to 7.5 percent from 25 percent. But these small triLUTIphsare not enough: Vitiually every society understands what it means to wage a struggle for liberation. It means mobilizing every available resource. It means involving men and women on an equal basis. It means accepting the vital role to be played by young people. And it means sparing no effort and brooking no diversions until all of society is liberated. That is what is needed now-nothing less. We should be waging war, not mustering the troops. We must save lives today. 0 About the Author: Carol Bellamy, executive director of UNICEF, contributed this comment to the International Herald Tribune.

in the library. It is the first center of its kind in India. The Mother Teresa Ward currently has ten beds, but doctors expect the numbers to rise dramatically in coming years due to the alarming rise in HJ V carriers. Dr. M. Rajendra Sundaram tells us that TB is one of the most common opportunistic diseases that strikes HIV/AIDS patients, and all TB patients are tested for HJY. But, he says, it is still difficult to compile accurate data on the extent of the epidem ic. Like the other vibrant GOs that liaison with APAC, Teddy Trust has diverse projects, centering around children's education, health care, women, animal husbandry and HIV/AIDS interven-

tion programs with truckers and women in prostitution. They also the political support is not adequate," Prasada Rao says unhesitarget the Madurai brothels, pimps, autorickshaw drivers, room tatingly. He adds, "The management capability at the state level boys, lodge owners and doctors, to educate them and recruit peer is also not uniform." But to him the biggest obstacle is the stigeducators. After a brief stop to meet some of the peer educators at ma of HIV /AIDS: "It is still there in the society and it is still the Teddy office, coordinator Rita James takes us out to the field. there in the health care providers." He hopes to overcome the On the way, I asked Dr. Zafrullah about the future of the APAC attitude problems with training programs. Progress has been program. "It will work," he says, but with qualifiers. "We can't be made in civil rights. Some important cases in the Supreme Court sure that those who say they use condoms do so all the time." and high courts have supported the rights of HIV-positive people. In his Independence Day address, Prime Minister Vajpayee Money can break down the barriers, he says. The sex worker who says no to sex without a condom for Rs. 100 will often do it for made special reference to HIV /AIDS prevention in India. All this Rs. 1,000. It is a deadly arithmetic. But for many women in pros- encourages people in the field. There are many things hampering titution, like 30-year-old Valli, who operates a brothel from her the effort, of course. Prasada Rao cites the success of the polio house in a low-income neighborhood ofMadurai, respectability is eradication program, remarking "Illiteracy hinders, but we must more important. She has children. New to the sex trade, she was introduced to it by a friend. Her husband doesn't work, disappears all day, and demands money from her. Her factory job is not enough to provide for her children and living expenses. But Reduce high risk behaviors (practice safe sex) she is serious, she says, about practicing safe sex. Reduce efficiency of transmission (use condoms, treat STDs) She and her regular client have both been tested for HIY. Disseminate information widely about HIV/ AIDS Tamil Nadu, however, is one of the few places and its prevention with such effective implementation. Dr. Bitra George of Salaam Baalak Trust in New Delhi says that though a few NGOs are at a basic stage of outreach take it in stride." He continues, "People are socially conscious. work, there is virtually "nothing happening" in Delhi, in spite They pick up the message very fast the moment you put it across of financial inputs from international funders. "There is a lack to them correctly." Monitoring the epidemic is problematic, as of sufficient prevention and evaluation mechanisms and lack of estimates must be made in the absence of hard data, but he feels, trained and knowledgeable persons in state bodies to direct "The numbers show there is an increase in India, but the way it programs." He says, "We need to strengthen our prevention is progressing is different from Africa. Yes, it is increasing, but programs for STD control because we know the relationship of at a slow pace." Prasada Rao is cautiously positive: "I think the STD and HIY." He believes there should be a shift to familyeffort has increased manifold," he says. "Our main emphasis focused reproductive health programs to encourage behavioral should be on a sustained and organized effort for the next three changes in the community. And, he adds, "NGO, government or four years, to make people aware and to see that the risk and donor coordination are all essential." He is concerned groups are properly identified, and that control ofSTDs, condom about the information gap surrounding HTV/AIDS, saying promotion and mass awareness programs are taken up. Once we "People are getting to know the term but don't understand the do that I think we will be able to at least control this, instead of concept." He continues, "Here is an opportunity for us, but we seeing an increase in the number of cases." As it leads the world population, so India leads the world's are still very complacent. There is not the strong political will fueling efforts and still no strong coordinated effort to dissemHIV figures, according to recent estimates. Siddharth Dube inate knowledge about prevention. Health education to children calls it, without exaggeration, a "fire in the tinderbox forest." It has leapt across boundaries of high-risk, low income groups in schools needs to be strengthened," he adds, pointing out that into the middle class and the elite. More wives are unknowlstatistics show children are becoming sexually active earlier and need to know about safe sex. ingly infected by their husbands, more HIV-positive children Over at NACO, the special government agency set up in 1992 are being born, while health facilities to care for the increasing to confront the HIV/AIDS epidemic in India, director lY.R. number of victims are insufficient and medical workers relucPrasada Rao is at the center of a beehive. His staff of around 50 tant. Immediate coordinated efforts between government agensupport the decentralization of programs to the states. "NACO cies like NACO, NGOs and funders are obviously the key. One provides them with funds, the programs, technical resources and can only hope that, as envisioned by those working in the gova mechanism by which progress of work is monitored," he ernment and successful NGOs, that the prevention drive will explains. He-and others at NACO-agree that political will is work, the HIV/AIDS wildfire will not become a firestorm. It is important. What are the biggest problems faced currently? not a moment too soon to replicate the example set by states "Getting adequate political support at the state level. It is availlike Tamil Nadu throughout India. It is the only way to stem the inevitable, devastating tide. D able in a number of states today, but there are still some where

HIV PREVENTION

The omes, not hospitals, are where we'll maintain our health in the foreseeable future. And prevention, not treatment, will be the medical mantra of this millennium. Whether they're developing

inexpensive gadgets to track your health at home, tailoring medical treatments to your genes, or sending in tiny robots to scrub plaque from your arteries, researchers have their sights set on ever-higher levels of personalized medical care. Their prediction: Medicine of the future will be less invasive, more effective and consequently less costly. Not sure if you have a cold or a throat infection? Sensors on a toothbrush might measure the levels of proteins in your saliva and make a diagnosis. If you do have an infection, information from the Human Genome Project will make it possible to figure out exactly which antibiotic will work best for you. And if you're on the road, the Internet will offer 24-hour access to medical specialists, regardless of where you are in the world. But perhaps the ultimate in personalized medicine will be tiny robots that constantly patrol your bloodstream for signs of cancer or heart disease. Sound far out? As the following pages reveal, the cornerstones of such technology are being laid right now.

lice Pentland and her older brother Alex always thought it would be fun to author research papers together. In their shared world of academics, the first name listed on published papers tends to receive the most weight and, consequently, a better shot at promotion. But since both their names would appear as AP. Pentland, the top birds wouldn't know which was the first. While they have published a few papers together, this sort of sibling bantering has gotten them a lot further than ruffling a few feathers. Their close personal and professional relationship over the years has also put the two at the forefiont of a project that promises to turn medicine upside down. By building directly into people's homes medical devices that can pick up signs of an illness long before it becomes chronic, the two researchers hope to put basic medical care into people's own hands. The idea for the project came about several years ago, when the siblings were returning from a trip to Japan. Sitting on the plane, Alice, who is chair of del111atologyat the University of Rochester Medical School, was telling Alex, who is academic head of MIT's Media Lab, about one of her biggest frustrations as a dermatologist: the lack of painless technology to decipher whether a mole is cancerous. Alex, whose lab was working on computer software that could recognize faces, suggested building a device that periodically snapped pictures of a person's body to identifY problematic moles. Imaging software could then zero in on moles and measure characteristics such as

Duse color, diameter and degree of asymmetry to distinguish the cancerous from the noncancerous more accurately than the human eye can, and without excising tissue for laboratory analysis. "The more I thought about it," Alice recalls, "the more it seemed like a good idea." So she approached Philippe Fauchet, chair of the electrical and computer engineering department at Rochester. Fauchet was working on a proposal for an engineering research center, and Alice wanted to know ifhe could help her build the device Alex had envisioned. At first, Alice was looking for a monitor that dermatologists would use in their offices. But after several conversations concerning, among other things, the poor state of preventive medical care, the rising cost of treating illness, the miniaturization of technology, and its plummeting cost, the three began to bat around ideas for other medical gadgets. Soon they came up with a much grander plan: Why not focus the research center's efforts on building gadgets for people to monitor their own health at home? "Right now," explains Fauchet-a small-statured man with a heavy French accent and big, even profound, ideas"the system waits until you get sick and then diagnoses what you have. It then throws multimil1ion-dol1ar technology such as MRI machines and surgery at you to fix the illness. It's a pretty inefficient use of resources because it waits until the patient sees there's something wrong.

That can be very late in the development of a disease." Take heart disease, for example. Blood pressure, cholesterol level and other biological factors are predictors-the attack is simply the final blow. But what if every time you brushed your teeth, tiny sensors checked your saliva for telltale biological signs ofa heart attack? Each time you rested the brush on its holder it would compare that morning's results with your norm. If it found something unusual, it would beep, signaling you to head to the doctor. That's a part of the scenario that Fauchet and the Pentlands envision in your bathroom in the not-too-distant future. Now the three are heading up a new division at Rochester cal1ed the Center for Future Health-with the goal of building medical gadgets, like the toothbrush sensor and the melanoma monitor, that people will use at home. It's a technological approach to an idea that's becoming the medical mantra of the new mil1ennium: preventive medicine. Within the past 10 years, an onslaught of data has shown that diet and exercise play an enormous role in fighting disease. The American Cancer Society, for example, attributes one-third of all cancer deaths to poor diet. As a result, the health care industry has begun slowly shifting its focus to prevention as a way to control costs. Health insurance companies already encourage regular physicals, and some even give rebates to policyholders who exercise regularly at gyms. But these

efforts fall short, says Alex Pentland, because the tests necessary to gather simple information about people's health, such as heart rate and blood pressure, are still at the doctor's office. "We want to go beyond hospitals and doctors and empower people," explains Alex. "This way, when you decide to talk to someone about an illness, it's early and you have a lot of information. So that it's not just, 'It hurts, doc.' Instead, it's, 'Here's a whole lot of information about proteins in my body. Let's talk about why it hurts.' The doctor can then search a database and look at 90 other people who had similar symptoms and immediately say you have XYZ." Because it focuses on prevention, such technology would help people and save costs, and clinical researchers could benefit too. Sensors on a toothbrush that could record, say, 10,000 peoples' diets and exercise regimes over several years would be an accurate and powerful source of information on environmental factors that contribute to disease. The melanoma monitor is just one of several early-stage projects the center is planning to build. Others include a network of fiber-optic cables as thin as a strand of human hair that could become part of a sma11 bed, which constantly monitors pulse, respiration and temperature; or a smart bandage equipped with microchip sensors that quickly identifies bacteria to determine which antibiotics would be effective for treatment.

A Hospital at Home Feeling tired? It's not the late-night parties; your blood iron content is low. In the future, that information may not come from your doctor, but from your home Pc. Researchers at the University of Rochester are building sophisticated but inexpensive medical gadgets for people to monitor their health at home. Here's a sampling:

Fancy Footwear

Melanoma Monitor

People with spinal cord injuries and diabetes are at high risk of developing foot ulcers. Smart socks made of hair-thin fiber-optic cables woven into a comfortable fabric could prevent foot ulcers altogether. A tiny light source on the cuff would shoot light through the cables. Uneven pressure on the foot would disturb the flow of light, alerting the system of a problem such as an imminent ulcer. The system would wirelessly transmit an alert to a home PC. Rochester scientists are presently testing different types of fiber-optic cables to find the appropriate one, while scientists at Georgia Institute of Technology are searching for the best fabric.

A digital camera takes an image of a patient's body, perhaps each month in the shower. A computer measures mole characteristics and beeps if it detects any changes in a mole's size, shape or color.

The ultimate goal is to build these gadgets into homes much the way kitchen appliances are today. Take the melanoma monitor. In recent years, instruments called dermoscopes that can detect melanoma with far greater accuracy than physical examination alone have hit the market. But they require extensive training to interpret the data; as a result, only about 15 percent of dermatologists perform the procedure. Efforts are under way to marry the dermoscope to computer software that can automatically measure and analyze mole characteristics, and they are meeting with impressive success. Some research groups have reported that their computer-based melanoma-monitor prototypes correctly identify melanomas with aLmost 100 percent accuracy. The Rochester team's monitor, however, is the only one that puts the computer analysis of whether a mole has changed on a home Pc.

With the cost of digital cameras coming down, they will become cheap enough within five to 10 years to install several in a person's bathroom, perhaps behind tiles in the shower, as Alice envisions it. For people at high risk, the cameras would snap pictures every month or so and send the images to a voice-activated computer that would turn the pictures into 3-D images. Mathematical algorithms would then measure mole sizes, shapes and optical characteristics (light moves through cancerous moles differently than through normal moles). If the computer detected any changes, it would alert a patient to see his dermatologist. Rochester researchers led by Kiriakos Kutulakos have already built a prototype melanoma monitor that clinics will test later this year. The prototype consists of a series of large digital cameras connected to a computer by a mess of cables and

wires-a clunky setup that's a far cry from the gadget the Rochester team hopes to see in people's homes. But, says Alex, "The technology is there; the challenge is to make it easy to use." For someone whose career is devoted to studying and building technological systems that interface machine with machine, Alex is remarkably cynical about some mainstream devices. "I love digital cameras up to the point where you have to get images off them," he says. "At that point, what you should do is throw them in the trash." He's even more disdainful of computers-they crash too frequently and require professional service when problems occur. Instead, Alex looks to television as one model for how these medical devices should be designed. "Half the people in the world have never made a phone call, yet 80 percent have used a TV," he says.

Smart Toothbrush An array of sensors on a toothbrush would check breath, saliva or sweat for electrolyte levels to determine risks such as an imminent heart attack. Sensors that can analyze proteins aren't yet small enough to fit on a toothbrush.

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Thoughtful Spectacles Memory glasses could help people with memory problems. A miniature camera built into the eyeglass lens could relay images to a portable computer equipped with pattern-recognition software. The glasses would automatically detect images of loved ones, or grocery items, and the computer could offer audio instructions such as: "The ~(lr~ person you're looking at is your brother Bill." 1(( Scientists have already built the glasses and , continue to develop the software. .~

"How are you going to make these technologies more like a TV and less like a digital camera? The TV's success has to do with culture, and the fact that it's a source of entertainment and information." That emphasis on how people interact with technology has inspired the smart medical home-a testbed for the center's gadgets that is presently being built inside Rochester's Strong Memorial medical center. The home will be surrounded by labs in which scientists trained in fields ranging from engineering to sociology will hash out ideas for medical gadgets. They'll build prototypes into the home and observe people interacting with the gadgets through one-way mirrors. This sort of feedback will help researchers create better devices. And while gadgets such as home-based glucose and heart rate monitors already exist, gadgets built into the smart home

will be connected to a single device, say the home PC, which users will be able to access. "Several companies sell distinct products," Fauchet adds, "but most of these companies put out one-shot kinds of things. To have an impact on a significant problem in society, you have to design a rational integrated system. All of our devices will be able to talk to one another." In addition to university funding and private grant money to build the smart home, the project's coffers are jingling with corporate cash: Kodak has signed on a sponsor, and Alice and Fauchet are absolutely ebullient. Corporations with manufacturing and marketing know-how, they say, are essential for getting these devices to market. While support from companies like Kodak is a step in that direction, other challenges, such as participation from the medical community, lie ahead. But Alex seems unconcerned, at least

LAST NIGHT. STRESS ::-._

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Brainy Bed The same technology used in the smart socks could be incorporated into a smart bed that monitors sleep patterns and vital signs. A prototype device that can monitor babies' sleep patterns exists.

for now. He's counting on history to be a good predictor of the future: "It's almost inconceivable to us that we could be in control of our health. But in other parts of our society, that's already changed. No one thought ATMs would work when they were introduced 20 years ago because people needed the personal touch of the banker. But that wasn't true. Online stock trading is also exploding today. "Last year people spent more than $25 billion out of their own pockets for nutritional supplements, massage therapy and other treatments not covered by medical insurance, a sure sign that people want more control over their health," Alex continues. "A real revolution is happening. In the next five to 10 years, it will be possible to build sensors that are almost as powerful as the entire pathology lab at Massachusetts General hospital and cost less than a dollar." 0

The Power of

Knowing

An Interview with Rick Wilson by Christopher Miller

Rese rchers are ra lng to decode the' building blocks of human ":life. "This is iust "~ the beginning. It's ~ like landing on ~ the moon," says ~ Rick Wilson, research scientist.

Our Genes Fueled by advances in technology, both the public and private efforts to decipher the sequence of DNA base pairs that make up the code for a human are racing ahead. Already, the public effort led by a consortium of scientists at five centers around the world reports that it has completed almost 20 percent of the DNA sequence and has a rough draft of the other 80 percent. It has hit those numbers five years earlier than first anticipated. The private effOli, led by Rockville, Maryland-based Celera Genomics, says it too has completed a rough draft. But beyond the project's historical significance, how will knowing the DNA sequence of humans benefit medicine? And what pitfalls lie ahead? To answer these and other questions, Assistant Editor Christopher Miller spoke to Rick Wilson, co-director of the genomesequencing center at the Washington University School of Medicine in St. Louis, one of the primary centers of its type in the country and one of the five involved in the public effort.

The term "standard genome" has been thrown around a lot. What is it and whose genome is being sequenced? RICK WILSON: It's a reference DNA sequence taken from several individual participants, for scientists doing various sOlis of research. It'll function essentially like a road atlas, whereby they can 路figure out in greater detail where they want to go to study. Individuals can be compared with this reference sequence to find out where variations occur. When the genome sequence is finally complete, what will be its primary medical applications? Once the genes for specific diseases are identified, which is the next big challenge after sequencing is complete, the most immediate application will be in diagnostics. You'll be able to get tested to see if you're carrying the gene that will predispose you to a certain disease. In many cases, changing your lifestyle may alter your susceptibility. Another immediate application will be to tell you if your DNA predisposes you to an abnormal drug reaction. In the future, knowledge of your genes might also help eliminate some diseases. But that's a long way off. Who controls this data? The data we're generating property.

thinking really hard about. We will need to pass laws that prevent this type of discrimination from happening. It's another thing that people will need legal protection against. Is there a potential for a backlash from the public? Yes. The genome project has been deliberately handled very differently than initiatives involving genetically modified foods-another genome-related effort that's recently seen public backlash. We've realized that a person's genome is very powerful information that can be used for good or bad. As a result, 5 percent of the project's budget is being devoted to studying and making legislative recommendations about the ethical, legal and social issues surrounding the science. Will knowing our gene sequence make it easier to find a mate? It's probably going to make it even harder. You won't only worry about finding someone good looking and with whom you can have a good time, for example, but you'll also worry about people carrying genes for funny noses or curly hair or whatever. Ifboth of you have the same genes, you'll wOITY about all your kids having funny noses too.

are public

What are some risks of knowing our individual genome? It's going to be possible to look at someone's genetic composition and say that this person has a gene that predisposes him, for instance, to alcoholism, or that he is going to get cancer. There will be a lot of opportunity for genetic discrimination. That's something we need to be

What else would you like to add? This is just really the beginning. It's like landing on the moon-a huge accomplishment, but we did not know anything about the moon. We've had to do lots of experiments and go back a couple of times. With the Human Genome Project, things aren't going to change overni&ht. And, don't be afraid of it. This is something people should really be excited about. 0

Virtual Healing

By GUNJAN

SINHA

.B. Carnett figured he might be coming down with the flu when he strolled downstairs to the mess hall for breakfast. He opened his mouth to say "good morning," but only a croak came out. His voice was scratchy and hoarse, and his muscles ached. For several weeks, he had been investigating the operations of the world's largest open-pit coal mine, located in the heart of Borneo, trying to streamline its production. Today he was headed back home for a week of family time and relaxation. He gathered his bags and headed to the airport, where he climbed into a charter plane headed for Bali. Six flights and two and one-half days later, he finally landed in New York. By that time, not only was he weak,

feverish and growing disoriented, he clearly had something far more serious than the flu: An aneurysm the size of a golfball began to balloon out of an artery. It was pinching one of his vocal cords, so he was hardly able to speak. A three-hour car ride still stood between him and home in Cape May, New Jersey. He called his company's rental car agency, but his voice was so hoarse the agent hung up, thinking it was a crank call. He headed to the airport rental desks, where he was finally able to get a car. He climbed in and drove the entire distance alone, but barely remembers the ride. Carnett was infected with a potentially fatal tropical bacterium. During the next month, it would take three operations and an army of doctors, some of whom were on the opposite side of the world, consulting and consorting electronically to save his life. Cases like Carnett's are becoming more common. More than one in five adults traveled for business at least once last year, according to the Travel Industry Association of America-that's a 14 percent increase since 1994. And the jet-setting has a sinister side effect: "We've seen more and more unusual diseases," says Michael Braffman, chief of Infectious Diseases at Pennsylvania State Hospital and one of Carnett's doctors. "We now see several cases of malaria each year, dengue fever, typhoid fever, as well as others." The problem isn't merely that more Westerners are catching exotic diseases, but also that Western doctors have little experience in treating them. "People come back from trips not feeling well and then go to their personal doctors. But doctors who aren't trained in infectious diseases don't know a lot about tropical diseases,"

Braffman explains, "and while infectiousdisease people have some knowledge, it's usually all book knowledge." Fortunately, technology and the power of the Internet are quickly leveraging medical know-how through an exploding field called telemedicine. The same telecommunication links that connect physically distant and culturally disparate people via the Internet are also enabling doctors to examine, diagnose and one day even operate on a patient without the two being in the same place at the same time. The telemedicine industry has doubled worldwide from $6.8 billion in 1997 to $13.8 billion in 1998, reports New York City-based Waterford Telemedicine Partners, an investment firm. The company forecasts that the industry will grow 40 percent annually over the next 10 years. By 2010, it estimates, at least 15 percent of all health care services worldwide will be provided via telemedicine-and not merely to business travelers. Several companies are developing websites where doctors can store medical information from X-rays, MRI scans, ultrasound images, blood reports and other sources for sharing with colleagues across the country. NASA's Ames Center for Bioinformatics in Moffett Field, California, is also working with remote clinics in Hawaii, Alaska, the Navajo nation reservation in New Mexico and the University of California, Los Angeles, to set up a communications network for doctors at all sites to simultaneously view images of organs in 3-D. The connections will act as a teaching tool as well as a means for remote doctors to consult with experts on problematic cases. NASA hopes that in the future, touch-feedback

robots might even enable surgeons to operate on astronauts in outer space. "Telemedicine has actually been around since 1959, when a doctor for the first time conducted a psychiatric consultation via closed-circuit TV," explains Peter Leitner, CEO at Waterford. "What's driving the industry today is the pervasiveness of telecommunications infrash'ucture and information technology, the low cost of computer hardware, and the skyrocketing cost of health care." One person leading the charge is Daniel Carlin, founder of the Bostonbased World Clinic. Set up in 1998 to provide medical care to travelers, the clinic runs 24 hours a day. "We operate just like any emergency room, except the patient is not physically there," says Carlin. The clinic is a stand-alone medical command center staffed by board-celtified emergency physicians who work in shifts. Clients can contact the clinic by using the telephone, fax machine, e-mail, Internet, videoconferencing and satellite. Carlin has already treated a number of medical cases remotely. One of Carlin's first "e-patients," for example, was a ship crew member who had an infected ear

while at sea. "The crew member's ear canal was swollen shut, and I needed the captain to open it up," explains Carlin. "But I was terrified he was going to push the surgical instrument in too far and pierce the eardrum." Carlin e-mailed a cutaway anatomical view of the ear along with detailed instructions telling the captain how to operate. As a result, the captain was able to help his crew member. In another case, a sailor's ear was paltially torn off in an accident. His wife e-mailed a digital picture of the injury to Carlin. He sent her instructions on how to reattach the earwhich she did, successfully. Telemedicine put Carnett on the road to recovery too. Blood tests at Pennsylvania State Hospital confirmed that he had a disease called Meliodosis, which also became known as the Vietnam time bomb after some 35 American soldiers died from it during the war. The disease is caused by a safety-pin-shaped bacterium called Pseudomonas burkholderia. The bug lives in soil and water and is prevalent in Indonesia and parts of Australia. Although Braffman had read about the organism in textbooks, he didn't know

Medicine on the Net According to Cyber Dialogue, a market research firm, the sixth most common reason people go online is to research their health concerns. But with thousands of websites devoted to medical and health information, how can consumers SOlt fact from fiction? As a general rule, look for sites that are affil iated with or endorsed by reputable institutions and whose content is reviewed by a board of experts. Below are a few that might serve as a first step. General Health and Medicine www.mayohealth.org www.intelihealth.com

www.asco.org www.oncolink.upenn.edu

Research and Prescription Drugs www.rxlist.com drkoop.com

Nutrition and Fitness www.pueblo.gsa.gov www.shapeup.org

Doctor in a Box Suitcase-size telemedicine boxes may bring the doctor virtually to your doorstep. Several companies have prototype boxes equipped with thermometers, miniature electrocardiogram machines, glucose meters and video cameras. People can perform tests on themselves and electronically send the data to their doctors. As part of a pilot program, Matsushita Electric has installed a few boxes in the homes of about 20 elderly people in Japan.

how best to treat it. Making matters worse, a literature search he conducted turned up only three previously repOtted cases of the infection. And the data were too old to be useful. His colleagues had little advice to give-and when Braffman presented Carnett's case to a citywide conference in Philadelphia where more senior doctors were present, no one offered any words of wisdom. That's when telemedicine began figuring into the case. A colleague of Braffinan's at the University of Pennsylvania knew a microbiologist named Gary Lum through a newsgroup they shared. Lum lives in the NOtthern Territory of Australia where P burkholderia is endemic. Dming the rainy season, underground bacteria hitch a ride to the surface on floodwaters. Last season alone, Lum treated more than 40 cases of the Pseudomonas infection. Lum turned out to be an invaluable resource. "I e-mailed him," says Braffman, "and for several months Gary would sort or hold my hand and say, 'Well, this is what I would do and this is the drug of choice.'" Braffinan also corralled two Pseudomonas expelts who live in Thailand, and the four of them collaborated on a 10ng-tenTItreahnent plan for Camett that entailed months of intravenous and subsequent oral antibiotics. Today, one and a half years after his battle with the bug began, Carnett's treatment can be considered only partially successful. One of his vocal cords was permanently damaged by the aneurysm, and two heart operations left so much scar tissue Carnett feels a constant pressure on his chest. His voice now a raspy whisper and his mobility limited, Carnett has been forced to retire. But thanks to some quick-thinking doctors and technology that enabled them to consult easily, Carnett has gotten away with his life. "Telemedicine is unstoppable," says Carlin. "Thousands of villages and towns have nurses and skilled examiners but no doctors. We have the ability to give one person the brain of a whole medical center." 0 About the Author: Gunjan Sinha is an associate editor of Popular Science magazine.

A serious environmental threat, medical waste requires special handling. It is becoming easier as new technologies become available to zap this abundant and potentially hazardous garbage. he recent focus on the management of biomedical waste disposal in India and a new law which makes it mandatory for the health care sector to segregate and disinfect the waste, is changing the casual attitude toward this dangerous source of pollution. This change throws up fresh challenges involving different sectors in the search for sustainable solutions. The new requirements also introduce a large array of products and services to cater to the emerging needs. India has a diverse and geographically dispersed health care system. Though inadequate for its vast population, it is yet multilayered and largely government-run. In urban areas, there is an equal involvement of the pri vate sector through nursi ng homes, clinics, blood banks, pathological laboratories, etc. Many cities have large state-owned hospitals with a capacity of 500 or more beds. Rural areas are serviced through more than 22,000 primary health centers and about 1,000 district-level hospitals. There are also a large number of other health care providers such as indigenous medicine providers, along with quacks and unregistered medical practitioners. All produce biomedical waste.

Waste generated during the process of patient care is generally classified as biomedical waste in India. Such waste has been unregulated here until recently. Quantity estimates in urban areas range from 1.5 to 2 percent of municipal waste. For example, New Delhi, with a population of ten million, produces about 70 tons of biomedical waste per day. Though the quantity is relatively small, it can pose various risks, and has been very poorly managed in the past, after being dumped along with municipal waste. Disposables have added to the problem. While the need for better infection control gave rise to plastic disposables for products such as syringes, urine bags, IV bags, and catheters, these need safe disposal to prevent reuse.

Many communities are exposed to pollution and infection from biomedical waste owing to poor handling practices, unsafe transpOliation, inadequate treatment and improper disposal. The large health care workforce is primarily at risk. For example, several workers were exposed to stored, untreated infectious waste in a Delhi hospital recently. Similar cases of untreated wastes were uncovered in a recent survey covering over 30 hospitals in Delhi. The study, jointly carried out by the Delhi State Health Department, Delhi Pollution Control Committee and Srishti, a nongovernmental organization, indicates a high incidence of needle prick injuries from sharps such as syringes to medical personnel. Worldwide, according to a World Health Organization (WHO) study, 8 to 16 million hepatitis-B, 2.3 to 4.7 million hepatitis-C and 80,000 to 160,000 HlV infections are estimated to occur from reuse of syringe needles without sterilization. A portion of these syringes comes from waste. There have been cases of illegal sale of used syringes, bandages and cotton for reuse, especially in rmal locations, yet another serious concem. Two months ago, a racket to collect and resell such syringes across NOith India was uncovered in DeUli. Earlier, it was found that infected bandages

and used cotton wool were being sold to mattress and quilt manufacturers. Those engaged in waste picking and recycling (estimated to be more than one million nationally) handle and collect dangerous medical wastes, and in the process, suffer injuries and infections. Incinerator operators, mostly pati-time and untrained staff, are generally unaware ofthe dangers posed by toxic emissions, yet they regularly handle bags with needles sticking out and body fluids spilling over. Health workers handling waste are commonly not given basic preventive shots such as tetanus and hepatitis-B. The community at large is exposed to potentially infectious liquid waste as well as what is openly dumped. It is exposed to toxic emissions especially from small onsite incinerators, which in dense cities are often located in residential areas. Such incinerators burn mixed wastes including plastics, mercury, batteries and medical waste at low temperatures and with no emission control. Medical waste incinerators are one of the largest sources of dioxin, a known carcinogen, as identified by the U.S. Environmental Protection Agency (EPA), largely through the combustion of chlorinated compounds including polyvinyl chloride (PVC) plastics.

is still tardy. During the past four years while the law has been in the making, Indian NGOs and committed individuals have largely catalyzed the process with the help of the media. In a spirit of affirmative action, they have been disseminating infol1nation through well-designed field guides, creating model programs, and imparting training to help the health care sector cope with the risk. P3Iticipation fi'om various sectors including the government, bilateral and multilateral funding agencies, the corporate sector, health care organizations and the media has also been encouraged. Simultaneously, there is a need to ward off the dumping of obsolete technology in the form of on-site incinerators, and to find solutions centered in better housekeeping, segregation, waste minimization, and occupational safety rather than merely end-of-pipe technologies. The key word for the safe handling of biomedical waste is "management." There are various stakeholders involved in the issue. These include the government at both the policy and regulatory levels, the public and private health care sectors, the industries that provide products and services, national and international funding agencies, technologists, scientists, the vital civic sector and NGOs.

From July 2000 onwards, medical institutions in eight metropolitan cities risk closure and fines if they do not comply with the amended Biomedical (Management and Handling) Rules, 1998, which has been catalyzed by NGOs and judicial interventions. By 2002 the law, amended for the second time this year, will extend to the entire country. The law makes it mandatory for all institutional health care providers to segregate their waste in notified categories, disinfect and make it unrecognizable (to prevent reuse) before disposing it safely. There are provisions for altemate teclmologies such as autoclaving, microwaving and chemical disinfecting, offsite treatment and a ban on the combustion of PVC plastics. Noncompliance attracts a strict penalty. Though there has been a dramatic change in the operating environment in the ShOitduration of four years, on-the-ground progress

After issuing the rules, the government still has a critical role to play. Even though the "polluter pays" principle demands that the responsibility of complying with new requirements lie with the health care facility, multi-stakeholder paliicipation has to be facilitated. To implement centralized waste treatment facilities, the state can help in the cooperation required between the municipalities, health care providers and the corporate sector. Training needs to be institutionalized and standardized. [t can be made P3lt of medical and nursing school curricula. More emphasis can be placed on encouraging the growth of medical waste disposal business with sophisticated waste disposal teclmologies so that international standards may be maintained at a reasonable cost. Strengthening enforcement of the new regulation is essential. Though some hospi-

he second amendment this year to the Biomedical (Management and Handling) Rules, 1998, which lays down stringent punishment for violating regulations on the handling and disposal of biomedical waste, has thrown open a largely untapped market of biomedical waste management devices for Indian as well as foreign companies. The issue of biomedical waste management, which is slowly gaining momentwll in Indian cities due to NGO activity and media awareness campaigns, is yet to be picked up in smaller cities which also generate medical waste in substantial amounts. Even in the large cities, onJy a few hospitals have proper non-polluting waste management facilities installed. A host of Indian companies including start-ups in industrial equipment are either manufacturing medical waste management devices or are marketing products of U.S. and other foreign companies. Leading U.S. companies like Sanitec International Holdings and Tuttnauer have been successful in creating a sizable installation base in some Indian cities through distributors. Some like Sanitec and American Exporters Inc., both based in New Jersey, are providing technical consultancy to Indian concerns and some others are still trying to make a dent in the Indian market. But the future competition in this field will be guided by two factors---environment-friendliness and cost effectiveness of non-incineration technologies and products. Incinerators, which rely on direct combustion ofharzardous waste, have become potential polluters and a health hazard. Sanitec, a world leader in the field, has in its range of products a microwave disinfection unit, which shreds and treats segregated medical waste including pathological waste to render it Luu路ecognizable and reducing its risk to public health and safety. The unit, which has received approval 拢i路omthe New York State Department of Health, is the first nonburn technology in the world for treating pathological waste, and has more than 80 installations allover the world. [n a microwave system, waste is thoroughly disinfected using moist heat generated by microwaves. Sanitec products are marketed by Mumbai-based Maridi Ecothenn Systems, which has also tied up with American Exporters Inc. for technology sourcing, funding and joint ventures; with Cascade Engineering Inc. in Michigan for trolleys and with Interplast in ew York for waste collection bags, according to Maridi's CEO Ramesh Babu. Sanitec is also sharing its experience in setting up common waste treatment facilities in cities that include vehicle design, disinfection methods, safety while transporting and segregation of wastes and workers' safety

tals and organizations have undettaken training and capacity building programs with the help ofNGOs and private trainers, yet owing to a lack of enforcement, less than 5 percent of the approximately 150,000 hospital beds in eight cities have been following the required procedures. Those who have taken help of NGOs include Shimla in Hinlachal Pradesh, pollution control boards of Andhra Pradesh and Tamil Nadu, and Delhi-based Holy Family Hospital, Orthonova Hospital and Trained Nurses Association.

Intemational agencies, such as the WHO, have sponsored six model hospitals in the country. The World Bank, which has

with Maridi, which manufactures plasma ARC incinerators and autoclaves. The Sanitec microwave disinfection system reduces input waste material by 80 percent in volume without generating any liquid effluent and hazardous emissions. The first Sanitec installation in the countly is coming up at a common medical waste disposal facility in Bangalore, the contract for which has been bagged by Maridi, Babu says. Aditya Diagnostics Pvt. Ltd. in the capital has started marketing autoclaves and shredders of California's San-T-Pak Inc., another major player in the field, since last Februaly. But the distTibutor is still gaining a foothold and no hospital in Delhi at present has installations of San-I-Pak. Conceived and designed in 1995, the San-I-Pak "Auto" series sterilizers vi11ually eliminate the need for operator handling and the units are extremely compact, taking 60 percent less space than similar systems capable of handling significantly less volume. With 23 years of manufacturing experience, the company has over 450 installations spread across four continents. One company which has numerous installations in Delhi is New Yorkbased Tuttnauer Company Ltd. Delhi hospitals which have Tuttnauer autoclaves and sterilizers installed include the All India Institute of Medical Sciences, Guru Tegh Bahadur Hospital, Deen Dayal Upadhyaya arayan Hospital, Hospital, GB. Pant Hospital, Lok Nayak Jayaprakash EsCOl1SHeart Institute and Research Centre and Sanjay Gandhi Memorial Hospital, said B.B. Kapoor, CEO of Olmon Medical Pvt. Ltd. in Delhi, which distributes Tuttnauer products in India. Stericycle Tnc. in JIlinois, listed tenth by Fortune on its list of the 100 fastest growing companies, is the largest regulated medical waste lnanagement company in NOt1h America. Eleven times larger than its nearest competitor, the 10-year-old company has a host of products lined up like Steritubs-rugged reusable plastic storage containers suitable for all potentially infectious medical waste including containers for sharps ;md fluids, transpo11 dollies, safety lids, and its patented ETD process for treating regulated medical waste. Bondtech Corporation in Somerset, Kentucky, neither has any exclusive distributor in India, nor any installations, but it has been quoting several jobs through various agents, informed Bondtech official Angel Aguiar. The company specializes in autoclave systems;that can be custom designed to process 115 kilograms to 2,727 kilograms of medical waste. Florida's Bio Arc Inc., formed in July last year, currently does not mar-

a specific focus on safe biomedical waste handling in its State Health Development Programs, now funds only non-incineration technologies. Some bilateral agencies are exploring capacity building aid, while others have helped fund cleaner technology options like autoclaves, or have institutional collaborations to address occupational safety issues. Funding for industry participation is still not easy to obtain. Agencies like HUDCO (Housing and Urban Development Corporation), which are leaders in financing urban infrastructure, have a keen interest in funding private biomedical waste projects, but require security collateral. Often, since investment risks are not clearly defined in these relatively uncharted projects, entre-

The traditional response to biomedical waste disposal was to install on-site incinerators in health care facilities. However, over time they were found to have severe environmental and health impacts in the form of air emissions and toxic ash. Documentation of their poor operation, not only in developing countries, but also in developed countries, suggested that use of this teclmology was not solving the problem. In fact in 1998, EPA mandated stricter standards for on-site medical waste incinerators in tbe U.S., in particular for dioxin emissions. These new regulations are ex-

ket its environment-friendly Plasma Arc Reduction (PAR) units in India but hopes to assign a disu'ibutor for India. A PAR unit electrically desu'oys waste in a plasma cloud and does not require waste segregation. The company, howevel~ does not intend to enter the Indian market until the U.S market is secured for its products, says senior company official MUITay Vance. Tempico Medical Processing Company Inc. in Los Angeles manufactures rotoclaves-units for sterilizing infectious waste and rendering it harmless-which, it claims, are environment-fi'iendly and cost effective. It has recently acquired representation in India with Warden Surgical Company Private Ltd. with offices in Mumbai, Hyderabad, Bhopal and Kamataka with liaison agents in Delhi, Bhopal, Goa and Rajasthan. "We look forward to provide our fine rotoclave system to hospitals in India who wish to sterilize their medical waste, not merely disinfect it, and to do it with no adverse effect on the environment at an extremely low operating cost of$0.015 per kilogram of waste," said Sid Alexander, the company's vice president. A relatively new low-cost alternative to current medical waste disposal methods has been developed by Portland-based Clean Pro Industries Inc. The teclmology relies on cement-based solidification that incorporates a range of materials like gypsum, lime and portland cement to form a slurry that fixates the wastes. By physical and chemical treatment of hazardous waste through solidification, the waste is fixated and stabi Iized in a cement matrix that does not allow release of fluids under pressure. Clean Pro does not have any specific plans to enter the Indian market, its primary focus being on the U.S. clients. It would, however, consider the idea after further research and developing appropriate contacts, senior Clean Pro official Forrest L. Falmer told SPA . A lot of Indian companies are also getting into the job of collecting medical waste, maintaining common waste disposal facilities and manufacturing non-incineration waste treatment apalt from distributing equipment of foreign companies. These include Hyderabad-based GJ. Multiclave (India) Ltd. and Medicare Incin Pvt. Ltd., Millennium Tecbnologies in Visakhapatnam, Safe Environ in Vijayawada, Aireff deTox Incineration Ltd. in Mumbai and Rockwell Industrial Plants Ltd (RIPL), a nonresident Indian company based in New Delhi. -Dipesb Satapatby

~ C'J ~

ture, vacuum, pressure show that the necessary

iJj ~

ditions

~ :>

'j!

have

been

and indicators to sterilization conachieved.

Micro-

waving uses high frequency waves to raise the temperature

of the waste

and

render it disinfected. Metal waste is not microwaved. Dry heat systems use heat at a temperature and for a time sufficient to ensure waste disinfection. In chemical

steri lization

the waste

is ex-

posed to chemical agents to disinfect some, though not all, types of organisms. Newer treatment technologies such as plasma arc were developed by the military and still are in the experimental stage as far as medical waste is concerned. These could prove too expensive for their relatively smaller demand volume. Plasma is an ionized gas, which becomes an electrical conductor. Gas is passed through

an electric

arc, thus

reaching

very high temperatures of about 5,500 degrees Celsius. This is known as "thermal" or "hot" plasma. The plasma arc subjects the waste to a high temperature in the plasma or inert medium, and then encases it in a glass-like medium. Other technologies such as the Electro Thelmal Deactivation (ETD) process, patented by Stericycle, a FOltune 100 company and a leader in waste management

in the U.S.,

are more established. The process uses an oscillating energy field of low-frequency radio waves to heat regulated medical waste to temperatures that destroy pathogens such as viruses, bacteria, fungi and yeast,

pected to lead to the closure of 80 percent of incinerators there. Rising standards and subsequent costs of incinerators have led to a shift in the market to non-burn technologies, and the emergence of alternatives.

have been developed and are crowaving now 111 use. Although relatively new in India, auto-

markets in countries Argentina.

1ike Brazil

and

claving is a standard sterilization procedure used in developed countries that essentially

Non-incineration treatment technologies include steam sterilization, chemical disin-

exposes the waste to saturated steam under pressure in a vessel. Waste autoclaves nor-

fection, dry heat sterilization methods. Newer technologies

mally should have devices to measure and record operating criteria such as tempera-

and other such as mi-

without melting the plastic content of the waste. Stericycle is finding

Technicians prepare an autoclave at the Escorts Heart Institute in New Delhi. The autoclave. which has long had a place in hospitals in the developed world, is now becoming available in India. It adequately sterilizes instruments that must be reused through steam heat. Waste autoclaves disinfect waste to prevent dispersal of infectious diseases after disposal.

The corporate

sector

is an impoltant

stakeholder, one which can help in making the process of change real and permanent and which has great scope for development in India. Many products and services are required. From off-site waste treatment and disposal products affordable mometers,

centralized facilities to

for safe sharp handling,

bags,

alternatives to merClllY thernon-PVC based products such

as IV bags, blood bags, safer syringes and clean technology based treatment models.

Low-tech and dangerous, ragpickers sort through medical waste at a dump behind a Delhi hospital. Often unaware of the risks and inadequately protected, such workers are vulnerable to disease. They sometime sell used syringes which are repackaged by unscrupulous dealers and put back on the market.

Clearly there is an emerging market for such products and services, which may expand as more patiS of the country are covered by the Biomedical Rules. The Indian corporate sector has only begun to respond to this potentially large market. Basic waste management equipment such as non-PYC colored bags, waste autoclaves, needle cutters and worker safety gear, not available earlier, are now both being marketed and manufactured indigenously. Technologies such as autoclaves and microwaves are also available. The markets for these are developing, though slowly. Delhi, for example, has installed nine Israel-made autoclaves in various hospitals. Microwaves, available both in small as well as large off-site models, are also

eliciting interest. The smaller models are particularly useful in small laboratories and nursing homes. At least one Indian company is now manufacturing autoclaves, and many more are producing needle destroyers. It must be kept in mind that the market for safer alternative technologies will grow only if cheap and polluting incinerators are kept out. Foreign companies also see a market in products and services in this field in India. A number of U.S. players have a presence. Among them are San-I-Pak, one of the largest manufacturers of autoclaves in the world and with a large installation base in the U.S. Another is Sanitec, which manufactures microwave-based treatment systems. A project mooted by an Indian entrepreneur using the Sanitec system was awarded the first clearance by the Central Pollution Control Board (CPCB) as a centralized facility for Delhi in 1996. Though the project is yet to take off, cities such as Bangalore have also endorsed the technology for a centralized system. A Canadian company has recently completed a project analysis to install a centralized treatment and disposal system in Delhi. Four cities~Hyderabad, Bangalore, Chennai and Delhi~are in advanced stages of installing or operating zonal biomedical waste treatment facilities to be run by Indian private entrepreneurs at a cost ranging from Rs. 6 to Rs. 12 per kilogram of solid waste. Hyderabad has two common waste treatment and disposal facilities, run by 0.1. Multiclave (India) Private Ltd. and Medicare Incin Pvt. Ltd. Both of them are servicing approximately 3,500 beds each. The Chennai Municipal Corporation has allowed a Mumbai-based company Aireff deTox Incineration Ltd. to operate a centralized facility for all its hospitals on a buildoperate-transfer (BOT) basis. The Delhi Government has contracted India Waste Energy Development Ltd. to utilize the spare capacity of treatment and disposal plants at four hospitals~Deen Dayal Upadhyaya Hospital, Lal Bahadur Shastri Hospital, Babu Jagjivan Ram Hospital and Guru Tegh Bahadur Hospital~to treat waste of private nursing homes. A centralized facility is expected to be operational by December 2000 in Bangalore using a mi-

crowave device from Sanitec. This microwave has reportedly recently obtained an authorization from New York State Department of Health to treat pathological waste, and hence may not need an incinerator at all for pathological waste, ifthe Indian authorities also give such a clearance. One product sorely required is a shredder. Since a serious concern is the possible reuse of plastic waste, waste material must be mutilated or shredded besides being disinfected before disposal. Good quality shredders, which can take care of fine needles, will not generate aerosols and are safe to use, are essential. A couple of manufacturers have started making them in India, and there is a range available internationally, such as those made by Sanitec. Research is also underway for newer designs of disposable syringes. Disposable syringes are used on a mass scale, particularly in immunization programs of the Indian Government. But there are problems with disposal, which lead to unscrupulous reuse. Yarious companies and international NGOs are trying out new designs and containment devices. These incorporate features such as retractable needles, a locking plunger and nonstandard neck-size needles. Higher costs, more than five times higher, is the barrier to product acceptability. Attempts are being made to bring the price down. Even with all these developments, it does appear that over the next few years medical waste disposal practices will be completely overhauled. There are still difficult issues to confront: capacity building, training, technology, product availability and enforcement of regulations with greater polluter accountability. These are especially critical in India where the health care sector has to cope with a resource crunch and poor quality health care. Longterm sustainable solutions to medical waste management need continuing, careful intervention and the active patiicipation of all stakeholders. 0 About the Author: Ravi Agarwal is the chief coordinator of New Delhi-based NGO Srishti that works on issues related to wastes and taxies. He is also afounder member of Taxies Link, a national information exchange on toxic issues.

Lifelong billboard guys like Arturo "Arte" Moreno and Karl Eller have heard all the wisecracks-but now they're enjoying the last laugh. As the executives running the United States' two biggest billboard companies, Outdoor Systems Inc. and Eller Media, they are leading an eye-popping revival of the billboard industry, the oldest and simplest media business around. Spending on outdoor advertising-which includes bus shelters, subway posters, street furniture, stadium displays, and mall and airport signs as well as traditional billboards-is growing by nearly 10 percent a year, faster than newspapers, magazines and broadcast TV, though not as fast as cable or the Internet. Last year, advertisers spent about $4.8 billion on out-of-home media, twice what they'll spend advertising online. More important, an industry once known for pushing cigarettes, beer, and Burma Shave, and for delivering the most prosaic messages-EAT ATJOE'S, 6 MILESAHEAD-has become hip. Imageconscious marketers like Gap, Calvin Klein, Apple and Disney are paying $100,000 a month or more for attentiongetting displays in New York's Times Square and along Sunset Strip in Los Angeles. Even Internet trendsetters like Hot-Bot and Excite rely on billboards to stay visible in the real world. It's quite a turnabout for an industry that thrived before television but then was spurned by Madison Avenue. "Outdoor used to be known as the beer, butts and babes medium," says Andrea MacDonald, president of MacDonald Media, a New York agency that specializes in out-of-home advertising. Now, she says, "everything's changed. Other media are fragmenting, new technology had made us more creative, and advertisers are seeing billboards in a new light." Investors who anticipated the billboard renaissance have profited handsomely. The 52-year-old Moreno, who began as a billboard salesman, took Outdoor Systems public on April 24, LOS ANGELES路 Billboards funded by Mitsubishi Electric promote the Los Angeles Chamber Orchestra.

1996, with little notice from Wall Street; the stock price has grown by 1,460 percent since then, making it one of the top IPOs of the late 1990s, right up there with Yahoo and Amazon.com. Lamar Advertising, America's third-largest billboard firm, went public a few months later; its stock has grown by 335 percent, easily outpacing the market. As for Karl Eller, the industry's 70-year-old senior statesman, he sold his Eller Media firm to radio operator Clear Channel Communications in 1997 for a thenrecord $1.15 billion. "Since the outdoor companies got access to the capital markets, their values have gone through the roof," says Tom Vanderslice, an investment banker who specializes in media at CJBC World Markets. Suddenly, billboard companies that had traded at no more than ten times cash flow in private deals were being valued at multiples in the mid-teens by the public markets, setting off a wave of consolidation. Since 1996, the Big Three of billboards-Outdoor Systems, Eller and Lamar-have spent more than $5 billion to gobble up dozens of momand-pop operators, as well as the outdoor divisions of big companies like Gannett and 3M. Together they control about 40 percent of the revenues generated by the 400,000 or so billboards across America; as industry giants, they can operate efficiently and provide one-stop shopping to national advertisers. Like other rising stars of the information age, billboards have gone high tech. Digital teclmology developed at MIT has transformed the way billboards are made. Until the 1990s, most billboards were hand-painted on plywood. Quality was inconsistent; worse, when paint faded and wood chipped, billboards became eyesores. Today, computer-painting technology has all but eliminated the old-fashioned sign painter, and plywood has given way to durable vinyl that can be cut to any size, then rolled into tubes for easy shipping. Huge graphics can be produced more quickly and at lower cost, and digital printing ensures faithful reproduction-so that Levi's blue jeans, say, look precisely the same everywhere. Interestingly, Metromedia Technologies, the company

that brought computer painting to the market, is owned by billionaire John W. Kluge, who's been a major force in the billboard business for four decades. From 1959 to 1986, Kluge owned Foster & Kleiser, then America's biggest billboard operator, and Metromedia is now the world leader in large-scale imaging. Other innovators are adding three-dimensional structures, digital tickers and continuous motion to outdoor ads. Broad social trends also favor billboards. Americans are spending fewer hours at home, where TV, cable, magazines, newspapers, books and the Internet all clamor for attention. People are spending more time than ever in their carsdai ly vehicle tri ps are up 110 percent since 1970, and the number of cars on the road is up by 147 percent-and for most people the only media options in a traffic jam are radio and billboards. Billboard salesmen like to say that they reach consumers when they're on their way to spend money at the supermarket or the mall. Finally, there's the cost factor: Billboards are the cheapest way to reach mass audiences. Prices vary widely, of course, but advertisers typically pay a CPMthat's the cost per 1,000 viewers-of about $2 for billboards, compared with $5 for drive-time radio, $9 for magazines, and $10 to $20 for newspapers or primetime television. (The billboard equivalent of Nielsen is the Traffic Audit Bureau, which occasionally sends out spotters to count passing cars.) While most advertisers are still local-the motel beckoning a weary traveler-national sponsors are increasingly using the medium to build their brands. In 1998, Ford made what is said to be the biggest single buy in billboard history, a multiyear deal with Outdoor Systems worth about $50 million. Other buyers aim for narrower targets. Startec, a global telecoll1 company, buys posters outside ethnic food markets to sell its international phone service to immigrants. "I'm running Russian copy in a New York neighborhood, Filipino in San Francisco, Arabic in Detroit," says media buyer Andrea MacDonald. Buyers and sellers agree that demand is so strong that the industry probably won't be hurt by the

CHICAGO: Familiar faces of a jazz artist and Michael Jordan.

HOUSTON Old-fashioned targeted marketing.

federal tobacco settlement of 1998, which forces cigarette ads off billboards; tobacco now accounts for less than 10 percent of industry sales. While billboard operators would love to raise their rates, well-managed companies can generate robust cash-flow mar-

gins of 40 percent to 50 percent at today's prices because, unlike competing media, they don't spend money on news or entertainment. "We're a pure advertising medium," Eller says, with a contented smile. An industry historian, putting the best face on things, writes that billboards con-

vey "an advertising message directly, without the distractions intrinsic to newspapers, magazines, radio and television." (Hmm. Shall we stop writing now, to end this distraction?) 0 billboard operator will ever have to hire a reporter, fire an outrageous deejay, or ante up $13 million

MANHATTAN: Billboard on Fifth Avenue (left); ATLANTA: The view from a restaurant patio in Buckhead includes a billboard with rotating slats.

an episode to keep a popular TV drama. Who says content is king? It all sounds like a simple route to media moguldom of a sort, but it's not. Just ask General Electric, Gannett and 3M, which floundered when they tried their hand at billboards. Better yet, ask

Karl Eller and Arte Moreno, who are neighbors in Phoenix, the nerve center of the global billboard industry. These barons of billboards have a lot in common. Both are Arizona natives who are nuts about sports: Eller helped start the Fiesta Bowl; Moreno owns a small piece of the Arizona Diamondbacks. Both got into the business right after college: Eller as a "leaseman" in 1952, renting land for Kluge's Foster & Kleiser; Moreno as a salesman for Eller, 20 years later. ("My first commission check was $2.25," Moreno recalls. "I should have saved it, but I needed the money.") And both have a passion for billboards. "It's a business that, once you get into it, you just can't get it out of your blood," says Eller. Moreno agrees, saying, "It's a fun business, a people business. Lots of entertaining, going to ball-games or the theater." Don't, however, expect to find Karl and Arte sharing a skybox anytime soon. They were once close, but they are no longer on speaking terms. Neither cares

to explain why, but the ill will apparently dates back to a 1992 deal involving Eller, Moreno and Gannett, where both had worked. They've fought fiercely ever since over acquisitions and ad dollars. It's fitting that Eller is a Phoenician because his career has risen from the ashes a couple of times. He bui It his first company, Combined Communications, into a media conglomerate of billboards, radio, TV stations and newspapers before selling it to Gannett for $373 million in 1978; less than six months later, he left after trying to dislodge the CEO, Al Neuharth. Eller resurfaced as president of Columbia Pictures before it was sold to Coca-Cola, but then struggled as CEO of the Circle K convenience-store chain, which went bankrupt on his watch. Practically broke, he returned to billboards in 1992, persuading Gannett to sell him 350 "faces" in Phoenix in 1992. From that modest beginning he built Eller Media, now a unit of Clear Channel. He remains CEO of the unit, which generated about $865 million in revenue and $376 million in operating cash flow in 1998, analysts say. A soft-spoken man who gets to work most days by dawn, Eller says the business

is trickier than it appears. "There's a big skill set," he says. "I know what it takes to lease a billboard location. I know what it's like to fight ordinances in a city. I know how to really sell the concepts and creative to the advertiser." Focus is a key. Gannett, a newspaper company, treated Outdoor as a stepchild, as did 3M, which got into the industry to promote a reflective tape that was supposed to embellish billboards at night. Even GE Capital, which financed the purchase of Foster & Kleiser from Kluge, paid too much, backed the wrong executive, and lost money for years. Recalls GE's Jack Welch: "I told the board we'd better be careful if we were buying from John Kluge." Meanwhile, Moreno, a hard-charging Vietnam veteran, had quit his job at Gannett in 1984 to join forces with Bill Levine, the Phoenix restaurateur who started Outdoor Systems. They increased sales from less than $500,000 to 90 million in a decade through aggressive salesmanship and dozens of small acquisitions. That gave them the heft to issue stock and

take out big bank loans to buy the Gannett and 3M outdoor units, for a total of $1.7 billion. "Leverage is the American way," Moreno says with a chuckle. By cutting overhead and raising prices, they ratcheted up margins in a hurry. "Arte's a master operator," says James Marsh, Prudential Securities' media analyst. For 1998, analysts say, Outdoor Systems will report revenues of about $780 million and operating cash flow of about $370 million. The company's surging stock price and generous grants of options have made many of its 1,500 employees wealthy. Moreno's stake is worth about $800 million, but he remains a down-to-earth guy who opens his own mail, has no secretary, and is called Arte by all around him. Both Outdoor Systems and Eller are expanding abroad, with Outdoor Systems moving into Mexico and Eller focusing on Europe. Both are also eyeing Chancellor Media's billboards, which are up for sale. Moreno bought a sports marketing company to sell arena signage two years ago,

NEW ORLEANS: Billboard alongside Interstate 10, befl,veen the airport and downtown.

and he's already the country's biggest seller of ads inside malls. Indeed, the latest trend in out-of-home media-as you've surely noticed-is to surround us with messages. A GE Capital-backed company called Media Vehicles plasters billboards on big trucks. Alvern, a Norwegian firm, sells ads on gasoline nozzles at 20,000 service stations across the U.S. Ads can be found on the sides of shopping carts and taxicabs, in the restrooms of hip urban bars and in the air above spOlis events like the Super Bowl, which last year hired its own air-traffic controller to guide the passing blimps. Remember when the Russians launched a rocket into space with the Sony logo on it? Not even the sky is the limit for the billboards of tomorrow. 0 About the Author: Marc Gunther is a senior writer with Fortune magazine.

Into the Zone

continued

from page

best they can possibly be. Last week, for example, you could find retired tennis champ Jim Courier (getting in shape for his new career as a commentator), a dozen executives from Macy's department store, a nO-kilogram sumo wrestler, and various amateur athletes wandering the LOE grounds. They came to improve their performance on the playing field, in the boardroom, or in life in general-and what they got is an intense workout for both the mind and the muscles. "When there's no time left on the clock, you're two points down and on the foul line, what is that person thinking about before they shoot the shot? If they have one mental thought that says, 'If I miss this shot we lose' ...within moments, they are secreting negative brain chemistry," says Terry Lyles, LOE psychologist. It's all about taking yourself out of the moment, he explains, about using rituals to transport yourself before the shot or point. "They have to go from the mental side to tap into the emotional side next, which takes them to the physical part, which will be to shoot the foul shot. They've shot thousands of foul shots, but the issue is not shooting the foul shot, the issue is screaming fans, no time on the clock, and your whole team is looking for you to perform. Theissue is focus." "All of corporate America has its own form of stress, the same way the athlete has stress," says Rudy Borneo, vice chairman of Macy's West, who visited LOE last June. "It's really how you use that stress, how you build a format to make it positive rather than negative, how you can turn it into a growth factor." Tony DiCicco became head of the U.S. Women's World Cup soccer team in 1994; a year later, he hired sports psychologist Colleen Hacker. He knew that coaches often talk about the importance of the mental game but rarely give it time commensurate with its importance. He is certain that hiring Hacker strengthened both individual and team performance. DiCicco points out that he is not alone in a growing appreciation of the value of sports psychologists: The U.S. Olympic team had only one in 1988, but it had 100 by 1996. There are now over 100 academic pro-

grams specializing in sports psychology, at least three academic journals and over 1,000 members listed by the Association for the Advancement of Applied Sports Psychology. And elite professional and amateur teams and athletes seem to be increasingly using their services. The business. These specialists are taking the lessons of great athletes and coaches and shaping them into techniques that aspiring peak performers can learn to use. Sports Publishing Inc. of Champaign, Illinois, whose books discuss how athletes get in the zone, plans to release 112 titles this year, about double last year's number. In the past few years, Simon & Schuster has published and reissued such titles as Golf Is a Game of Confidence and Executive Trap: How to Play Your Personal Best on the Golf Course and On the Job. Many professional sports teams have psychologists on call, but that's a largely reactive, therapeutic approach. But another approach is spreading. Baseball's Cleveland Indians have a three-man performance-enhancement program that costs about $300,000 a year and deserves some credit for five straight American League Central Division titles since 1995, two of which led to World Series appearances. ob Troutwine, a psychologist in Liberty, Montana, has helped 18 NFL teams decide which players to recruit and how to use them. In 1998, Troutwine urged the Indianapolis Colts to draft Tennessee's Peyton Manning over another quarterback with similar statistics, Washington State's Ryan Leaf. A personality test showed that Manning was confident, but not brash, and Troutwine liked the fact that he was the son of former NFL quarterback Archie Manning. Troutwine was vindicated: Manning did well with the Colts, and Leaf, who was drafted by the San Diego Chargers, has flailed as a quarterback, insulated fans, and wants to leave the team. "In general you want competitive players," says Troutwine, who also consults for such corporate clients as Ford Motor Co., and Sprint Co., "but if a team is in a building phase, a hypercompetitive

player may not handle losing very well." The trend in hiring sports psychologists has yet to trickle down to the lower levels of sport, according to AlbeIt J. Figone of California's Humboldt State University. But that's in large part because coaches view motivation and the mental game as their prerogative, even if they usually give it too little attention. Stanford University's Jim Thompson, director of the Positive Coaching Alliance, thinks it's absurd to use this stuff on kids. "All the SPOltSpsychology in the world isn't going to help the average kid unless he has tremendous skills as well," Thompson points out. "The danger is that parents might think, gee, if I could get my kid a good SPOltSpsychologist, he could be Tiger Woods. Well, no." Kid stuff. But back in Orlando, Neil Clausen is on the court for his daily tennis lesson, nailing one perfect backhand after another. Just 10 years old, this pint-size player already has a clear idea of his goals ("I'm here because I'm trying to go to .Wimbledon") and an even more pronounced conception of what it's going to take to get there: "1 need to work on my racket preparation, but things like concentration are very important [too]. I see players throwing their racket around ...and I just don't think it really works, I don't think it's very nice." His mother brings him to LOE six days a week. "We will go to matches and whether it's professionals or 12-year-olds, you have some incredible athletes, physically blessed people, who are just not able to pull it off during a match, all because their mental strength

lets them down, or they couldn't focus, or they got distracted," she says. Neil is a quick study. In a pretend match, in between points, he quietly, solemnly goes through his own rituals: He adjusts strings on his racket, for one thing, and works on his breathing. In an interview last year with Psychology Today, Richard Suinn, who in 1972 became the first sports psychologist to serve on the U.S. Olympic sports medicine team, listed the mental skills that modern sports psychology focuses on, including "stress management, self-regulation, visualization, goal setting, concentration, focus, even relaxation." Sound good? It's clear why so many who are outside sports respond to what sports psychology offers. "If you attack work, family, spiritual life the way you attack a game, it all works the same way," says Peter Cathey, chief operating officer of XPO Network Inc., a start-up interactive marketing company. Cathey has faced several challenges recently-moving across the country to start a new company, dealing with his mother's death, and putting his father in the hospital. But he says he's never felt more mentally fit, thanks to skills acquired at LGE. "There's no emotional hit in the face 1can't deal with." "If Tiger goes out to play and doesn't take a good relaxing breath or relax once in two hours, then that tension shows up as a bogey," explains stay-at-home mother Caryn Rohrbaugh, of Lemoyne, Pennsylvania. Rohrbaugh went though LGE so that she could perform better in the home and enjoy her time there. "For me, two hours of not taking a breath, not eating right, not being in the right mind-set tUl11Sup as impatience, forgetting to schedule something, a general feeling of being overwhelmed. It's still a bogey, though." There is no question that the mental toughness developed by world-class athletes has pulled them through trials off the playing field as well as on-another reason why so many people are drawn to the peak performance ideal. Perhaps no sport is more mentally demanding than competitive cycling, and champion Lance Armstrong demonstrated some of the mental grit he acquired over years of

fierce competltlve racing by struggling back from testicular cancer. Diagnosed with the disease in 1996, he not only survived the surgery and debil itating chemo treatments but came back to win the Tour de France in 1999, a story recounted in his book, It's Not About the Bike. The most honest, articulate and (not coincidentally) influential specialists will tell you forthrightly that they are drawing on the collective wisdom of the best proven minds in the field-the great coaches of past and present. Many of them are or have been coaches themselves, and most are athletes, former or active. Bob Rotella, former director of the sports psychology program at the University of Virginia and now a full-time consultant to golf professionals and other athletes, says that so much of the formal psychology that he read in graduate school focused on dysfunction and problems that he "turned to people like Vince Lombardi or [UCLA's] John Wooden and studied their philosophies." otella has taught what he calls "learned effectiveness" for years, which means, he says, "teaching about being in the best state of mind, basing your thinking on where you want to go, not where you've been." Doing so., Rotella found himself in strong sympathy with the work of at least one theoretical psychologist, the great turn-of-the-century thinker William James. James, whose work is making a strong comeback these days because of its emphasis on the conscious mind and the will, spoke clearly to Rotella. "He seemed to fit with what I learned from the coaches." That might sound like a dubious distinction to some intellectuals, but James probably would have taken it as a compliment. The power of the mind to shape reality was one of his lasting beliefs. Just as James is the quintessential American thinker for having created a serious philosophy of human potential, so the best sports psychologists, and not just Rotella, extend that philosophy in popular form, often in an eloquent popular literature that includes books by Rotella himself (many written with Bob Cullen) and

such modern classics as Michael Murphy's Golf in the Kingdom. Obsession. Proponents of peak performance see it as laudably consistent with the American dream of self-betterment and the pursuit of happiness. "To me, pursuing excellence is why we came to America," says Rotella. But John Hoberman, a University of Texas professor who has written often about the dehumanization of sports, sees the emphasis on performance as part of the contemporary obsession with competitiveness, an obsession that crowds out other human and civilized values, "including," he says, "moderation and balance." But do critics like Hoberman ignore the possibility that peak perfonnance might entail leading a richer, more balanced life, one that can allow more attention to others, including family, friends and community? Being in the zone or the flow may be in fact a supremely human value, partiCLIlarty if it is, as many SPOltSpsychologists

contend, a state in which our peak capacities are exercised almost without thinking. After all, competition is a reality that cannot be wished away; why not learn to manage it as best as one can? As Woods commented after he'd won, "I had a-a weird feeling this week-it's hard to describea feeling of tranquillity, calmness." Csikszentmihalyi, who now directs the Quality of Life Research Center at Claremont Graduate University, sees peak performance state as a concept or ideal that can approach his notion of flow, but only with difficulty. "In my work," he explains, "I'm trying to understand how to make life better as it goes. The question is, why are you experiencing the peak performance state-for its own sake or in order to win? If winning, the goal, takes over, the pleasure of the doing fades." In other words, if the peak performance state becomes merely an instrument, its resemblance to true flow will vanish. But there is no guarantee, of course, that this

will not happen in any discipline or under.taking that one pursues, whether it be the making of pottery in the spirit of Zen or the playing of the piano in the spirit of the heck of it. When and if peak performance ceases to be the kind of activity that another quintessential American, Robert Frost, writes about in his poem "Two Tramps in Mud Time," then it might well become a lesser thing. Listen to the poet describe the state that he aimed for, and consider its possible relevance to our peak performance culture: But yield who will to their separation, My object in living is to unite My avocation and my vocation As my two eyes make one in sight. Only where love and need are one, And the work is play for mOltal stakes, Is the deed ever really done For Heaven and the future's sakes. 0 About the Author: Jay Tolson is a senior writer with U.S. News & World Report.

ON :EHE LIGHTER

"My goal is to die before there's a technology breakthrough that forces me to live to a hundred and thirty. " ÂŠ The New Yorker Collection 2000 Barbara Smaller from Cartoonbank.com. All nghts reserved.

SIDE

Reprinted by permission of the Saturday Evening Post. All nghts reserved.

even

a S 0 InAmerica il isn'l crickel, bullans are slillled uP. When did our fun and games become so depressing? It sometimes seems you can hardly hear the cheers beneath the din of disgruntled parties: Sports owners are forever claiming that they need more profits; atMetes and their agents complain that they deserve a bigger piece oft/lOse elusive sums; andfans worry that all these profits are corrupting the games they love. Is there a way that the 21st-centUlY sports industry might make successful, globalized businesses of their teams, treat the players as well as they deserve, and still maintain the loyalty of the fans? Here are seven possible solutions. PUT FANS FIRST In a country with a median family income of $35,000 a year, fans are forced to listen to people in the sports biz bicker over tens and hundreds of millions of dollars. This is insensitive, to say the least. Those of us in sports need to remember that we are in a discretionary entertainment business-we're not a necessity like food on the table or transportation to work. So we must fight to keep sports accessible to the fans and be sensitive to their interests. High ticket prices effectively screen out younger people and working families. FL (National Football League) tickets now average more than $45, and NBA (National Basketball Association) tickets average $48.37-up nearly 14 percent from last

ave season and I 08 percent since 1992. One relatively simple solution: Hold back 5,000 to 10,000 seats in football and baseball stadiums, and a lesser amount in basketball and hockey arenas, and distribute them at vastly reduced prices. ELIMINATE INFIGHTING In recent years, Major League Baseball, and NHL (National Hockey League), and the NBA all had strikes that hurt their fan bases. Meanwhile, the NFL is enjoying the greatest financial success in the history of professional sports. In 1995, Carolina and Jacksonville had franchise purchase fees of $ I 40 m illion; five years later, Houston's cost $700 million. The reason: labor peace. Agents, in particular, can be important arbiters between labor and managementbut they also have the power to stir up conflict. Their role cannot be simply to build up a client's bank account without any consciousness of the larger implications of their dealings. Agents must instead act as stewards of the sport: Instead of focusing solely on their clients' slice of the financial pie, they should work with management to help increase the size of the pie for everyone. GO HIGH-TECH We need to encourage the use of sports players and teams in entertainment-television, radio, the Internet, videotape, video games. Each of these fields is desperate for programming. Expanding the use of sports figures will provide more income-again enlarging the financial pie. GO GLOBAL We need to internationalize our professional sports into new markets with huge populations. Major League Baseball created some controversy when it opened last season in Japan-yet baseball is actually quite far behind the other major profes-

or s sional sports when it comes to international games and marketing. As it generates revenue from international fans, the globalization of sports may also help the games themselves, inspiring and cultivating talented players overseas. Most American athletes seem to recognize that, whatever the inconveniences of overseas travel, international fans can bring them worldwide name recognition, more lucrative endorsements, and perhaps eventually the chance to compete on a global scale. REINVENT THE STADIUM Every city that has a stadium older than five years wants a new one. And why not? For many franchises, the profits from naming rights, signage, PSLs (personal seat licensing), and premier seating can make a huge financial difference. But is it fair to use public funds to erect these private venues, which support private businesses, instead of spending those funds on hospitals and schools? Particularly in the case of NFL teams-which play only ten home games a year-stadium and arena sites should be combined with retail and entertainment complexes nearby (call them "sports towns") and interactive rides, creating foot traffic at times when games are not being played. Venues like these will also attract significant private investment, which can help build and maintain the arenas without having to go begging to tax-phobic electorates with squeezed municipal budgets. BEHAVE-AND BE REALISTIC Every major newspaper and television station in America feeds its readers an unremitting diet of player and coach misbehavior, both on and off the field. Examples are so abundant as to be unnecessary. Fans sense that player behavior has gradually degenerated, and that athletes feel invincible and unaccountable for their behavior.

Athletes are role models who trigger imitative behavior, especially in young people. The debate over whether they should be laden with this responsibility is therefore moot. At our agency, we ask that the athletes we represent retrace their roots to their high school, college, and professional communities and set up programs in them that enhance the quality of life there. In this way, players reach out to become a constructive part of their society and build the skills that will help their second careers. The danger for many young athletes is, of course, self-absorption. They have been catered to and had problems solved for them since they were young, and are often surrounded by oversized entourages whose only duty is to fawn over them. This undercuts their ability to see themselves as accountable for their behavior. At the same time, the public must recognize that its perceptions of player misconduct are partly illusory. There is a tremendous amount of press scrutiny of athletic misconduct using standards that were never applied to athletes in the "good old days." Fans fantasize about a golden past of athletics, of pristine behavior and an absence of greed. This is a past that never existed. PROMOTE WOMEN'S SPORTS The potential growth of women's sports at the collegiate and professional level is heavily dependent on how and when their games are televised to a general audience. If more television time is devoted to women's sports, with higher production values and bigger promotions, those sports will attract more fans and win more time on television. All the efforts in women's basketball and soccer need to be channeled into one league. We need more focus in team sports on individuals; women's soccer has shown that creating stars in a team sport can generate a huge audience. D About

the Author:

Leigh

Steinberg

is a

founding partner of Steinberg Moorad & Dunn, a Us. law firm representing more than 150 professional athletes, and the CEO of Assante Sports Management Group.

THE ERODE

SELF s reading, writing, health care, shopping, sex and gossip increasingly take place in cyberspace, it is suddenly dawning on us that the most intimate details of our daily lives are being monitored, searched, recorded and stored. For most citizens, the greatest threat to privacy comes not from special prosecutors but from employers and from all-seeing websites and advertising networks that track every online move we make. Consider the case of DoubleClick Inc. For the past few years, DoubleClick, the Internet's largest advertising-placement company, has been compiling anonymous data on our browsing habits by placing "cookie" files on millions of our hard drives. Cookies are electronic footprints that allow websites and advertising networks to monitor our online movements with granular precision. Some websites can monitor the search terms you enter and the articles you skim. After DoubleClick sends you a cookie, you will find yourself receiving targeted ads when you visit the websites of its 2,500 clients. So, for example, if you were to visit AltaVista's auto section, DoubleClick might send you cheerful ads from GM or Ford, thoughtfully ensuring that you don't see them more than two or three times. As long as users were confident that their virtual identities weren't being linked to their actual identities, many were happy to accept cookies without thinking about them. Then last November, DoubleClick bought Abacus Direct, a database of names, addresses and information about the offline buying habits of90 million households, collected from the largest direct mail catalogs and retailers in the United States. In January, using Abacus' detailed records, DoubleClick began to compile profiles linking individuals' actual names and addresses with their online and offline purchases. Suddenly, shopping that had once seemed anonymous was being archived in personally identifiable dossiers. Under pressure from privacy advocates and from dotcom investors, DoubleClick announced last March that it would postpone its profiling scheme until the federal government and the e-commerce industry agree on privacy standards. Still, the DoubleClick controversy points to the inherent threat to privacy in a new economy that is based, in unprecedented ways, on the recording and exchange of intimate personal information. There are many fearful consequences to the loss of privacy, but none perhaps more disquieting than this: privacy protects us from being misdefined and judged out of context. This protection is especially important in a world of short attention spans, a world where information can easily be confused with knowledge. When intimate personal information circulates among a small group of people who know you well, its significance can

Do you find yourself looking over your shoulder when you are surfing the Internet? Maybe you should.

be weighed against other aspects of your personality and character. But when your browsing habits or e-mail messages are exposed to strangers, you may be reduced, in their eyes, to nothing more than the most salacious book you once read or the most vulgar joke you once told. And even if your Internet browsing isn't in any way embarrassing, you run the risk of being stereotyped as the kind of person who would read a particular book or listen to a particular song. Your public identity may be distorted by fragments of information that have little to do with how you define yourself. In a world where citizens are bombarded with information, people form impressions quickly, based on sound bites, and these brief impressions tend to oversimplifY and misrepresent our complicated and often contradictory characters. The sociologist Georg Simmel observed nearly 100 years ago that people are often more comfortable confiding in strangers than in friends, colleagues or neighbors. Confessions to strangers are cost-free because strangers move on; you never expect to see them again, so you are not inhibited by embarrassment or shame. In many ways the Internet is a technological manifestation ofthe phenomenon of the stranger. There's no reason to fear the disclosure of intimate information to faceless websites as long as those websites have no motive or ability to collate the data into a personally identifiable profile that could be disclosed to anyone you actually know. By contrast, the prospect that your real identity might be linked to permanent databases of your online-and offline-behavior is chilling, because the databases could be bought, subpoenaed or traded by employers, insurance companies, ex-spouses and others who have the ability to affect your life in profound ways. The retreat of Double Click may seem like victory for privacy, but it is only an early battle in a much larger war--one in which many expect privacy to be vanquished. "You already have zero privacy-get over it," Scott McNealy, the CEO of Sun Microsystems, memorably remarked last year in response to a question at a news conference introducing a new interactive technology called Jini. Sun's rosy website promises to usher in the "networked home" of the future, in which the company's "gateway" software will operate "like a congenial party host inside the home to help consumer appliances communicate intelligently with each other and with outside networks." In this chatty new world of electronic networking, your refrigerator and coffee maker can talk to your television, and all can be monitored from your office computer. The incessant information exchanged by these gossiping appliances might, of course, generate detailed records of the most intimate aspects of your daily life. Your liquor cabinet might tell Pinkdot.com, the online grocer, that you are low on whiskey, prompting your television to start blaring

ads for Alcoholics Anonymous. But this may not be what Sun Microsystems has in mind when it boasts about the pleasures of the "connected family." New evidence seems to emerge every day to support McNealy's grim verdict about the triumph of online surveillance technology over privacy. A former colleague of mine who runs a website for political junkies recently sent me the "data trail" statistics that he receives each week. They disclose not only the Internet addresses of individual browsers who visit his site, clearly identifying their universities or corporate employers, but also the websites each user visited previously and the articles he or she downloaded there. And it is increasingly common to find programs in the workplace that report back to a central server all the Internet addresses that employees visit. After the respected dean ofthe Harvard Divinity School was forced to step down in 1998 for downloading pornography on his home computer, a former Harvard computer technician wrote an article for Salon, the online magazine, criticizing his former colleagues for snitching on the dean. "In the server room of one of my part-time jobs," the techie confessed, "I noticed that a program called Gatekeeper displayed all the Internet usage in the office as it happened. I sat and watched people send e-mail, buy and sell stocks on e-trade and download pictures of Celine Dion. If I had wanted I could have traced this usage back to the individual user." survey of nearly a thousand large companies conducted last year by the American Management Association found that 45 percent monitored the e-mail, computer files or phone calls of their workers, up from 35 percent two years earlier. Some companies use Olwellian computer software with names like Assentor or Investigator, available for as little as $99, that can monitor and record every keystroke on the computer with videolike precision. These viliual snoops can also be programmed to screen all incoming and outgoing e-mail for forbidden words and phrases-involving racism, body patts or the name of your boss-and can forward suspicious messages to a supervisor for review. E-mail can be resurrected from computer hard drives even after it has ostensibly been deleted. And companies are increasingly monitoring jokes and e-mail sent from home as well as work over company servers. The most common justification for Internet and e-mail monitoriJlg in the workplace is fear of liability under sexual harassment law, which requires companies to protect workers from speech that might be construed to create a "hostile or offensive working environment." Because employers can't be sure in advance what sort of e-mail or web browsing a particular employee might find offensive, they have an incentive to monitor far more Internet activity than the law actually forbids. Changes in the delivery of books, music and television are extending the technologies of surveillance beyond the office, blurring the boundaries between work and home. Last summer, for example, Amazon.com was criticized for a feature that uses ZIP codes and domain names to identify the most popular books purchased online by employees at prominent corporations. (The top

choice at Charles Schwab: Memoirs of a Geisha.) And anonymous browsing continues to be under assault. The Sprint wireless web phone that I bought in March promptly revealed my new telephone number to Amazon's pre-programmed website when I dialed in the hope of discreetly looking for ordering information about my new book. The same technologies that are making it possible to download digitally stored books, CDs and movies directly onto our hard drives will soon make it possible for publishers and entertainment companies to record and monitor our browsing habits with unsettling specificity. "Snitchware" programs can track not only which books you read but also how many times you read them, charging different royalties based on whether you copy from the book or forward part of it to a friend. Television, too, is being redesigned to create precise records of our viewing habits. A new electronic device known as a personal video recorder makes it possible to store up to 30 hours of television programs; it also enables viewers to skip commercials and to create their own lineups. One of the current models, TiVo, establishes viewer profiles that it then uses to make viewing suggestions and to record future shows. And in a world where media conglomerates like AOL-Time Warner can monitor your activities in cyberspace and then use your browsing habits to determine the content that is beamed to you through television, books, movies and magazines, the integrated media box of the future may have surveillance capabilities that make DoubleClick's database look benign. As if that weren't bad enough, Globally Unique Identifiers, or GUIDs, are making it possible to link every document you create, message you e-mail and chat you post with your real-world identity. GUIDs are a kind of serial number that can be linked with your name and e-mail address when you register online for a product or service. Last ovember, RealJukebox, one of the most popular Internet music players, with 30 million registered users, became a focus of media attention when privacy advocates noted that the player could relay information to its parent company, RealNetworks, about the music each user downloaded, and that this could be matched with a unique ID number that pinpointed the user's identity. At a conference about privacy in cyberspace held at the Stanford Law School in February, a lawyer for RealNetworks, Bob Kimball, insisted that the company had never, in fact, matched the GUIDs with the data about music preferences. Neveltheless, hours after the media outcry began, RealNetworks disabled the GUIDs to avoid a DoubleClick-like public relations debacle. But some currently available software products, like Microsoft's Word 97 and Powerpoint 97, embed unique identifiers into every document. Soon, all documents created electronically may have invisible markings that can be traced back to the author or recipient. There is nothing new about the fear that technologies of surveillance and communication are altering the nature of privacy. A hundred years ago, in the most famous essay on privacy ever written, Louis D. Brandeis and Samuel Warren worried that new media technologies-in particular the invention of instant photographs and the tabloid press-were invading "the sacred

precincts of private and domestic life." What outraged Brandeis and Warren was a mild society item in Boston's Saturday Evening Gazette that described a lavish breakfast party that Warren himself had put on for his daughter's wedding. Although the information wasn't inherently salacious, Brandeis and Warren were appalled that a domestic ceremony would be described in a gossip column and discussed by strangers. At the beginning of the 21st century, the Internet has vastly expanded the aspects of private life that can be monitored and recorded. As a result, cyberspace has increased the danger that personal infOimation originally disclosed to friends and colleagues may be exposed to, and misinterpreted by, a less-understanding audience. Gossip that in Brandeis and Warren's day might have taken place in a drawing room is now recorded in a chat room and can be retrieved years later anywhere on earth. Several months ago, for example, the Washington Post described the case of James Rutt, a man who worried that his Internet past might be misconstrued if taken out of context. Rutt had spent years unburdening himself in a chat group. Although he had been happy to speak candidly in the sympathetic confines of a space characterized as "a virtual corner bar," once he was appointed to a new position as CEO of Network Solutions Inc., he feared that his musings about sex, politics and his own weight problem might embarrass him, or worse. Fortunately for Rutt, the chat group offered a special software feature called Scribble that allowed him to erase a decade of his own postings. But as intimate information about our lives is increasingly recorded, archived and not easily deleted, there is a growing danger that a part of our identities will come to be mistaken for who we are. In certain circles today it's not uncommon for prospective romantic partners, before going out on dates, to perform background checks on each other, scouring the Internet for as much personal information as possible. And these searches can be a deal-breaker: a friend of mine, after being set up on a blind date, ran an Internet search and discovered that her prospective partner hao been described in an article for an online magazine as one of the 10 worst dates of all time; the atticle included intimate details about his sexual equipment and performance that she was unable to banish from her mind during their first-and only-dinner. These are the sorts of details, of course, that friends often exchange in informal gossip networks. The difference now is that the most intimate personal information is often recorded indelibly and can be retrieved with chilling efficiency by strangers around the globe. In a famous essay on reputation published in 1890, E.L. Godkin, the editor of The Nation, elaborated on the distinction between oral and written gossip. As long as

gossip was oral, and circulated among acquaintances rather than strangers, Godkin wrote, its objects were often spared the mortification of knowing they were being gossiped about. Oral gossip is a flexible way of enforcing communal norms while still respecting privacy. When neighbors gossip about one another's intimate activities, those who behave badly will soon feel the indirect effects of social disapproval. The wrongdoers can then con'ect their misbehavior without feeling that their public faces have been assaulted. And because all of the relevant parties know one another well based on close personal observation, individual transgressions can be weighed against the broader picture of an individual's personality. Cyberspace, however, has blurred the distinction between oral and written gossip by recording and publishing the kind of private information that used to be exchanged around the water cooler. Unlike oral gossip, Internet gossip is hard to answer, beyberspace has cause its potential audience is anonymous and unbounded. A website blurred the distinction called Disgruntled Housewife, for between oral and exatnple, offers an appalling feature written gossip by' designed to promote "giriy solidarity recording and through bile-spewing," in which publishing the kind women from around the country write in to describe the most intimate of private information secrets of former lovers they dislike. that used to be (The men are identified by their exchanged around hometowns and sometimes by their the water cooler. full names, a few letters of which are fatuously omitted.) Furthermore, when gossip is archived, it can come back to haunt you. If, in a moment of youthful enthusiasm, I posted intemperate comments to an Internet news group, those comments could be retrieved years later simply by typing my name or Internet protocol address into a popular search engine. For more and more citizens the most important way of exchanging gossip is e-mail. But instead of giving private e-mail the same legal protections as private letters, COUltSare increasingly treating e-mail as if it were no more private than a postcard. In an entirely circular legal test, the U.S. Supreme COutt has held that constitutional protections against unreasonable searches depend on whether citizens have subjective expectations of privacy that society is prepared to accept as reasonable. This means that as technologies of surveillance and data collection have become ever more intrusive, expectations of privacy have naturally diminished, with a corresponding reduction in constitutional protections. More recently, comts have held that merely by adopting a written policy that warns employees that their e-mail may be monitored, employers will lower expectations

of privacy in a way that gives them virtually unlimited discretion to monitor whatever they please. Even when employers promise to respect the privacy of e-mail, courts are upholding their right to break their promises without warning. A few years ago in a case in Pennsylvania, the Pillsbury Company repeatedly promised its employees that all e-mail would remain confidential and that no employee would be fired based on intercepted e-mail. Michael Smyth, a Pillsbury employee, received an e-mail message from his supervisor over the company's computer network, which he rea4~at home. Relying on the company's promise about the privacy of e-mail, he sent a heated reply to the supervisor, supposedly saying at one point that he felt like killing "the backstabbing bastards" on the sales force, and referring to a holiday party as the "Jim Jones Kool-Aid affair." espite the company's promises, it proceeded to retrieve from its computers dozens of e-mail messages that Smyth had sent and received, and then fired him for transmitting "inappropriate and unprofessional comments." Smyth sued, arguing that the company had invaded his right to privacy by firing him. But the court blithely dismissed his claim on the grounds that Pillsbury owned the computer system and therefore could intercept e-mail sent from home or work without invading its workers' legitimate expectations of privacy. This can't be right. I'm at home as I type these words, but the computer on which I'm typing is owned by the law school I teach at, as is the network that supplies my e-mail access. I would be appalled if anyone suggested that the provision ot these research tools gave my law school the right to monitor all the e-mail I send and receive. In 1877, the Supreme Court held that postal inspectors need a search warrant to open first-class mail, regardless of whether it is sent from the office or from home. And searches of e-mail can be even more invasive than searches of written letters. Georg Simmel wrote about the ways in which written letters are peculiarly subject to misinterpretation. Because letters lack the contextual accompaniments-"sound of voice, tone, gesture, facial expression"-that, in spoken conversation, are a source of clarification, Simmel argued, letters can be more easily misinterpreted than speech. With e-mail, the possibilities of misinterpretation are even more acute. E-mail combines the intimacy of the telephone with the infinite retrievability of a letter. And because e-mail messages are often dashed off quickly, they may, when taken out of context, provide an inaccurate window onto someone's emotions. In 1997, for example, Judge Thomas Penfield Jackson chose Lawrence Lessig of Harvard Law School to advise him in overseeing the antitrust dispute between the government and Microsoft. When Microsoft challenged Lessig's appointment as a "special master," Netscape officials turned over to the Justice Department an e-mail message that Lessig had written to an acquaintance at Netscape in which he joked that he had "sold my soul" by downloading Microsoft's Internet Explorer. The Justice

Department, in turn, gave Lessig's e-mail to Microsoft, which claimed he was biased and demanded his resignation. In fact, Lessig's e-mail had been quoted out of context. As the full text of the e-mail makes clear, Lessig had downloaded Microsoft's Internet Explorer to enter a contest to win a PowerBook. After installing the Explorer, he discovered that his Netscape bookmarks had been erased. In a moment of frustration, he fired off the e-mail to the Netscape acquaintance, whom he had met at a cyberspace conference, describing what had happened and quoting a Jill Sobule song that had been playing on his car stereo: "Sold my soul, and nothing happened." And although a court ultimately required Les'sig to step down as a special master for technical reasons having nothing to do with his misinterpreted e-mail, he discovered that strangers were left with the erroneous impression that the e-mail "proved" that he was biased, and that this forced him to resign. The experience taught Lessig that in a world where most electronic footsteps are recorded and all records can be instantly retrieved, it is very easy for sentiments to be taken out of their original context by people who want to do someone ill. "The thing I felt most about the Microsoft case was not the actual invasion (as I said, I didn't really consider it an invasion)," Lessig wrote in an e-mail message to me after the ordeal. "Wh.at I hated most was that the issue was just not important enough for people to understand enough to understand the truth. It deserved one second of the nation's attention, but to understand the issue would have required at least a minute's consideration. But I didn't get, and didn't deserve, a minute's consideration. Thus, for most, the truth was lost." Lessig felt ill treated, in short, not because he wasn't able to explain himself, but because in a world of short attention spans, he was never given the chance. In what might be seen as poetic justice, Microsoft itself was embarrassed in the antitrust trial that followed when e-mail from top executives, from Bill Gates on down, was turned over to the government and introduced in court. Unchastened by my friend Lessig's experience, I behave as if my online life isn't virtually transparent, even though I understand on some level that it is. Not long ago, I visited my law school's computer center to find out how many of my online activities were in fact being monitored. "If! happen to be in the server room, I can watch you send e-mail, and I'll know who you're sending it to," said the discreet head of the center. Beyond that, I was pleased to learn, the law school has decided not to install the programs that many companies use to monitor the browsing, reading and writing of their employees in real time, or to make regular copies of hard drives, including the cache files that record all the Internet documents a user has downloaded. But if I, like the former dean of Harvard Divinity School, asked school technicians to repair my home computer, the school would be able to reconstruct my personal and professional online activities with telescopic precision. Perhaps the only sane response to the new technologies of surveillance in cyberspace is unapologetic paranoia. If so, my candidate for the perfectly rational man is K., one of my former students. K. wears green Army fatigues and black boots and

spends much of his day shredding and covering his electronic tracks. "In my home office, I have five computers with AtGuard personal firewalls," he explained to me not long ago. "With AtGuard you can monitor how many backdoors you have open to the Internet, so if someone is spying on you with a hacking program like BackOrifice or NetBus, you can kill that connection." Whenever a website tries to send K. a cookie, AtGuard fires back a cookie that says, "Keep your cookies offmy hard drive." Aware that files and e-mail can be resurrected from his hard drive even after they are deleted, K. also uses a suite of security tools called Kremlin. Every time K. turns off his computer, Kremlin does a "secure total wipe" of his 20 gigabyte hard drive, scribbling electronic graffiti, in the form of zeroes and ones, over all the free space so that any lurking, partly deleted files will be render~d illegible. This takes more than an hour. K. also uses Kremlin to encrypt his personal documents in a secure folder on his hard drive, and he carefully chose a nonsense password, garbled with upper- and lowercase letters and numbers, so that it can't easily be cracked by a "brute force attack program" that might hypothetically bombard his computer with millions of random words generated from an electronic dictionary. Impressed by his vigilance, I asked K. what, precisely, he was trying to hide. "It's more an ideological act than anything else," he said. "I know that I can be surveilled at all times, so I feel like I have a responsibility to resist." ot everyone agrees that there is reason to resist the brave new world of virtual exposure. This is, after all, an exhibitionistic culture in which people cheerfully enact the most intimate moments of their daily lives on web cams and on Fox TV. It is a culture in which 2,000 confessional souls have chosen to post their most private thoughts on a site called Diarist.net, which boasts, "We've got everything you need to know all about the people who tell all." Defenders of transparency argue that there's no reason to worry about privacy if you have nothing to hide and that more information, rather than less, is the best way to protect us against being judged out of context. We might think differently about a Charles Schwab employee who ordered the eminently respectable Memoirs of a Geisha from Amazon.com, for example, if we knew that she also listened to the Doors and subscribed to Popular Mechanics. But the defenders of transparency are confusing secrecy with privacy, and secrecy is only a small dimension of privacy. Even if we saw an Amazon.com profile of everything the Charles Schwab employee had read and downloaded this week, we wouldn't come close to knowing who she really is. (Instead, we would misjudge her in all SOlis of new ways.) In a surreal world where complete logs of every citizen's reading habits were

available on the Internet, the limits of other citizens' attention spans would guarantee that no one could focus long enough to read someone else's browsing logs from beginning to end. Instead, overwhelmed by information, citizens would change the channel or click to a more interesting website. Even the most sophisticated surveillance technologies can't begin to absorb, analyze and understand the sheer volume of information. The Federal Bureau of Investigation (FBI) recently asked U.S. Congress for $75 million to finance a series of surveillance systems, including a new project called Digital Storm, which will allow it to vastly expand its recordings of foreign and domestic telephone and cell-phone calls, after receiving judicial authorization. But because it can't possibly hire enough agents to listen to the recordings from beginning to end, the FBI plans to use "data mining" technology to search for suspicious key words. This greatly increases the risk that information will be taken out of context: as "60 he battle for privacy Minutes" reported, an analyst at the must be fought on Canadian Security Agency identified a mother as a potential terrorist after she many fronts-legal, told a friend on the phone that her son political and had "bombed" in his school play. technologicalFiltered or unfiltered, information taken and each new out of context is no substitute for the genuine knowledge that can emerge only assault must be slowly over time. vigilantly resisted Moreover, defenders of transparency as it occurs. have adopted a unified vision of human personality, which views social masks as a way of misrepresenting the true self. But as the sociologist Erving Goffman argued in the 1960s, this view of personality is simplistic and misleading. Instead of behaving in a way that is consistent with a single character, people reveal different patis of themselves in different contexts. I mayand do-wear different social masks when interacting with my students, my editors, my colleagues and my dry cleaner. Far from being inauthentic, each of these masks helps me try to behave in a manner that is appropriate to the different roles demanded by these different social settings. If these masks were to be violently torn away, what would be exposed is not my true self but the spectacle of a wounded and defenseless man. Goffman also maintained that individuals, like actors in a theater, need backstage areas where they can let down their public masks, tell ditiy jokes, collect themselves and relieve the tensions that are an inevitable pati ofpublic perfOimance. But in the new economy of information exchange, white-collar workers are increasingly forced to work under constant surveillance like the dehu-

manized hero of "The Truman Show," a character who has been placed on an elaborate stage set without his knowledge or consent and whose every move, as he interacts with the actors who have been hired to play his friends and family, is broadcast by hidden video cameras. The inhibiting effects on creativity and efficiency are palpable. Surveys of the health consequences of monitoring in the workplace suggest that electronically-monitored workers experience higher levels of depression, tension and anxiety and lower levels of productivity than those who are not monitored. Unsure about when, precisely, electronic monitoring may take place, employees will necessarily be far more guarded and less spontaneous, and the increased formal ity of conversation and e-mail can make communihe ability to expose cation less efficient. in some contexts Moreover, spying on people without their aspects of our knowledge is an indigidentity that we nity. It fails to treat its conceal in other objects as fully deservcontexts is ing of respect and treats indispensable to them instead like animals in a zoo, deceiving freedom, friendship them about the nature of and love. their own surroundings. In The Unbearable

Lightness

Being,

Milan Kundera describes how the police destroyed an impOliant figure of the Prague Spring by recording his conversations with a friend and then broadcasting them as a radio serial. Reflecting on his novel in an essay on privacy, Kundera writes, "Instantly Prochazka was discredited: because in private, a person says all sorts of things, slurs friends, uses coarse language, acts silly, tells dirty jokes, repeats himself, makes a companion laugh by shocking him with outrageous talk, floats heretical ideas he'd never admit in public and so forth." Freedom is impossible in a society that refuses to respect the fact that "we act different in private than in public," Kundera argues, a reality that he calls "the very ground of the life of the individual." By requiring citizens to live in glass houses without curtains, totalitarian societies deny their status as individuals, and "this transfOlmation of a man from subject to object is experienced as shame." A liberal state should respect the distinction between public and private speech because it recognizes that the ability to expose in some contexts aspects of our identity that we conceal in other contexts is indispensable to freedom, friendship and love. Friendship and romantic love can't be achieved without intimacy and intimacy,

in turn, depends upon the selective and voluntary disclosure of personal information that we don't share with everyone else. Also, as Kundera recognized, privacy is necessary for the development of human individuality. Any writer will understand the impoliance of reflective solitude in refining arguments and making unexpected connections. (In an odd but widely shared experience, many of us seem to have our best ideas when we are in the shower.) Indeed, studies of creativity show that it's during periods of daydreaming and seclusion that the most creative thought takes place, as individuals allow ideas and impressions to run freely through their minds without fear that their untested thoughts will be exposed and taken out of context. It is surprising how recently changes in law and technology have been permitted to undermine sanctuaries of privacy that Americans have long taken for granted. Even more surprising has been our relatively tepid response to the new technologies of exposure. There is no reason to surrender to technological determinism; no reason to accept the smug conclusion of Silicon Valley that in the war between privacy and technology, privacy is doomed. On the contrary, a range oftechnological~ legal and political responses might help us rebuild in cyberspace some of the privacy and anonymity that we demand in real space. The most effective responses may be forms of selfhelp that allow citizens to cover their electronic tracks, along the lines of the Kremlin technology that my student K. uses to scour his hard drive or the Scribble technology that James Rutt used to erase his own chat. The fact that路e-mail, for example, is hard to delete and easy to retrieve is pmily a consequence of cunent technology, and technology can change. Companies with names like Disappearing Inc. and ZipLip have introduced a form of self-deleting e-mail that uses encryption technology to make messages nearly impossible to read soon after they are received. When I send you a message, Disappearing Inc. scrambles the e-mail with an encrypted key and then gives you the same key to unscramble it. I can specify how long I want the key to exist, and after the key is destroyed, the message can't be read without a herculean code-breaking effort. At the moment the most advanced technology of anonymity and pseudonymity in cyberspace is offered by companies like Zero-Knowledge Systems, which is based in Montreal. For a modest fee, you can disaggregate your identity with a software package called Freedom, which initially gives you five digital pseudonyms, or "nyms," that you can assign to different activities, from discussing politics to surfing the web. (Why any of us needs five pseudonyms isn't entirely clear, but the enthusiasm of the privacy idealists is sweet in its way.) On the Freedom system, no one, not

even Zero-Knowledge itself, can trace your pseudonyms back to your actual identity. "You can trust us because we're not asking you to trust us," says Austin Hill, Zero-Knowledge's 26-year-old president. Hill has a messianic air about his role in vindicating what he considers to be the universal human rights of privacy, free speech and the possibility of redemption in a world where youthful errors can follow you for the rest of your life. "Twenty years from now, I'm going to be able to talk to my grandkids and say I played an instrumental role in making the world a better place," he says. "As the Blues Brothers say, everyone here feels that we're on a mission from God." Freedom makes traceability difficult by encrypting e-mail and web-browsing requests and sending them through at least three intermediary routers on the way to their final destinations: each message is wrapped like an onion in three layers of cryptography, and each router can peel off only one layer of the onion to learn the next stop in the path of the message: Because no single router knows both the source of the message and its destination, the identity of the sender and the recipient is difficult to link. ZeroKnowledge assigns pseudonyms using the same teclmology, and so the company itself can't link the pseudonyms to individual users; if it is subpoenaed it can only turn over a list of its customers, who can hope for anonymity in numbers. But should people be forced to resort to esoteric encryption technology with names like ZipLip and Zero-Knowledge every time they want to send e-mail or browse the web? Until anonymous browsers become widespread enough to be socially acceptable, their Austin Powers-like aura may deter all but the most secretive users who have something serious to hide. Moreover, every technological advance for privacy will eventually provoke a technological response. For this reason, some privacy advocates, like Marc Rotenberg, the director of the Electronic Privacy Information Center, argue that anonymity on the Internet should be a legal right, rather than something achieved with a commercial product. Americans increasingly seem to agree that Congress should save us from the worst excesses of online profiling. In a Business Week/Harris poll conducted last March, 57 percent ofthe respondents said that the goyernment should pass laws regulating how personal information can be collected and used on the Internet. The European Union, for example, has adopted the principle that information gathered for one purpose can't be sold or disclosed for another purpose without the consent of the individual concerned. But efforts to pass comprehensive privacy legislation in the United States have long been thwarted by a political reality: the beneficiaries of privacy-all of us, in the abstract-are anonymous and diffuse, while the corporate opponents of privacy are well organized and well heeled. In the hope that the political tide may be turning, Senator Robert Torricelli has introduced a bill that would forbid a website to collect or sell personal data unless users checked a box allowing it to do so. This "opt in" proposal has been vigorously and successfully resisted by the e-commerce lobby, which insists that

it would cripple the use of online profiling and cause advertising revenues to plummet. The e-commerce lobby prefers a more modest Senate proposal that would require websites to display a clearly marked box allowing users to "opt out" of data collection and resale. But it's not clear that "opt out" proposals would provide meaningful protection for privacy. Many users, when confronted with boilerplate privacy policies, tend to click past them as quickly as teenage boys click past the age certification screens on X-rated websites. Moreover, many people seem happy to waive their privacy rights in exchange for free stuff. There is now a cottage industry of companies that offer their users product discounts, giveaways or even cash in exchange for permission to track, record and profile every move they make, and to bombard them with targeted ads on the basis of their proclivities. his

is.about as rational as allowing a camera into your bedroom in exchange for a free toaster. But it's easy to forget why privacy is important until information you care about is taken out of context, and by that point, it's usually too late. In cyberspace, as in cheap hon"or movies, your ghosts can rise up to haunt youjust when you think the danger has passed. There is no single solution to the erosion of privacy in cyber' space: no single law that can be proposed or single technology that can be invented to stop the profilers and surveillants in their tracks. The battle for privacy must be fought on many frontslegal, political and technological-and each new assault must be vigilantly resisted as it occurs. But the history of political responses to new technologies of surveillance provides some grounds for hope. Although Americans are seldom roused to defend privacy in the abstract, the most illliberal and intrusive technologies of surveillance have, in fact, provoked political outrage that has forced the data collectors to retreat. In 1967, after the federal government proposed to create a national data center that would store personal information from the IRS (Internal Revenue Service), the census and labor bureaus and the Social Security administration, Vance Packard wrote an influential article that helped to kill the plan. We are trained in this country to think of all concealment as a form of hypocrisy. But we are beginning to learn about how much may be lost in a culture of transparency-the capacity for creativity and eccentricity, for the development of self and soul, for understanding, friendship and even love. Perhaps someday we will look back with nostalgia on a society that still believed opacity was possible and was shocked to discover what happened when it was not. There is nothing inevitable about the erosion of privacy in cyberspace, however, just as there is nothing inevitable about its reconstruction. We have the ability to rebui Id some of the private spaces we have lost. What we need now is the will. D About the Author: Jefji-ey Rosen is an associate professor at the George Washington University Law School and the legal affairs editor of The New Republic. This article is adaptedji-om his recent book The Unwanted Gaze: The Destruction of Privacy in America.

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technology that will cashier the linguists, mathematicians and hackers who have traditionally devoted themselves to breaking codes comes with a cool name: quantwn cryptography. Ordinary cryptographic systems rely on scrambling messages so thoroughly that only a recipient with a code key can unscramble them. Quantum cryptography uses random eodes lacking in any pattern that might offer clues to a code breaker. More important, it allows the parties transmitting the code to send it without the fear that it might be intercepted without their knowledge. The result? Unprecedented secrecy an9 security-two commodities that are increasingly rare in a world dominated by the free flow of information. For futurists, the development of quantum cryptography is a kind of cosmic victory for personal privacy. Quantum cryptography is more powerful than any computer or eavesdropping equipment that could ever be built. Its impregnability stems from one of the quantum world's weirder but better-known features: that merely observing a quantum system changes it irreversibly. In the realm of quantum mechanics, measuring any system-coded pulses of light, for example, in a fiberoptic cable that is infiltrated by a spy-leaves an unalterable trace that immediately betrays the presence of an eavesdropper. In ordinary communications, the pulses are relatively bright, containing zillions of photons. A spy can siphon some of the light from the pulses without being noticed. Quantum cryptographers send pulses so faint that they go through the line one by one. Each pulse that a spy observes is altered in a way-that is obvious to the intended recipient. The beauty of the system is that two branches of a bank, say, do not actually have to send the record of a transaction itself. The two branches simply work up a long string of random numbers known only to them, using the faint laser pulses. Those numbers act as a code to encrypt the digital version of a transaction. The encrypted version can be sent over just about any sort of communication line. Cryptographers knew by the 1920s that a completely random code, used just once, is unbreakable. The code is not the meaningful information itself-just a shared string of nonsense numbers. Once added to a true message, another stream of nonsense results. Only if the code is substracted does the information emerge for the recipient. One way to effect the quantum system is using special crystals that in essence "clone" a single photon into two photons with identical properties. This cloned state lets the code's sender and recipient-traditionally called Alice and Bob--generate the code. How does this work? One of the most popular methods has to do with the polarization of photons. When you turn a pair of Polaroid sunglasses in the sun, the glare you see reflected on the

sidewalk is the result of photons being polarized in different directions-vertically or horizontally, for example. The quantum twist on this idea is that the photons' actual polarization cannot be known until they are actually measured as a quantity. The polarization of a series of photons passing through the crystal is random-sometimes horizontal, sometimes vertical. It is this randomness that enables codemakers to create the perfect code. So, to make the code, Alice fires a photon into the crystals and collects one of the two that come out. She sends the other photon to Bob. Both parties then place a detector behind the equivalent of Polaroid sunglasses; each orients his or her glasses horizontally, then vertically, in a random sequence. Only if both Alice and Bob guess right for a particular photon do they get a detection. After performing this operation on zillions of photons, Alice and Bob discuss at what point they made detections. Simultaneous detections tell them that they've used the same polarizer settings, because the photons are identical. In comparing their results, Alice and Bob do not reveal what the settings actually were in the cases when their results matched. They simply agree that they will convert each vertical detection into a binary 0 and each horizontal into a binary 1. Only Alice and Bob know what the actual series is. If an eavesdropper-usually called Eve-has succeeded in intercepting some ofthe photons, Alice and Bob can discover her interference by comparing just a few of their measurements. If their vertical and horizontal detections do not all match, they know that the quantwn system has been breached and that they should discard the code. Some professional cryptographers look askance at quantum cryptography, pointing out that leaks will still occur, as they have throughout history, when people use codes incorrectly or spill information after they have been deciphered. Moreover, the method's practitioners-notably Richard Hughes at Los Alamos National Laboratory and Nicolas Gisin at the University of Geneva-have been able to transmit codes, using the faint pulses of laser light, across a distance of only 50 kilometers. Still, chances are good that quantum cryptography will be in use in a decade or so. Like most new technologies, it will probably be used first by those with the power and the resources to deploy it: international banks and nuclear command centers. Of course, as the technology becomes more practical, it should seep down to individuals. Then, the details of life that have been laid bare in recent years to snooping-e-mail, credit card numbers, financial records, purchases-will be returned to their rightful place, to the realm of absolute privacy. 0 About the Author: James Glanz is a science writer who frequently contributes to The New York Times.

n the past, countries spoke of being trading partners. A better yardstick of how integrated economies are is the amount of technology and know-how they exchange. In a manner that no one had predicted even a decade ago, India and the United States have become fellow travelers in the information age. Or, to put it otherwise, the two countries have become "knowledge partners." This was

an underlying theme during the recent state visit by Prime Minister Atal Bihari Vajpayee to the United States. Addressing the U.S. Congress during his visit in September, Vajpayee said, "Measured in terms of the industries of tomorrow, we are together defining the partnerships of the future." President Bill Clinton gave a simple example of this

aspect ofIndo-U.S. relationship during the state dinner he hosted in honor ofVajpayee in the White House. "When Americans call Microsoft for customer support today, they're as likely to be talking to someone in Bangalore or Hyderabad as to someone in Seattle," he said. The most tangible bit of the knowledge conduit between India and the U.S. is composed of optical fibers and silicon. In other words, the two are most closely pat1nered when it comes to information technology. Vajpayee referred to this during his speech to the U.S. Congress. "Today, on the digital map, India and the United States are neighbors and partners. India and the U.S. have taken the lead in shaping the information age." Events surrounding Vajpayee's visit to the U.S. highlighted how the bilateral technology bond is now developing in ways that go far beyond the traditional government-to-government attempts to boost the exchange of goods and capital. For one thing, the knowledge trade has empowered the Indian-American community, providing them with a hard-nosed economic stake in Indo-U.S. relations. In a recent interview with the Los Angeles Times during a visit to California, the Minister for External Affairs Jaswant Singh said, "Americans of Indian origin have acted as a catalyst to Indo-U.S. relations that even I didn't see 10 years ago." He had no doubts what had made the difference. "What has been the catalyst? Knowledge-based industry," he said. Singh echoed the comments of the Vice President and Democratic presidential candidate Al Gore, during the meal Gore hosted for Vajpayee in September. Gore said, "Indian-Americans have been at the forefront of the information revolution." He could have added that his own campaign website is hosted by Exodus Communications, a multibillion-dollar Silicon Valley firm founded by two south Indian immigrants to the U.S. The Prime Minister, while speaking to a group of Indian-Americans at Blair House, lavishly praised their cyberaccomplishments, saying "You, IndianAmerican entrepreneurs, have shown with your successes in information technology

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Q that East and West can not only meet, but they will meet on equal terms!" Vajpayee went on to say how they had transformed the image of Indians in the U.S. and were now inspiring a younger generation of Indians at home. Though Vajpayee's health disallowed him from traveling to California and putting his personal stamp on the IndoU.S. knowledge partnership by visiting and speaking at Silicon Valley, there was no shortage of action at the level of ~ private businesses and individuals in ยง September. The second session of the ~ U.S.-India Commercial Dialogue was held during Vajpayee's visit and saw four development agreements signed on areas ranging from energy to electronic commerce. A number of meetings were held to enhance the Knowledge Trade Initiative launched during Clinton's earlier summit meeting in India. The bilateral industry working group, that included the Federation of Indian Chambers of Commerce and Industry (FICCI) and the United States India Business Council, had met in San Francisco a few months before Vajpayee's visit. A FICCI account of the meeting said the meeting's strong emphasis on the New Economy was its "most striking develop-

Top and above: Prime Minister A tal Bihari Vajpayee addresses a joint session of the Us. Congress on Capitol Hill, September 14, 2000.

ment." According to FICCI, "There is a clear convergence of interest and views on the need for both governments to take steps to liberalize two-way trade in information technology, IT-related services and knowledge-based industries." The September summit's flip side was the steady stream of U.S. knowledge industry heads who made their way to India. It was a real measure of the IndoU.S. knowledge partnership that their visits had little connection with the diplomacy going on in Washington. They came to India for purely commercial reasons. The most prominent of them was the founder and Chairman of Microsoft Bill Gates. Gates gave evidence of his deep, and long-term interest in India by holding a conclave with the chief ministers of 10 Indian states, ranging from the largely agrarian state of Haryana to the established information technology exporters like Andhra Pradesh and Karnataka. Gates later said, "It's very healthy that such rivalry exists between Indian states to promote IT." Newspaper reports say the Kamataka Chief Minister, S.M. Krishna, reportedly gave Gates a statue of the Buddha. Krishna told Gates that the Buddha was India's last great export, and information technology would be the next one. Close on Gates' heels came a number of other cyber greats like the head of SGI (formerly known as Silicon Graphics) Robert Bishop, and the chairman of Dell Computers Michael Dell. The head ofIntel had dropped by India earlier in the summer and the head of Cisco Systems is expected to arrive in the next few months. Another visitor was the former head of Apple Computers John Sculley, who commented on India's "good reputation" in the U.S. information technology sector. The private relationship between Indian and U.S. information technology firms is noteworthy because of the way the two sides seem to be able to provide solutions to each other's problems and offer services that fit each other's needs. Thus U.S. service industries that need to hold down their bottom lines but also provide quality customer service are turning to call center firms in India. According to the National Association of Software and Service

Ambassador Richard F. Celeste On Prime Minister Vajpayee's Official Visit to the United States

rime Minister Vajpayee's visit was very, very successful. It not only registered concrete progress in a number of areas, particularly on the economic agenda, but perhaps more importantly, it advanced what President Clinton described as a new chapter in Indo-American relations. When President Clinton was in India he and the Prime Minister signed a Vision Statement and laid out ~ an architecture of our relationship into the future that :;; focused on high-level dialogue befitting two countries ~ that are genuine partners in addressing global concerns. ; When the Prime Minister came to Washington, his ffi visit underscored the importance of this high-level dialogue. It followed almost immediately the second round of talks between Foreign Secretary Lalit Mansingh and Under Secretary of State Thomas Pickering. It was preceded by a few days by a visit by the National Economic Adviser Gene Sperling to meet with Principal Secretary Brajesh Mishra. Both of these senior conversations were manifestations of our commitment to communicate in a regular and highlevel fashion with each other. People ask whether the new day in Indo-U.S. relations will continue beyond a new administration. To me the answer is emphatically yes. That was underscored by the manner in which the leaders of both political parties greeted the Prime Minister when he spoke to a joint session of Congress, and by the keen interest of the leadership of the Senate Foreign Relations Committee and the House International Affairs Committee. That was evident in his session with the Vice President. Continuity was also a theme in each of the exchanges that the Prime Minister had with representatives of our business community and our civic society. Above all, the new warmth in U.S.-India relations was very much on the minds of the Indian-American community who came enthusiastically to welcome the Prime Minister and to express their pride in their country of origin as well as their country of adoption. In some respects, for me, the most memorable events related to the dedication of the Gandhi Memorial in front of the Indian Embassy in Washington, which President Clinton attended, spending half an hour when he had only planned to spend a few minutes. The Prime Minister later spoke to an audience of nearly 1,000, primarily Indian-Americans, who had gathered at a reception and luncheon hosted by the Indian Ambassador Naresh Chandra. You could sense in the air a feeling of pride that moved in both directions: the pride that the Prime Minister felt representing India in the United States and his genuine feeling that we are natural allies, and the pride that Americans felt welcoming him to our country and understanding what this new relationship means for both countries. I would say that the year 2000 marks not only the beginning of the new millennium but also a watershed for our relationship. People will look back on both President Clinton's trip to India in March and the way he was received and Prime Minister Vajpayee's visit to the United States in September and the way he was received as the beginning of a new, important partnership between our two countries. -L.T.

Companies (NASSCOM) and McKinsey Consultants, such call centers could employ 200,000 Indians and provide the country $3.7 billion in earnings by 2008. Amazon.com, the best known dotcom in the world, is among the US. firnls who entrust their customer care to an Indian firm. The call center demand, in turn, is causing problems in India. India is starting to feel a manpower pinch as it is running short of trained call center workers. In response, specialized US. training firms are setting up shop in the subcontinent and providing eight- to 10-week-long courses on how to be a call center worker. Another problem is the lack of broadband facilities in,India, a serious drawback given the high volume of data that call centers handle. So US. finns like Citrix Systems are peddling technology which will allow Indian firms to squeeze more bytes through old telephone lines and low capacity fiber optic links. Citrix's Director Marketing Daniel Heimlich was recently quoted as saying India was a perfect market for the sort of technical backup he provides for long-distance customer servicing and back office operations. And U.S. companies are among the many firms instaling the broadband capacity that India needs. Enron Corporation is largely known among Indians as a power producer. Its latest venture in the country, however, is a $250 million investment to set up or lease broadband facilities in eight Indian states.

he Indo-US. information technology matchup is occurring all along the value addition chain and branching into every sector of the industIy. Indja and the US. may be on opposite ends of the globe. But when it comes to e-security or Internet services or venture capital, they are, to recycle Vajpayee's phrase, neighbors on the digital map. And their proximity increases with the passage of time. Chrysalis Capital's Director Shujaat Khan has said venture capital flows into India reached $100 million last year but given present rates of growth they could well reach $2 billion by 200 I. So strong is the US.-India link that Goldman Sachs issued a report last month

Clockwise from above left: All smiles at a state dinner hosted by the President and First Lady Hillmy Clinton at the White House; getting down to business at a session in the Cabinet Room; Prime Minister Vajpayee and Vice President Al Gore share a quiet moment at a luncheon hosted by the Vice President at the State Department; counterparts meet again: Foreign Minister Jaswant Singh and Secretary of State Madeleine Albright.

Above: Prime Minister Vajpayee and President Clinton during the welcome ceremony on the White House lawns. Far right: The Prime Minister with Benjamin Gilman, Chairman of the House International Relations Commillee. and other members of Congress, September j 4. 2000. Right: The Prime Minister addresses the US.-India Business Summit, organized by CII and the National Association of Manufacturers in New York.

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saying India's information technology industry is overdependent on the U.S. market. Infosys Technologies, one of Bangalore's biggest silicon stars, earns 78 percent of its sales from the U.S. But the dependency is mutual and beneficial. As the Goldman Sachs report acknowledges, India's information technology sector has been able to notch up growth rates of 60 percent a year in large parts because of the buoyancy of the U.S. economy. The

and make it a key contributor to his company's ambitious plans to build an operating system for the Internet, the so-called ".Net project." However, nothing quite matches the enthusiasm the huge service and technology multinational GE has shown for India. The head of GE, Jack Welch, was another person who made a September sojourn to India. While here, Welch announced that his company would set up what is only GE's second multidisciplinary technology center in the world in Bangalore. The other one is in upstate New York. The Bangalore center is expected to become the company's biggest center with a 10-hectare spread, 1,000 scientists and $130 million worth of capital behind it. Economist Jairam Ramesh has called this a "landmark."

reverse link is that the U.S. economy's record long boom is in large part because of its information technology sector and the competitiveness Indian programmers have provided it. As Vajpayee told the U.S. Congress, "Over the last decade, this new technology has sustained American prosperity in a way that has challenged conventional wisdom of economic growth." The Indo-U.S. knowledge partnership is also spreading into other sectors. The

elch has no doubts about GE's decision to invest so much in India's brainpower potential. .~ He first came to India in 1989 and kept ~ coming back. By 1995 he was publicly saying India had the "intellectual infrastructure" of a developed nation. Over ~ time, GE has become the single largest ; buyer of Indian software-at present it Q buys $250 million worth. Welch says the 路decision to make India his firm's research Confederation ofIndian Industry (Cll), in and development base was made during his last visit to the country. "Our use of a report issued during Vajpayee's visit, cited 10 major economic sectors where [Indian] intellect has far outpaced our wildest dreams .. .India is truly the intelthe two countries could cooperate to boost lectual partner of GE. We do more sourcbilateral trade. Of these, seven were ing of brains from India than any other industries steeped in technology. They country outside the U.S." As far as he was included biotechnology, financial serconcerned, "We are using the intellectual vices, drugs and pharmaceuticals, and capital of the total country." environmental business. No technology It is not as if India and the U.S. are sector is too obscure. No sooner had he neglecting the social consequences of the returned from Washington, Vajpayee was information age. One of the clauses of the speaking before a chemical industry exhibition in New Delhi and talking about joint statement issued during Vajpayee's India's prospects in digital medicine and visit reads: "The two leaders pledged their joint commitment to bridge the digital how the country could attract foreign divide, both within and between couninvestment in that area. tries, so that the benefits of information One ofthe most interesting facets ofthe technology may advance the economic rise of the U.S. and India as knowledge and social development of all citizens, partners is in the realm of pure research rich and poor." Clinton indicated that and development. For example, Gates announced he would triple the size of India was already showing the way when he said at Vajpayee's state dinner, "In Microsoft's Hyderabad research center

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India, the best infOlmation available on maternal health and agriculture can now be downloaded by growing numbers of villages with Internet hookups." New Delhi and Washington will also sponsor two conferences on bridging the digital divide, the first of which will be held in November not too far from Silicon Valley.

ecognizing the stake it has in a steady supply of trained Indian minds, the U.S. information technology industry is also getting into the welfare act. When he came this September, Gates pledged $5 million for rural education in In9ia. The head of Intel had earlier promised to fund thousands of software teachers in the country. The Karnataka chief minister has made a proposal to Gates that goes the whole hog. He asked Microsoft to partner his state government in two areas: spreading e-governance and providing technical and managerial support for various public projects. Finally, he urged that the Bill and Melissa Gates Foundation consider funding the bringing of information technology to 50,000 schools throughout his state. Whether at the private or at the government level, both India and the U.S. are determined to deepen and broaden their knowledge partnership. In an article on Indo-U.S. relations published by International Herald Tribune in September, Vajpayee urged that "Barriers to mutually enriching science and technology must be removed to promote creativity and knowledge to the full." Almost on cue, the U.S. Congress, by overwhelming margins in both houses, passed a bill this month raising the ceiling on the number of H-l B visas-the commonest immigration route for itinerant Indian software programmers to work in the U.S.-to an all time high of 195,000 per year for a period of three years. 0 About the Author: Pram it Pal Chaudhuri is an associate editor of the Hindustan Times in New Delhi.

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President Clinton, sculptor Gautam Pal, Prime Minister Vajpayee and Foreign Minister Jaswant Singh at the unveiling of the Gandhi statue infront of the Indian Embassy, Washington, D.C

Anand Lal Shimpi hat will you call a website which attracts more than 1.5 million hits a day and generates a million dollars in ad revenues? Simply astonishing? What will you call the creator-and the CEOof that site who, at just 17, jets around the country to attend computer conferences, shakes hands with corporate heads and goes to school in his BMW? Just incredible? This is what Anand Lal Shimpi, CEO of AnandTech, Inc., the creator of <www.anandtech.com> does. Anand is the son of Lal Shimpi, who went to Boston from Mumbai with a scholarship to study at the University of Boston in 1976 and worked in a restaurant on quid pro quo for food. Lal Shimpi is now a computer science professor at St. Augustine's College in Raleigh, NOlth Carolina. Anand is inspired by his father and has no qualms in saying, "If my Dad can do it, so can I. My interest in computers came from my father, but my interest in hardware came frQm my mother. She is the handy person in the house interested in electronics and carpentry." Inspirations apart, Anand Shimpi puts in more than 19 hours of hard work in a day starting from 6 and ending around 3 a.m., attending his school and reviewing hardware for his site. "He has always been getting straight As, only since last year he has been getting a few Bs because of the pressure of business," says his father. AnandTech, originally named Anand's Hardware Tech Page, was actually stalted as a guide to upgrading socket-7 system to an AMD K6-based computer. Anand was preparing a guide documenting his upgrade to the K6 and to discuss problems encountered during his upgrade. While he was searching for a vendor from whom he could purchase a decently priced K6, he was quietly taking names and email addresses from users who responded to a posting he made on one of his old favorites, the comp.sys.ibm.pc.hardware.chips newsgroup. He eventually compiled a list of around 50 individuals who expressed interest in receiving a copy of this guide when it was complete. "But, with the fact that the cheapest K6 I could get my hands on was around $700, the guide wasn't going to be completed anytime soon. I felt obligated to supply the 50 people on this list with some sort of information about K6, so with the extra time on my hands now that I had no guide to write, I decided to compile a bit of information about

computer hardware in general as well as the motherboards that would be surrounding the K6's release," says Anand. Anand's Hardware Tech Page was originally hosted on a free Geocities account and moved through 13 different hosts and is currently hosted by Gisystech. His site, anandtech.com, which was initially started to review hardware out of compulsion since he could not afford to buy expensive computer parts, attracted millions of hardware enthusiasts and hardware manufacturers. He opted for hardware to review from the manufacturers instead of money. In a couple of years the ads started pouring in and now a California-based adveltising agency is looking after the site's advertising operations. "Anandtech.com is as good as any other website. What's unique is Anand's age," an Intel spokesman said in one of the Fortune articles. As far as Anand's future is concerned, he is to pursue his engineering studies at NOlth Carolina State University. As far as anandtech.com goes, "Whether it is a $50 product or a $1,000 product it is essentially somebody else's money and you have to be careful when you tell people what to do with their money. When manufacturers submit a product for review they know how tough our standards are and how strict we can be. So they are aware of the risks associated with," says Anand. While showering immense appreciation for the team members at AnandTech, he reserves his ultimate tributes for the people who really read his site. "AnandTech is a growing entity, and we will continue to grow and expand in order to suit the needs of the readers. You all are the reason that I started the site, those 50 individuals who responded to my post on a newsgroup are the true reason why AnandTech exists and the thousands of daily readers are the reason why I as well as the rest of the team keep on cranking out the reviews and articles. There have been quite a few memorable moments in AnandTech's history, but the most memoraple have been those involving you all, the fans and the readers. My goal from the staJt has been to deliver what you all want, and it's a goal that the growing AnandTech team shares as a whole," beams the banner at anandtech.com. It is encouragement not only to hardware shopper but to teenage entrepreneur. -K. Muthukumar

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Feeus President Clinton Signs New H-18 law President Bill Clinton on October 21 signed the new H-1 B visa bill into law. The bill increased the number ofH-18 visas to 585,000 to be issued over the next three years. The U.S. Senate overwhelmingly passed the much-awaited H-lB legislation to allow up to 195,000 highly skilled foreign workers to enter the United States annually on special H-lB visas. The Bill, approved in the Senate by a 96 to 1 vote on October 3, raised the number ofH-lB visas that can be issued annually by the Immigration and Naturalization Service (INS) for the next three years. President Clinton, while signing the legislation, said that the new law recognizes "the importance of allowing additional skilled workers into the United States to work in the shOtt run, while SUPPOlting long-term effOtts to prepare American workers for the jobs of the new economy." The new legislation allows visa requests filed before September 1 to be counted toward 2000 so that 195,000 visas will be available for 2001. The President also signed into law another bill that doubles the application fees that companies will have to pay for H-I B visas: from $500 to $1,000. The additional fund generated through this measure is to be utilized to provide American workers with increased education and training in information technology.

H-lB visa recipients, actively sought by U.S. businesses for hard-to-fill high technology positions, include workers in computer software, electronics and telecommunications, but may also include architects, educators and medical professionals-all of whom must possess at least a bachelor's degree. However, the measure includes a provision for fashion models deemed of "distinguished merit and ability," according to the INS. Under the previous law, the government had issued 115,000 H-] B visas for the fiscal year that ended September 30, 2000, and without a new legislation this number would have dropped to 107,500 and eventually to 65,000 visas in fiscal year 2002.

and customs of the New World," The book provides detailed information regarding the travel formalities and state-wise tourist infOtll1ation. It features a directOly of INS offices, a model immigrant visa application fonTI, INS questions and answers on new affidavit of suppOtt, etc. Arun C. Vakil, author of Gateway to America, is an expert in various aspects of America-its lifestyle, education, history, geography, political systems, visa regulations, etc. Gateway to America at Rs. 300 is available from Indo-American Society, Kitab Mahal, D. Sukhadwala Marg, Mumbai400 001 or Jaico Publishing House, 127 M.G. Road, Mumbai-400 023.

Gatewav to America

Change in Visa Fee

The Mumbai-based Indo-American Society recently published the third edition of its handbook, Gateway to America. The new edition provides useful visa information to all kinds of travelers to the United States, be they first time visitors, students going for higher studies, business visitors, temporary workers or skilled professionals, tOL!rists, and even Indians living in America. In the Foreword, former Ambassador to U.S. and eminent jurist N.A. Palkhivala describes the almanac as "a Solomon's mine of information" that contains advice and insight into the rules, regulations, ways

Due to exchange announced categories November of fees for visas:

change tn the rupee-dollar rate, the U.S. Embassy the revision of visa fee for all of visas with effect from 1,2000. The following is the list immigrant and non-immigrant

Non-immigrant

Visa

Application fee: Issuance fee: Immigrant

Rs.2,115 Rs.3,525

Visa

Application fee: Issuance fee: Returning residents fee:

Rs. 12,220 Rs. 3,055 Rs. 2,350. -A.V.N.

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