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Thursday, 21 March 2013

The placebo effect is present in every medical intervention



The western concept of an autonomous self does not account for how a doctor's beliefs can influence the patient's health
Doctor treats patient
'A contributing factor of the effectiveness of the placebo is the reputation, charisma and convictions of the doctor administrating it.' Photograph: Stockbyte/Getty Images
A recently published study declared that 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy. This is not a scandal because a placebo is an effective, proven intervention that stimulates our bodies' own capacity to heal itself.
The placebo effect is present in every medical intervention, not just those procedures, such as sugar pills, where the placebo effect is the only known agent at work. To understand exactly how it works would be the equivalent of understanding in full how our mind influences our physical heath, and I expect we still have plenty more to discover in that area.
The concept of the self being an autonomous being is a deeply held belief in western civilisation, but we affect each other all the time. If our doctors wholeheartedly believe that the treatments they are giving us have every chance of working, we are more likely to believe it too. I don't know if this is the effect of mirror neurons or quantum physics, but it happens. It's not that the doctor is just a technician treating our disease, but is also a person who influences us. Bedside manner is more than an optional add-on luxury. If a doctor's influence makes us feel more positive about our health, it will make us more optimistic, and our optimism has a direct effect on our health. For example, research has shown our expectations about recuperation or complications significantly serve as self-fulfilling prophecies for how we recover after surgery.
In 1955, the inventor of the double-blind design form of testing, Henry K Beecher, discovered that 35% of patients found satisfactory relief from a placebo. It is thought that a contributing factor of the effectiveness of the placebo is the reputation, charisma and convictions of the doctor administrating it, as these affect a patient's belief system. In Beecher's study, this might have been missing, because the dispenser of the drug would have known that the drug might just be a sugar pill – so this 35% may be a conservative estimate of the efficacy of placebo.
These days, when testing the placebo effect, we can get the MRI scanner in on the act. Tor D Wager conducted a study in 2004 with a placebo cream he told the subjects would take away pain. He then inflicted pain on them and watched them in the scanner. Those who had been given the cream (the control group had nothing) showed "placebo effect patterns" in the prefrontal cortex. This part of the brain activates when anticipating pain relief and triggers a reduction of activity in pain-sensing areas of the brain. Wager suggests that this interplay within the prefrontal cortex may also trigger a release of pain-relieving opioids in the midbrain.
So when you look your toddler in the eye and kiss his boo boo better, you are probably setting this process into play. You could say, "let me trigger a reduction in your pain sensing brain activity", but "mummy kiss it better" works fine.

Cricket - Imran Khan on Pataudi


  

PTI  
Former Pakistan skipper Imran Khan revealed that during his formative years he looked up to Mansoor Ali Khan Pataudi for inspiration.
Addressing a gathering at the Tiger Pataudi Memorial Lecture here on Monday, Imran said there was certain enigma about Tiger Pataudi whose academic qualification was equally noteworthy as his cricketing exploits.
“I grew up admiring two persons. One was my first cousin Javed Burki and the other being Mansoor Ali Khan... The duo played together at the Oxford University about a decade before me.”
“My idol (Burki) would tell me if Mansoor Ali Khan had not lost vision in one eye, he would have broken all the records. The quality of strokes he could play with one eye, mere mortals cannot play...”
He further said that what made Pataudi different was he had quality education along with playing international cricket, something that had helped on the field.
“I had always looked up to him. Excelling in education and playing international sport is the most difficult thing to. It takes incredible willpower. But once you do it you have huge advantage,” he said.
“We were in awe of Tiger. He was so casual. Cricket was not his bread and butter. If it become your profession, you would never take the risk to achieve great heights. You would always try to play safe. You aim high, take risks and develop this fearlessness. What makes you invincible is self-belief.”
Imran believes that Tiger Pataudi's on-field flamboyance had a lot to do with the fact that he believed that cricket was a game which should be enjoyed.
“Tiger treated cricket as something which was to be enjoyed. That's why he was so flamboyant and had the charisma.”

Cricket - Pataudi on field placings for Prasanna



S. DINAKAR
   
VIGNETTES FROM THE PAST: From left: Bishan Singh Bedi, Abid Ali, Mayor of Melborune R.T. Talbot, Erapalli Prasanna and skipper Tiger Pataudi during India’s tour of Australia in 1967-68.
The Hindu ArchivesVIGNETTES FROM THE PAST: From left: Bishan Singh Bedi, Abid Ali, Mayor of Melborune R.T. Talbot, Erapalli Prasanna and skipper Tiger Pataudi during India’s tour of Australia in 1967-68.
Technically and strategically brilliant, Tiger Pataudi was a path-breaking captain for India; he was always a move ahead of his adversary.
An aggressive skipper required an equally attacking bowler as his sword arm. In this context, off-spinning wizard Erapalli Prasanna and Pataudi were kindred spirits.
In the historic clash of 1968 in New Zealand, where India registered its first overseas series triumph, Prasanna claimed 24 wickets in four Tests at 18.79.
In the earlier leg of the tour against a strong Australia team, Prasanna grabbed 25 wickets in four Tests at 27.44.
Pataudi, as Prasanna revealed to The Hindu, was a huge influence on him. The off-spinning great provided us with a fascinating insight into how Pataudi discussed field placings with him.
His logic was that a right-handed batsman must play a leg-spinner on the off-side and an off-spinner on the on-side. He also used to say that unless I turned the ball too much, which would allow the batsman to play me fine, there was no need for a fine-leg.”
Scientific reasoning
Prasanna elaborated, “Initially I had a deep fine-leg and he modified it into a deep square-leg to the right of the umpire.
“If you draw a straight line between the two short-legs, forward and backward which he stationed for me, you would reach the deep square-leg which Tiger had suggested. Everything he said had a scientific reasoning. Then I had a squarish mid-on in the 30-yard circle and a mid-on.
“By making the batsmen reach out for the ball on the off-side with flight, he told me I could have them caught on the on-side if I imparted the right amount of spin,” the off-spinning great said.
Coming up with an example, Prasanna recalled how a silly point was removed for all-rounder Bernard Julien in the dramatic Test at Chepauk in the 1974-75 series. “This was done to provide the batsman a sense of space on the off-side since there was no silly point. Julien reached out and I got him caught and bowled on the on-side.”
Prasanna said, “Tiger made me visualise the field. I asked him why he was not having a long-on for me.
“He answered, ‘if the batsmen try to hit you from down the pitch, the ball, because of the revolutions on it, would travel at a 30-degree angle to be picked up near the 30-yard line at the squarish mid-on. And he said if the batsmen attempted to scoop me out of the park, the drift on the ball would see them play too early and force them to sky it between mid-on and mid-wicket.”
Tiger and Prasanna relished hunting down batsmen. The illustrious off-spinner remembers, “He would have four fielders on the off-side and rarely had a point for me. He would tell me that if the batsmen tried to cut me then I could get them.
“Tiger usually posted a silly mid-off, almost in line with the popping crease, a slip, an extra-cover and a short third-man or a gully for me. He would attempt to lure the batsmen with the large gap to the left of extra cover.”
Bold customer
Pataudi and Prasanna came across an equally bold customer in Ian Chappell during India's tour of Australia in 1967-68.
“Tiger told me that Chappell would jump out to smother the spin. We thought about it and decided on a short mid-on since I could make the ball hang in the air. Chappell had his moments but we also had him picked up at short mid-on on the uppish drive.”
Prasanna recollects how Pataudi made him aware of a batsman's blind spot.
“I was bowling round the wicket to the left-handed Australian Bill Lawry. Tiger asked me to come over the wicket and enlightened me about a batsman's blind spot, between the leg and the middle stumps. From a bowler's angle, it would appear to be on the right of the leg-stump. I pitched it in the right spot and the obdurate Lawry was finally dismissed.”
On another occasion, during the 1975 Test against the West Indies in Madras, Pataudi anticipated that Clive Lloyd would come after the bowling. “He still implored me to flight the ball. Lloyd thundered down the track, I got the ball to dip, and the batsman was stumped by a mile,” said Prasanna.
The gifted off-spinner had only one word to describe Pataudi. “He was a ‘genius',” he said in admiration.

Wednesday, 20 March 2013

Press regulation: a victory for the rich, the celebrated and the powerful


This new press regulator is all about revenge, not justice. It's hard to imagine a more chilling deterrent to serious investigation
matt kenyon
Illustration by Matt Kenyon
We can agree that the press had it coming. The victims needed revenge. Celebrities wanted redress. A few tabloid moguls got a bloody nose, and Ed Miliband got to meet Hugh Grant.But what happened on Monday in Westminster was a ludicrous way to engineer a more disciplined press. We do not have an independent regulator, but the agency of a political stitch-up. Any MP who claims this is not statutory regulation is a liar, and should be forced to retract and apologise, or face a million pound fine.
Press laws should not be written in the dead of night by a coalition of those worsted by newspapers. They have produced not just a royal charter, which might be no big deal, but a detailed remit of how a press regulator should operate, down to the prominence of apologies and the size of fines. MPs on Monday were salivating with regulatory power. The truth is that parliament was drinking deep from the well of disgust and revenge. As the veteran MP Peter Lilley bravely remarked, whenever parliament gloats over such deals "we invariably make our worst blunders".
Last month the distinguished US journalist Lawrence Wright came over to seek British publication of Going Clear, his detailed exposé of Scientology already published in America. He was told by publishers to forget it. His book was not reckless or inaccurate, but the Scientologists would make defending its publication in a London court prohibitively expensive. He went home empty-handed. As Chinese communists can attest, there are many ways to kill free speech short of murder.
Any regulation of the press should pass the Wright test. Will it make publishing what someone, somewhere does not want to see in print more or less likely? This week's legislation patently means less. A few innocent victims of press unfairness may gain redress. But the cheering across town this week is from the rich, the celebrated and the powerful, with parliamentarians in the van.
This debate has been dominated by the crime of phone hacking, largely at News International. Not a news report fails to mention it. This is an illegal activity that, under existing law, has seen dozens of journalists and police officers arrested and massive compensation paid. A paper has been closed, and exemplary punishment meted out. It needed no royal charter or late-night deal.
Certainly, those who complain if papers break statute or common law deserve a better route to justice. Britain is already tough on libel, defamation and privacy, as the Wright case illustrates, but the law tends to be for the rich. The appropriate reform is for these cases, if not resolved voluntarily, to come before a small claims court, to avoid the present deterrent of legal fees. That is the solution.
This week's proposals have no bearing on this at all, any more than did the tedious Leveson report. They are not about press illegality but something mysteriously called "misdemeanour" – that is scurrility, intrusion and unfairness. No one might complain here about a tougher monitoring of a code, to reprimand and seek apology. The existing complaints procedure works without fines and compensation, and merits strengthening. But we have to accept that sometimes there will be mavericks who are beyond reprimand. Free speech within the law is their entitlement.
The new regulator allows no time for this. Parliament sees no role for mavericks. Its target is not just celebrity intrusion but bias, unfairness and gossip in the style of Private Eye and the "off Fleet Street" plethora of news-and-comment websites. The regulator is obliged to offer a free arbitration service to anyone who feels traduced or unfairly treated by the press, imposing fines and compensation. Indeed, the service will have a vested interest in fines as it will be financed by "fine farming", like traffic wardens.
Parliament on Monday proposed no safeguards against this becoming a PPI-style stampede for anyone – including lobbyists – trying to grab a compulsory correction plus aquick payoff. Fining journalists for unethical deeds is a charter for the vexatious. It is madness. Fines and compensation at the arbitration stage will put editors in thrall to chief executives and nervous publishers.
Worse ensues if editors reject the new regulator and, because a matter of law is at stake, the case goes to a proper court. They there face punitive "million-pound" fines. Smaller publications and many in the provinces could be forced into closure. Almost by definition, such matters are likely to be seen by journalists as ones of principle. It is hard to imagine a more "chilling" deterrent to serious press investigation than this.
This is blatantly one-sided justice. It is as if the BBC charter were drafted by victims of Jimmy Savile, or church law drawn up by those abused by priests. It will certainly make some sections of the press more careful in their handling of the private lives of public people. But the baby's gone out with the bathwater. Northcliffe's maxim was that "news is what somebody somewhere wants to suppress; all the rest is advertising". The advantage today is with the advertisers, who will find it that much easier to stifle criticism and deter journalistic risk.
This is not the end of the world, and any such suggestion will sound self-serving from British papers. But, unlike the supine press so common abroad, they still have the irreverent vigour and diversity of a true political safeguard. This has been a grim, vengeful saga. The press faces tough times anyway, and must now do so wearing a ball and chain.

Cricket - Were the good old days really better?



Let's break it down to a few parameters and try to make an objective analysis
March 20, 2013
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Michael Clarke asks for a review, Australia v South Africa, first Test, Brisbane, November 9, 2012
The stakes might be higher these days, but the DRS has struck a blow for honesty © Getty Images 
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Technology or human eyesight? Helmets or bare bonces? Covered or uncovered pitches? Back-foot no-ball law or front? Arlott or Bumble? Does any breed of sporting spectator spend quite so much time as we cricket folk when it comes to debating the merits of the way we were and the way we are? Granted, our baseball and boxing counterparts in particular might scoff at such a suggestion, but they haven't seen their game repackaged as three distinct products.
"Before the Fall? Reflections on cricket in England during the 1950s" is that sagacious social historian David Kynaston's contribution to an annual lecture series at Lord's. A prolific author and academic whose books range from Austerity Britain to W.G.'s Birthday Party, Kynaston uses ten criteria to compare past with present: aesthetic, meritocratic, competitive, craft, excitement, personalities, sportsmanship, walking, crowd behaviour, "mattering", and coverage. Overall, he concludes, "it comes out pretty even".
Loath as I am to take issue with such an esteemed chronicler - and bearing in mind that I had yet to celebrate my third birthday when the 1950s ended - this strikes me as a perfect case of nostalgia overshadowing, if not fact, then assuredly common sense.
Given that we are six weeks away from the 50th anniversary of the most far-reaching of cricket's innovations,the limited-overs game (90 years, it should be noted, after the first knockout cup event was abandoned after a solitary match), now seems an apt moment to stand back and reflect on how far we have come and whether, on balance, we have advanced. Most of Kynaston's categories will do nicely, although it feels reasonable to merge walking and sportsmanship (is the former not an intrinsic, if extreme, aspect of the latter?).
Before we begin, let's reel back to a revealing Daily Express survey from that summer of '63: the "Better Cricket Competition". Readers were invited to make five suggestions to improve the County Championship, then the planet's lone competition for full-time pros. The judges - Alec Bedser, Doug Insole and Norman Preston, editor of Wisden - assessed 2000-plus entries, from whence came sundry proposals: overseas players, Sunday play, promotion and relegation, over-restricted first innings, more overs per hour, 15-pace run-ups, rewards for faster scoring, leg-before decisions to dissuade pad-play, and eight- or even ten-ball overs.
The more sensible of these would soon be woven into the first-class fabric, though it is intriguing to note that the judges were unanimous in insisting that the most pressing need was the elimination of time-wasting. In this respect, at least, it seems fair to say that cricket in 2013 lags a vast way behind 1963, though whether this matters is another kettle of cod entirely. It certainly didn't seem terribly important to those who completed the recent public surveys conducted by the ECB and Cricket Australia.
And so to the Kynaston Test. Not unnaturally, some of his sub-divisions permit more objective analysis than others. So, for all that he rightly deems it to be "somewhere near the core pleasure", let's dispense with the aesthetic, the "sensory aspect". The way he sees it, much has been lost through the arrival of "helmets, garish-coloured clothing, umpires no longer in white coats, sponsors' markings on the playing arena" and the "continual noise and exaggerated celebrations" of the players; such preoccupations will strike younger generations as profoundly old hat, not to say downright petty and daft.
Meritocratic
Fifty Aprils ago marked the start of the first English season to be unencumbered by the distinction between shamateurs and professionals: all hail the new meritocracy. Now, thanks to the multiplicity of formats, the ultimate meritocracy is with us: not only can even an Afghan earn a penny or two, you can have a disobedient body, like Shaun Tait does, and still put in a fruitful day's work by bowling four overs. Today: 2pts
Competitive
In the 1960s the average Test total was 323; over the past ten years it has been 350. Yet before we get too carried away with this apparent widening of the gap between bat and ball, the rise in scoring rates (from 2.49 runs per over to 3.27) has compensated handsomely for the reduction in the number of overs per day, the upshot being that the ratio of conclusive results has soared from to 53% to 74%. Throw in the fact that standards are far more uniform - while only England, Australia and West Indies were regular winners in the first period, this year alone has seen New Zealand take a one-day rubber against South Africa and force England to follow on, India all but reverse 2011-12's 4-0 loss to Australia, and Bangladesh trade 600s with Sri Lanka - and it's another no-contest. Today: 2pts
Craft
Uncovered pitches might have asked more of batsmen (and commensurately less of bowlers) but immeasurably more is demanded of today's practitioner. Who knows whether undimmable titans such as WG, Bradman or SF Barnes would have been so adaptable, but there is no question that Hashim Amla, Marlon Samuels and Graeme Swann are as effective over 20 overs and 50 overs as over five days. 1pt apiece
Excitement
Two words should suffice: "Virender" and "Sehwag". Or "Kevin" and "Pietersen". Or "De" and "Villiers". Or, if we're being thoroughly modern, "Shikhar" and "Dhawan". Or, if we're being meritocratic, "Lasith" and "Malinga" or "Saeed" and "Ajmal". Put it another way: when those of us who can remember that far back try to recall feeling excited while watching the game half a century ago, the options are generally confined to "Garry" and "Sobers". It helps, of course, that we can now trust our own eyes rather than parrot the word of others. Today: 2pts
 
 
Does cricket matter more than it did? In numerical terms, given growth in population, communication technology, access to games and ICC membership and funding, of course it does. But is it healthy for an essentially trivial pursuit to matter more?
 
Personalities
Comparing characters from different eras is even more ludicrous than comparing Jonathan Trott and his distant ancestor Albert (though we can at least claim with some confidence that Albert, the only batsman to clear the Lord's pavilion with a single blow, was the more aggressive). Again, greater visibility predisposes us to favour the likes of Shane Warne, but this is counterbalanced by largely unpublicised stories from an era when sportsfolk were less closely monitored and hence able to get away with more.
Hugh "Toey" Tayfield is justly celebrated as the greatest of South African spinners, but it was a complete revelation to me to learn, this very week, not only that he was a rampant womaniser who died penniless and largely forgotten in a hospice, but that during the 1960 Old Trafford Test he had been due to appear in court for allegedly failing to repay a £230 loan ("He was a slow bowler and even a slower payer" quipped the prosecution lawyer). We know Sobers and Ted Dexter would have been "personalities" in any era, but given the greater rewards for notoriety today, Tayfield might have met a very different end. 1pt apiece
Sportsmanship
You could be forgiven, here, for concluding that higher stakes and more frequent fixtures have left today lagging miles behind yesterday, but is that truly the case? "Long after the unenterprising cricket of this Test is forgotten, people will talk of two incidents which brought to a head the question of whether batsmen should 'walk'." So attested Basil Easterbrook in Wisden of the 1965 Newlands Test, referring to Eddie Barlow's decision to ignore two appeals for catches (both rejected) and Ken Barrington's self-ordered exit following a thin nick that eluded detection - arguably the least profitable act of vengeance in the game's history. On the other hand, the capacity of the DRS to expose the truth economists has sired, if not a revival of this most honest (if class-ist) of sporting customs, then certainly a few more incidences than I can recollect witnessing in previous decades. 1pt apiece
Crowd behaviour
Of the 11 riotous contests Ray Robinson analysed in The Wildest Tests, one was played in 1933, the others in the first quarter-century after the Second World War. Had he completed the book in 2002 rather than 1972, he would not have had many to add. Sure, there may be less inclination to applaud the opposition, but add comfier seats, more efficient policing of drunkenness and better protection from the elements to the joie de vivre of the Barmy and Swami armies, and there seems little reason not to believe things have improved.Today: 2pts
Mattering
Much the trickiest category. Does cricket matter more than it did? In numerical terms, given growth in population, communication technology, access to games and ICC membership and funding, of course it does. Kynaston disagrees, citing the rise in matches, freedom of player movement and alternative leisure activities alongside a decline in the ritual nature of the fixture list and a tighter focus on city-centre venues. But is it healthy for an essentially trivial pursuit to matter more? How often in days of yore did a bad result convince Indians or Sri Lankans to kill themselves? Yesterday: 2pts
Coverage
There is, of course, no comparison here whatsoever, whether in depth or breadth or even - because we see and know and understand more - quality (literary worth, again, is strictly a matter of taste). At the risk of sounding as disinterested as a mongoose pronouncing judgement on a drunk and disorderly cobra, the range and geographical sources of the voices on this site surely supply incontrovertible proof that we've never had it so good. Hell, if the residents of the Tower of Babel had co-existed this peacefully, we'd all be speaking Hebrew now. Today: 2pts
Final score: Today 13, Yesterday 5
Let's face it: nostalgia simply ain't what it used to be.

Monday, 18 March 2013

Paulo Coelho on Jesus, Twitter and the difference between defeat and failure


P

One of the world's most popular writers, Coelho has survived being sent to an asylum by his parents and tortured by Brazil's ruling militia
Paulo Coelho
Paulo Coelho: 'Take pride in your scars.' Photograph: David Brabyn/Corbis
In pride of place in the living room of Paulo Coelho's apartment in Geneva is a fan's portrait of the author. A pointillist work, the huge image consists of the colour-coded coffee capsules George Clooney endorses. The background is composed of ristretto capsules (black), while Coelho's eyes seem to have been picked out in decaffeinato intenso (claret). Perhaps sadly, the artist has not used the new linizio lungo (apricot) capsule to perk up the colour scheme.
  1. Manuscript Found in Accra
  2. by Paulo Coelho
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This is not the strangest gift he has received, Coelho says. "I'm in my apartment in Rio in 2000 and the doorbell rings and there's a beautiful woman, very tall, very sexy, green eyes. She was carrying a small tree. I said: 'What is this?' She said: 'Don't speak Portuguese.' She said: 'I came from Slovenia because I want to plant this tree here and I want to have a son with you.'" Long story short – Coelho put her on a flight home and saw her only once more, with a boyfriend in Slovenia. And the tree? That's not important now, he laughs.
For the next hour and a half he laughs a lot. A genial funster has today replaced the solemn preacher-novelist damned by one critic for writing "something David Hasselhoff might spout after a particularly taxing Baywatch rescue".
This incarnation may not be what has made the 65-year-old Brazilian an international bestselling author with 9.8 million Facebook fans, 6.3 million Twitter followers, and a fanbase embracing readers in the Islamic republic of Iran and the socialist republic of Cuba. Personally speaking, Coelho in the flesh is more appealing than Coelho the writer.
"Do you want to see my bow?" he asks at one point. Coelho is a keen archer. He has seen The Hunger Games and can confirm that Jennifer Lawrence's archery technique is authentic. "The only thing that relaxes me is archery. That's why I have to have apartments with gardens."
His other favourite activity is walking around Geneva. "I walk every day and I look at the mountains and the fields and the small city and I say: 'Oh my God, what a blessing.' Then you realise it's important to put it in a context beyond this woman, this man, this city, this country, this universe. It goes beyond everything. It goes to the core of our reason for being here." What if there is no reason for being here and – there's no easy way to put this – nice walks around Geneva are as good as it gets? "It's still a blessing." Good comeback.
Back to the coffee portrait. For Coelho, it demonstrates one of the cardinal virtues he extols in his new book, Manuscript Found in Accra – elegance. Why is elegance important? "I don't know what I wrote in the book, but elegance goes to the basics." He points to his portrait. "This is very elegant because if you take an isolated Nespresso capsule, it would mean nothing but with three or four you can create anything. So for me elegance is this." Nespresso PR people who are liking the way this piece is going so far may want to excise the next sentence from their press pack: "I don't drink Nespresso by the way."
Coelho's colour scheme is as minimalist as his portrait. Today he looks like a BrazilianSweet Gene Vincent: white face, black coat, white beard, black trousers, white shirt over black T-shirt, white wisps of hair, trailing behind him as he struts through the apartment in Cuban heels sipping black coffee. He has a butterfly tattoo on his left wrist.
Paulo Coelho at home Paulo Coelho in his office in 1995. Photograph: Roger-Viollet
The other virtues set out in his new book are boldness, love and friendship. A pedant might note that elsewhere in his writings, Coelho has argued that friendship is a form of love so should not be considered a distinct virtue. Also courage rather than boldness is the virtue you need if you are to realise the the message, expressed in his 1988 novel, The Alchemist, that wherever your heart is you will find treasure. But nobody, least of all Coelho, would suggest the oeuvre of the writer, who has sold 145m books worldwide and been translated into 74 languages, is devoid of contradictions. "If I have to summarise this book in one sentence, which would be very difficult," he says, "it is this: accept your contradictions. Learn how to live with them. Because they aren't curses – they are blessings."
The Jesus of the gospels was, Coelho argues, similarly contradictory. "Jesus lived a life that was full of joy and contradictions and fights, you know?" says Coelho, his brown eyes sparkling. "If they were to paint a picture of Jesus without contradictions, the gospels would be fake, but the contradictions are a sign of authenticity. So Jesus says: 'Turn the other face,' and then he can get a whip and go woosh! The same man who says: 'Respect your father and mother' says: 'Who is my mother?' So this is what I love – he is a man for all seasons."
Like Jesus, he's not expressing a coherent doctrine that can be applied to life like a blueprint? "You can't have a blueprint for life. This is the problem if you're religious today. I am Catholic myself, I go to the mass. But I see you can have faith and be a coward. Sometimes people renounce living in the name of a faith which is a killer faith. I like this expression – killer faith."
Coelho proposes a faith based on joy. "The more in harmony with yourself you are, the more joyful you are, and the more faithful you are. Faith is not to disconnect you from reality, it connects you to reality."
In this view, he thinks he has Jesus on his side. "They [those who model their sacrifice on Christ's] remember three days in the life of Jesus when he was crucified. They forget that Jesus was politically incorrect from beginning to end. He was a bon vivant – travelling, drinking, socialising all his life. His first miracle was not to heal a poor blind person. It was changing water into wine and not wine into water."
Paulo Coelho insists he has led a joyful, fulfilling life. It could easily have been otherwise. Born in Rio de Janeiro in 1947, he longed from a young age to become a writer, an ambition his parents frowned upon so much that they sent him, aged 17, to an asylum. "My parents thought I was psychotic. Like now, I read a lot and I didn't socialise. They wanted to help me."
He was eventually released in 1967 and enrolled in law school – one of several attempts to become, as he puts it disdainfully, "normal". Later he dropped out, became a hippy and made a fortune writing lyrics for Raul Seixas, the Brazilian rock star. Brazil's ruling militia took exception to his lyrics (some of which were influenced by the satanist Aleister Crowley). As a result, he was repeatedly arrested for subversion and eventually tortured with electric shocks to his genitals. These experiences, incidentally, account for his scorn for the idea that Chilean dictator Augusto Pinochet, who was photographed with Coelho's books on his shelves, might have learned anything from the Brazilian's thought: "I think he had never read my books. It was PR. I wonder if he knew the story of the author he would have been proud of having this book on his shelves. I was part of these dreadful years in South America."
Why, given his history, didn't he choose the path of renunciation? "But I did! After the asylum and torture, I said: 'I am tired. Enough. Let me behave like a normal person. Let me be the person who my parents wanted me to be – or society or whatever.' So back in 1975 I married someone in church, got a job. I was normal for seven years. I could not stand to be normal. Then I divorced and married another person who is now my wife [the artist Christina Oiticica] and I said: 'Let's travel and try to find the meaning of life.' I had money because I had been a very successful songwriter, so I had five apartments in Brazil. I sold everything and I started travelling."
His epiphany came in 1986 when he walked the 500-mile road to the Galician pilgrimage site Santiago de Compostela. He described his spiritual awakening there in one of his earliest novels,The Pilgrimage. "Then I said: 'It's now or never.' I stopped everything and said: 'Now I am going to fulfil my dream. I may be defeated but I will not fail.'"
This distinction between defeats and failure is central to Coelho's new book. The former are incidental, chastening wounds risked by those who listen to their heart, the latter a lifelong abnegation of the responsibility to follow your dream. Or as the narrator of Manuscript Found in Accra puts it: "Take pride in your scars. Scars are medals branded on the flesh and your enemies will be frightened by them because they are proof of your long experience of battle." That advice is borne of his life experiences? "Absolutely. I am proud of my scars and they taught me to live better and not to be afraid of living."
He looks at me sharply: "They taught me also to be a cold-blooded killer." Beg your pardon? "When I see people trying to manipulate me, I kill. No regrets, no hatred, just an act of – " He makes a throat-cutting gesture. He's not the fluffy bunny his writings might indicate him to be? "Ha! No! I can be very tough. If people think you're naive, they discover in the next second that they don't have heads. So love your enemy, but keep your blacklist updated."
Coelho clearly thinks highly of his readers and online fans. Indeed, Manuscript Found in Accra could be considered the ultimate tribute to them – the collaboration of sage and his online disciples. Share your fears, Coelho tweeted his followers, that I might offer hope and comfort. The resultant book consists of Coelho's meditations on such themes as courage, solitude, loyalty, anxiety, loss, sex and victimhood suggested by followers. Manuscript Found in Accra might function as an aphoristic grab bag of his principal thoughts. The treacly narratives of such novels as The Alchemist and Eleven Minutes have been excised but the cliches remain. He actually does write stuff like this: "It is better to have loved and lost than never to have loved at all" and "Don't give up. Remember it's always the last key on the ring that opens the door." Those of you who may so far have resisted the endorsements of Madonna, Julia Roberts or Bill Clinton may now be tempted to read him if only to test the proposition that Paulo Coelho exists to make Alain de Botton look deep.
Paulo Coelho and his wife Christina Oiticica Paulo Coelho and his wife Christina at home in Rio in 1996. Photograph: Robert Van Der Hilst/Gamma/Gamma-Rapho via Getty Images
Coelho lightly fictionalises this collection of putative aphorisms: the conceit is that we're reading a manuscript lost for 700 years, based on the talk a mysterious scholar called the Copt gave to the citizens of Jerusalem on the eve of its invasion by French crusaders. "The great wisdom of life," the Copt says toward the end of the book, "is that we can be masters of the things that try to enslave us."
How? Coelho says: "By taking responsibility. Today people aren't encouraged to take responsibility. It's easy to obey because you can blame a wrong decision on the person who told you to do this or do that. From the moment you accept that you're the master of your destiny you have to accept responsibility for every single action of yours. So why bother to follow my dreams? Then I can avoid being a failure – which is not true of course: you are a failure from the moment you don't allow yourself to be defeated."
Coelho by contrast snatched victory from the jaws of his several defeats. "Am I hyper rich? Yes. Do I want to prove this? No. Go back to your essence – don't play this consumerism game. This is nonsense. At the end of the day, the day that you die, the last minute, you have to answer this question: Did I really enjoy my life?"
How will he answer this question? "On 30 November 2011 I did," he says enigmatically. In that month, he was prompted to go for a scan by his agent Mônica Antunes, whose father had recently died of a heart attack. "She was worried that both her husband and I were smokers. I said: 'No way, Jose. Come on. I walk every day. I have a very healthy life. I don't smoke much – six cigarettes a day.'" But the day after his wife's 60th birthday he visited the cardiologist for tests. "He said: 'You're going to die.' I said: 'I don't believe you.' He said: 'You're going to die in 30 days. This part of your heart does not respond any more to electric impulses so probably it is blocked.'
"I was shocked of course. But I had time to answer this question that you just asked me. I remember I was in my bedroom and I said: 'If I die tomorrow, I would die very happy. First, I did everything I wanted to do in this life – sex, drugs, rock'n'roll. You name it I did it. Orgies and whatever." Orgies? "Oh yes. Orgies. Ha ha ha!
"Second, I had my share of losing but I did not quit. Third, I followed my road, my bliss, my personal life journey and I chose to be a writer. And I succeeded, which is more difficult, you know?
"Fourth, I've been married for 33 years to the love of my life. So what else can I ask? I will die with a smile on my face, with no fear, and I believe in God. So no problem if I die tomorrow. That is what I thought."
Paulo Coelho, you will have noticed, did not die when his doctor said he would. "But I pray that when I die I will die with the same state of mind I had on the 30th of November 2011."
How would he counsel his followers to die contented? "I can't tell them. I only know that the most important gift that you have is courage – be courageous." He lights a cigarette and smokes it in seeming defiance of what he calls the Unwanted Visitor, death.
In the January of every odd year since 1988, he has tried to find a white feather. Only if he succeeds does he write a book. Unfortunately for some of his critics, he found one earlier this year and so plans to write another book. It won't take long. "I write a book in 15 days. Then I go to social communities – I love social communities."
He means Twitter and Facebook. Why? "Twitter I think is an art. Because if you're connected to people you learn how to summarise. I used to do that when I used to write lyrics. It was always the tendency of my life to be clear without being superficial." He's not superficial? "No. Each sentence is dense, poetic."
Coelho signs a copy of his book for me: "Avoid those who say: 'I will go no further.' Love, Paulo Coelho."
As I walk from his apartment into a city of writers greater than Coelho (Rousseau was born and Borges died here), I wish, though not wanting to be ungrateful, he'd chosen a better quote from his book. For example: "Fate is never unfair to anyone. We are all free to hate or love what we do." That seems to me Coelho at his best, going beyond upbeat banalities and challenging those who make victimhood their identity.
At least he didn't write: "Cross me and you die." Though clearly he could have done.

I am beginning to dread Mumbai


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Shantanu Bhagwat in The Times of India
My favourite city when I was growing up has today become a place that I try hard to avoid. The reasons are not hard to find. Lack of an efficient system of public transport tops the list. Add to this, the traffic snarls. To this, add a humid climate and uncontrolled, chaotic crowds that jostle for space with shops, scooters, buses & cars.
Don’t get me wrong. There are still many things that keep me hooked on Mumbai. The spirit of enterprise, the numerous eating joints, the real feel of a cosmopolis and the walk along Marine Drive – to name just a few. But all these are increasingly overshadowed by my dread of being stuck in an endless traffic snarl or missing my meeting (worse, a flight) or having nowhere to go for a walk if I feel like unwinding after a long day.
Mumbai’s problems are not unique. At their core is the utter failure of government and administration to deal with rapid urbanisation that is happening across the length and breadth of India.  This urbanisation is the reason for Guwahati losing its charm. This urbanisation is the reason Delhi is fast becoming a cold, ruthless city seething with rage. It is what long-term residents of Pune dread. And it is the reason Bengaluru’s distances are now calculated in “hours” rather than kilometres.
To get a sense of the magnitude of the challenge we face, sample this:
  • Over 32% of Indians living in major cities still live in single room homes. In most Tier-I cities, “Affordable Housing” remains a pipe dream.
  • Almost no Indian city has water coming through the pipes that is safe to drink. Waste disposal remains a common problem across towns and cities in India
  • Sometime between now and the next 10 years, 3 Indian cities will be among the fastest growing cities world-wide. These are Ghaziabad, Surat and Fardiabad. “Twenty-two other Indian cities (will) also find a place in the top 100”. 
  • In Delhi, over 350 kms of nullahs (storm water drains) built hundreds of years ago now carry untreated sewage posing a grave risk to public health & environment 
  • On an average, 10-12 people die every day on the tracks of Mumbai’s suburban rail system. That is almost 4000 people each year. This has been going on for several years 
And finally this statistic which I doubt would surprise any of you: almost 50% of the population in most cities live in slum-like conditions.
About 3 years ago, I visited one such area in Mumbai. Situated within minutes from the famous RK Studios in Chembur, this area is called Cheetah Camp. Cheeta Camp is unusual because it is a “planned slum”. But the planning does not extend to sewers or basic provisions.
recent study discovered that the 117,000 residents of Cheeta Camp have just 38 usable toilets among themselves. That means roughly one toilet per 170 people. To understand what this means, take about 30-40 families in your neighbourhood. Now imagine all of them coming to your home to use our one toilet.   I think you get the picture.
Believe it or not, we actually have a “Ministry of Urban Development” with a cabinet rank minister in charge. The minister in charge is the redoubtable Kamal Nath – a man tagged with the “15% label” by Tarun Das, former Chief Mentor, CII and alleged to  have offered “jet airplanes as enticements” to  get support from MPs for the India-US civilian nuclear deal in 2008. 
Sadly the Ministry appears to have achieved little.  The Minister himself has publicly said, “We are not building for the future, unlike Hong Kong and Singapore. We are still catching up with the past” 
And his own Ministry’s survey on the state of affairs in our cities has highlighted glaring failures, including the fact that, “more than half of India's cities have no piped water or sewerage systems, four in five had water for less than five hours per day and seventy per cent households across the states had no lavatory.”  Not only has the Ministry failed to achieve much, it has been dragged into the murky CommonWealth Games Scandal too.
Unfortunately urbanisation is a dull topic for prime time TV. It does not arouse the kind of passion that can get people out on the streets. For most well-read, educated Indians whose stomachs are full, urbanisation is an inevitable “evil” that is ruining their towns and cities. It is the “evil” that is making water scarce; making groceries expensive, commuting a nightmare and jeopardising the safety of their children.
There is little realisation of the long-term implications of this “problem”. It seems most of us assume the challenges of “urbanisation” will be resolved on their own.
But we ignore urbanisation at our own peril. I believe, more than anything, dealing with the effects & impact of rapid urbanisation will be India's biggest challenge in coming decades.