Response to Comment by Mahadevan S et al.: Endocrine Chakras in the Endocrine Society of India logo

OUR LOGO The Endocrine Society of India (ESI) recently celebrated its 50th birthday. Its logo, created at its inception, in 1971, features the traditional Greek sign of Caduceus, as well as a Sanskrit shloka ‘yen sarvam idam tatam’.[1] This verse figures not once, but twice, in the Bhagavad Gita.[2] In chapter 2, verse 17, Lord Krishna replies to Arjuna, saying “know that since the Spirit which pervades the universe is imperishable and immutable, no one can effect his destruction.” In Chapter 18, verse 46, toward the end of the celestial song, he says “By adoration of that God, who has created all beings and who pervades the whole universe, through the undertaking of his natural calling, man attains to final accomplishment.” CONTROVERSY ESI is a scientific organization; one that should stand for rationality and reason, one that should rise above religion and tradition. What is it, then, that the founders of ESI wished to convey through their choice of logo and motto? What wisdom did they wish to hand down to us? THE CADUCEUS The Caduceus is an ancient Greco-Roman herald’s wand, with two snakes coiled around it, carried by the Greek God Hermes or Roman god Mercury. It is used as a symbol of medicine, predominantly in the United States. Though there is ample debate regarding the appropriateness of this imagery, as opposed to the Rod of Asclepius,[3] the Caduceus has a few features that link it closely to endocrinology. Medicine and chemistry (alchemy) were linked early on the course of evolution, and the Caduceus represents the important role of biochemistry and pharmacotherapeutics in modern endocrinology. Hermes and Mercury were associated with eloquence and negotiation, which are essential skills for chronic disease care professionals. These gods were thought to accompany the soul in the afterlife, and the choice of the Caduceus may have reflected the important role of mind-body medicine in endocrinology. A much simpler explanation, though, may be that the logo of the prestigious All India Institute of Medical Sciences (AIIMS), New Delhi, which includes this symbol, may have served as the inspiration for ESI’s design. That which pervades all The choice of “yen sarvam idam tatam” (“that which pervades all”) needs deeper thought and analysis. This is a verse that figures at the beginning, as well as the end, of the Bhagavad Gita. This means, certainly, that it is not an afterthought: Neither for the writer of the Gita nor for the crafter of the ESI logo. Is endocrinology the science that pervades all? Are hormones the spirit that pervade all? Are the feedback mechanisms that govern our body imperishable and immutable? Endocrinology certainly does pervade every field of medicine. It is hormones that facilitate our birth and growth, our survival and sustenance, and in fact, our emotions and humanness. Though no mortal body can last forever, the basic principles of endocrine function do seem to have an immortal constancy that crosses the boundaries of species as well as generations. Endocrinology is a “higher calling” for us endocrinologists, who view it not just as a vocation or fiduciary activity, but as a means of achieving a greater good for humankind. Our founder fathers too would have felt the same zeal and zest while forming the ESI. Their choice of the verse “yen sarvam idam tatam” reflects their passion and highlights their proactive attitude toward holistic well-being. COOPERATION AND COLLABORATION The choice of two motifs, the Caduceus, representing “modern” medicine, and the Bhagavad Gita, highlighting ancient Indian wisdom, is deliberate: It reminds us of the need for coexistence and collaboration, for cooperation and coaction in health care. It also teaches us, perhaps, to be open to what we do not know, and to be understanding of what we do not comprehend. This, we feel, feel, is what our seniors have bequeathed to as, through the ESI logo: A sense of respect for modern metabolism and endocrinology, as well as for ancient wisdom and science; and a sense of appreciation for both “biological” and mind-body medicine. ESI’s motto sets high standards for us, and we hope that we are able to live up to the expectations of our seniors, our peers, and most important of all, of our fellow citizens, whom we exist to serve. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Show more

Endocrinology, a young branch of medicine, has grown dramatically during the past century. The strong representation of endocrine scientists in the list of Nobel Prize laureates reinforces the importance of our discipline to modern health.[1] Advances in physiology, biochemistry, pharmacology, and imaging have helped improve clinical management over the past few decades. The growing pandemics of diabetes, obesity, and cardiovascular disease underscore the need for further development in our field.[2] In spite of the vast spectrum that endocrinology represents, endocrinologists often find themselves boxed into a corner. The beauty and breadth of endocrinology acts as a magnet for practitioners of alternative medical systems. These persons market themselves as hormonal specialists, and use unvalidated and unscientific means to spread disinformation amongst the gullible public. More often than not, this creates a communication gap between the community and us. This in turn acts as a barrier to acceptance of and adherence to modern endocrine care. Irrespective of the etiology, however, the responsibility for addressing this information discordance rests with qualified endocrine care professionals.[3] PERSON CENTERED ENDOCRINOLOGY Much has been written about person centered care, and how it is applicable to endocrinology.[4] In this communication, let us explore a few facets of person-friendly endocrine care which can help bridge the gap between endocrinology and the community. Our aim is to foster thoughts, words, and action, which can help improve health care seeking, acceptance and adherence, and lead to optimal endocrine health for all. GLUCOCRINOLOGY Diabetes, which is primarily an endocrine disorder with multisystemic manifestations, is often perceived through a cardiovascular prism. To ensure a balanced discourse, we have crafted the term glucocrinology. Glucocrinology refers to the bidirectional relationship of glycemia and endocrine function. This concept underscores the need to study endocrine physiology, and endocrine pathophysiology in order to understand glucose metabolism and its disorders. This concept has given rise not only to conceptual papers, but to an entire book,[5] as well as an international conference hosted by Endocrine Society of India (ESI) (courtesy Sandeep Julka, Indore, 2019). The term is used frequently in endocrine conversation in India and neighboring countries, and finds mention in the agenda of various educational meetings. The philosophy of glucocrinology is to promote holistic, endocrinology-led delivery of diabetes care. MIND BODY MEDICINE The word ‘holistic’ leads us to the subject of Mind Body Medicine (MBM). MBM is used to describe health assessment interventions that address the physical, biomedical, psychosocial, and mental aspects of health. Endocrine function is not limited to the working of hormones: it includes, and is impacted by the autonomic nervous system. While the discipline of neuroendocrinology focuses more upon the biochemical correlation of the nervous and endocrine systems, MBM takes a clinically relevant, patient oriented, preventative as well as management driven approach.[6] MBM has found its root in Indian endocrinology, with ESI holding the first ever international conference on Mind body Medicine in Endocrinology at Pune, 2020 (gratitude to Vaishali Deshmukh, Ameya Joshi). Along with MBM, the role of religion as a motivational tool to help improve acceptance and adherence of therapy, and improve health, is entering mainstream science.[7] The role of religion is not limited to patients: this can be used to benefit health care professionals as well.[8] I am mindful of the criticism this concept has faced within certain circles. I would categorically like to state that no where do we promote a particular religion or philosophy. Rather, we identify the best of existing scriptures, and share it with colleagues so that they are empowered to serve their community in a better and friendlier manner. If the patient we are treating is motivated by religiosity, we should not hesitate to use religion as a motivational tool. I would like to record the yeoman service of our members in spreading this concept beyond India's borders (Buddhism and diabetes care in Myanmar: Gagan Priya, Ameya Joshi, Girish Parmar). ESI's active team have simplified guidance on endocrine and diabetes care during the Ramadan and the Hajj, (leadership: AH Zargar, Shehla Sheikh)[9] as well as during other region-specific and religion-specific fasts and feasts.[10 11] COMMUNITY ENDOCRINOLOGY As the astute reader must have discerned, this opinion piece makes frequent mention of the community. All health care professionals, and all endocrinologists, are part of a larger community and ecosystem. With our community, we prosper. Without it, we lose our raison d'etre. Various Indian writings have highlighted the importance of person-centered endocrinology, community endocrinology and eco-sensitive endocrinology (or green diabetology).[12 13] These reinforce the need to involve the community as an active partner in all our activities. The choice of our webinar themes, including Transgender Endocrinology and Gender sensitive Endocrinology, as well as monthly international webinars, such as Endocrine Nursing, demonstrate an inclusive approach to the definition of the endocrine community, as well as the society that we serve. WELLNESS ENDOCRINOLOGY One of our most proactive outreach activities has the concept of wellness endocrinology. Wellness endocrinology utilizes knowledge of endocrinology to ensure optimal health for every member of society. Wellness endocrinology aims not only to manage, but to prevent endocrine dysfunction, and to promote optimal endocrine health among the public at large. A committed team of young Indian endocrinologists has been spearheading this theme, by interacting with the public through various social platforms[14](special mention Mohan T Shenoy, MN Satyavani, Ashok Venkataranasu, Nitin Kapoor, Gagan Priya). This is one area where India has emerged as a global leader, both in thought and in action. GLYCEMIC HAPPINESS Yet another philosophy we have initiated is that of happiness, including euthymic euglycemia, or glycemic happiness.[15] Currently, the definition of optimal diabetes care is based solely upon achievement of targets. We suggest that happiness, or quality of life be included as an integral part of our target. Happiness, in fact, can be viewed as a target as well as a tool to achieve this target. Similarly, in obesity, we call for a more comprehensive approach to assessment and management: obesity should be viewed as much more than a mere body mass index (BMI).[16] YOUTHFUL INDIA, COLORFUL INDIA All work and no play make us sick. Therefore, ESI believes in work life balance. The Colors of India cultural event has become a regular affair at our conferences (credit to Gagan Priya, Altamash Shaikh, Shehla Sheikh, Abhay Sahoo, Sambit Das, Sunil Kota, Belinda George, Indira Maisnam, Prem Narayanan, Om Lakhani). Our themes: Fashion and Fabrics of India (2016), Sports Endocrinology (2018) and Happy Hormones, Healthy Hormones (2019) reflect our attitude towards life. The motto of one of our state teams- “Haryanvi Hormones are Happy Hormones”, -reveals a quest for health and zest for life (”thara bhala ho”: “gadar” captains Sameer Aggarwal, Rajat Gupta and “andy” team of Arun Kumar, Ashok Kumar, Atul Dhingra, Dheeraj Kapoor, Hiya Boro, Manoj Kumar, Neelam Pandey, Parjeet Kaur, Rajneesh Mittal, Sandeep Chaudhary, Sandeep Kharb, Sunil Mishra, Yogesh Yadav). The bhangra team has shown the importance of a healthy lifestyle by example, rather than by words (meharbani to the mutiyaars Inderpreet Kaur, Kirtida Acharya, and gabrus Jubbin Jacob, Rajeev Khanna, Ramanbir Singh, Rakesh Goel, Mandeep Singla, Neeraj Garg, Parul Jain, Sachin Mittal, Sandeep Julka). The Yuvacrinology team (Prof SV Madhu, KVS Hari Kumar, Vijaybhaskar Reddy) is a novel initiative which tries to harness the energy and enthusiasm of our younger members (those young at heart) to ensure all round development. Our team is working to create meaningful collaboration with early career endocrinologists across the world as well (Tejal Lathia, Om Lakhani, Sunil Kota). REGIONAL ACTION, INTERNATIONAL COLLABORATION Indian endocrinologists have been working at local level to enhance endocrine awareness and education. ESI's annual events, the ESI AV Gandhi Award (SV Madhu, Sujoy Ghosh), ESI TYSA Award (Arundhati Dasgupta, Sanjay Saran, Sahana Shetty, SS Mangaraj, Ashish Sehgal, Om Lakhani, Prem Narayanan), EnSPIRE (Nishant Raizada, Nitin Kapoor) and ESI Fundamental Research workshop (Alpesh Goyal, Yashdeep Gupta; leadership Prof Nikhil Tandon) have emerged as pole stars on our academic calendar. Though we were able to have only one ESI Satellite Symposium this year (Madurai, the temple city of India, the tilak of Tamil Nadu: gratitude to V Kumaravel, S Sridhar), our members have held excellent endocrine meetings at state, national and global level (examples, SPEED led by Sameer Aggarwal, Saptarshi Bhattacharya; Coimbatore, Suresh Damodharan). The Kerala, Odisha, Tamil Nadu and West Bengal state chapters of ESI have conducted, or are planning annual conferences in virtual mode, and provide a platform for our fraternity to share their knowledge. While being proud Indian nationals, we are also responsible citizens of the world. ESI is a founder member of the South Asian Federation of Endocrine Societies (SAFES) and enjoys close and cordial relations with all neighboring countries. We contribute to the International Society of Endocrinology (ISE) with vigor and zeal: our enthusiastic participation is reflected in the education section of the ISE website as well as its newsletter.[17] The weekly webinars of ESI, as well as our Endocrine Week, scheduled for November, have been accredited by ISE (credit to KVS Hari Kumar, Saptarshi Bhattacharya, Shehla Sheikh). Our website[18] facilitates communication between our members, the society leadership, and the entire world (thanks to Prof Rakesh Sahay, Srinagesh, Deep Dutta). HORMONAL HARAMBEE: WORKING TOGETHER On the canvas of life, endocrinology is but a small discipline, and we are insignificant foot soldiers. If we work together, however, to contribute to the growth of our chosen subject, and to the well-being of our society, we can punch far beyond our weight, and fulfill our purpose. The Swahili word ‘harambee', which means ‘to pull or work together’ is an apt slogan for us. By enhancing focus on these facets of endocrinology, we can strengthen our discipline, and ensure sustainable growth for ourselves. In no way do we negate the importance of basic science, core clinical competence and academic research our field. Standing on the broad shoulders of our illustrious seniors, we hope to leave a better ecosystem for those who will follow and replace us. In fact, we visualize an “anandaloke, mangalaloke (an abode of joy and bliss” (Rabindranath Tagore) (”dhonnyobaad” Debmalya Sanyal, Soumik Goswami, Sujoy Ghosh), where endocrinologists are able to translate their research and technology into meaningful benefit for the population at large, to prevent as well as manage endocrine disease, and to promote endocrine health. Such a state, if achieved, will ensure that endocrinology continues to strengthen, and sustain, with humankind. Show more