The character of the medical profession, the manner in which medicine  is practised today and the direction of healthcare are shaped by our  environment with all its inequities of caste, class and gender. This character,  this manner and this direction are reinforced by the messages conveyed in the  medical education system, by the incentives of the new economic policies and  by the actions - or inaction - of regulatory authorities.

Such an understanding is expressed in various ways in this issue. An editorial  writer comments on the Sukhdeo Thorat Committee report documenting  faculty inaction against caste-based harassment of students in the All India  Institute of Medical Sciences. That the caste and other inequities reinforced in  medical school are expressed in medical practice is illustrated in an interview  with the director of a sperm bank; parents demand - and doctors arrange - sperm of the desired caste and economic background. 

The second editorial describes how the inequities in this environment are  reinforced by the government. As private medical care grows it seeks foreign  markets; hence the policy to promote "medical tourism" with tax breaks and other  incentives - even as the vast majority of poor Indians have no access to healthcare.

Stem cell "therapy" is another example of an industry promoted by the  government policy of turning a blind eye to its unregulated proliferation.  A commentary writer documents the unjustified claims that prompt the  desperate to spend their life savings in the hope of being cured of a serious  disease. Doctors undertake experiments with neither scientific basis nor  ethical clearance in the name of treatment.

Regulatory authorities indicate their inability - or unwillingness - to take  action against unethical practices. Another commentary writer describing his  encounters with corruption in medical practice points out that corruption has  infiltrated the profession at every level, including those agencies meant to  enforce ethical practice. Those who benefit from the existing system - within  medical practice and in society in general - have every interest in maintaining  the current state of affairs.

More than 500 health professionals, researchers, policy makers and students  attended the Indian Journal of Medical Ethics Second National Bioethics  Conference in Bangalore. We carry a report on the conference and comments  from participants.