Why diagnosing Alzheimer’s today is so difficult—and how we can do better 07-17

Shyam's take....

Bill Gates's next investment in Alzheimer’s research is in a new fund called Diagnostics Accelerator. This project of the Alzheimer’s Drug Discovery Foundation (ADDF) aims to accelerate bold new ideas for earlier and better diagnosis of the disease. Bill Gates is planning to invest more than 30 million for this cause. 

It is not for the first time, that research in Alzheimer disease management or prevention research has received attention or funding. However, when a person like Bill Gates devotes time and funds for a cause, the cause itself receives widespread attention from people all over the world. The awareness for the cause increases manifold. It gives direction to many philanthropists as to which cause they should invest. It simultaneously encourages the devoted scientists, researchers and the medical professionals working for this cause. These people not only find light at the end of the tunnel, they feel the entire tunnel has brightened up. This way Bill Gates involvement, more than the investment proves to be driver and huge catalyst. For me, his devoting time for the cause, is more important than his investment. I also like his idea of  venture philanthropy, it could mean that research could at least fund itself partially and the end product could bring back some returns for the investors or help create a corpus, that could fund further research.  Kudos Mr. Gates.

Now please read the article.....

When I announced that I was investing in Alzheimer’s research for the first time last fall, I thought I knew what to expect. I knew I would get to engage more deeply with the brilliant scientists and advocates working to stop Alzheimer’s—and I haven’t been disappointed. The things I’ve seen over the last seven months make me more hopeful than ever.

What I didn’t see coming was the amazing response I got from the Alzheimer’s community at large. Because my family didn’t talk publicly about my dad’s diagnosis before the announcement, I had yet to experience how remarkable the support community is. So many of you have shared your personal experiences with me, both in person and online (including here on TGN). It helps to hear from others who are going through the same thing.

Alzheimer’s research is a frontier where we can dramatically improve human life—both the lives of people who have the disease and their loved ones. I’m optimistic that we can substantially alter the course of Alzheimer’s if we make progress in several key areas. One of the biggest things we could do right now is develop a reliable, affordable, and accessible diagnostic.

The process of getting diagnosed with Alzheimer’s today is less than ideal. It starts with a cognitive test. If you don’t perform well, your doctor needs to rule out all other possible causes for memory loss, like stroke or a nutritional deficiency. Then your doctor can order a spinal tap or PET scan to confirm you have Alzheimer’s. Although these tests are fairly accurate, the only way to diagnose the disease definitively is through an autopsy after death.

There are two big problems with this process. First, it can be expensive and invasive. Most insurance plans in the United States won’t reimburse tests for Alzheimer’s. Patients often pay thousands of dollars out of their own pockets. Meanwhile, spinal taps can be scary and uncomfortable, and PET scans require the patient to stay perfectly still for up to 40 minutes. That’s difficult for anyone to do—but especially someone with Alzheimer’s.

Second, patients aren’t being tested for the disease until they start showing cognitive decline. The more we understand about Alzheimer’s, the clearer it becomes that the disease begins much earlier than we previously thought. Research suggests Alzheimer’s starts damaging the brain more than a decade before symptoms start showing. That’s probably when we need to start treating people to have the best shot at an effective drug.

This delay is a huge problem in the quest for a scientific breakthrough. It’s currently so difficult to find enough eligible patients for a clinical trial that it can take longer to enroll participants than to conduct the study. We need a better way of diagnosing Alzheimer’s—like a simple blood test or eye exam—before we’re able to slow the progression of the disease.  

It’s a bit of a chicken and egg problem. It’s hard to come up with a game changing new drug without a cheaper and less invasive way to diagnose patients earlier. But most people don’t want to find out if they have the disease earlier when there’s no way to treat it. The commercial market for Alzheimer’s diagnostics simply isn’t there. There’s promising research being done, but very few companies are looking at how to turn that research into a usable product.

That’s why my next investment in Alzheimer’s research is in a new fund called Diagnostics Accelerator. This project of the Alzheimer’s Drug Discovery Foundation (ADDF) aims to accelerate bold new ideas for earlier and better diagnosis of the disease. Today I’m joining Leonard Lauder, ADDF, the Dolby family, the Charles and Helen Schwab Foundation, and other donors in committing more than $30 million to help launch Diagnostics Accelerator.

Diagnostics Accelerator is a venture philanthropy vehicle, which means it’s different from most funds. Investments from governments or charitable organizations are fantastic at generating new ideas and cutting-edge research—but they’re not always great at creating usable products, since no one stands to make a profit at the end of the day. Venture capital, on the other end of the spectrum, is more likely to develop a test that will actually reach patients, but its financial model favors projects that will earn big returns for investors.

Venture philanthropy splits the difference. It incentivizes a bold, risk-taking approach to research with an end goal of a real product for real patients. If any of the projects backed by Diagnostics Accelerator succeed, our share of the financial windfall goes right back into the fund.

My hope is that this investment builds a bridge from academic research to a reliable, affordable, and accessible diagnostic. I expect to see lots of new players come to the table, who have innovative new ideas but might not have previously had the resources to explore them. If you think you’re one of these bold thinkers, we want to hear your great ideas. I encourage you to apply for funding on the new Diagnostics Accelerator website here.

Imagine a world where diagnosing Alzheimer’s disease is as simple as getting your blood tested during your annual physical. Research suggests that future isn’t that far off, and Diagnostics Accelerator moves us one step closer.

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Why a Grateful Brain Is a Giving One 12-31

The neural connection between gratitude and altruism is very deep, suggests new research.

When you think about gratitude and its place in our culture, you might not immediately think about morality—that is, matters of right and wrong.

Often, we make gratitude sound like it’s all about you. In the domain of self-help, we hear that gratitude is the single most important ingredient to living a successful and fulfilled life—or that when we are grateful, fear disappears and abundance appears.

In fact, research does support the idea that gratitude helps people who practice it. They report fewer physical symptoms of illness, more optimism, greater goal attainment, and decreased anxiety and depression, among other health benefits.

If you stop with feeling good, gratitude certainly seems more like a platitude than a moral emotion that motivates reciprocity and altruism. But here is where I think many of us get gratitude wrong.
There is a much older, pre-self-help conception of gratitude as an emotion with moral motivations.

To first-century philosopher Cicero, gratitude was a matter of religious obligation “to the immortal gods.” Modern psychologists such as Michael McCullough and colleagues have systemized it this way: Gratitude is a “moral barometer”—an acknowledgement “that one has been the beneficiary of another person’s moral actions.” They go on to argue that gratitude is also a moral reinforcer, meaning that you’ll see a “thanks” from others as a reward that will lead you to give more in the future.

My own work has tried to map the relationship between gratitude and altruism in the brain. I am discovering that the neural connection between the two is very deep, and that cultivating gratitude may encourage us to feel more generous. We don’t say “thanks” for selfish reasons. Far from it: Gratitude, like giving, might be its own reward.

Neural rewards for giving

When we think about research on the relationship between gratitude and altruism, there are generally two main approaches.

First, we can ask whether people who seem to be more grateful are also more altruistic. Researchers use questionnaires to determine the degree to which someone is characteristically grateful. They ask other questions to determine the degree to which someone is generally giving. Finally, they use statistics to determine the extent to which someone’s altruism could be predicted from their gratitude.

Such studies are helpful for understanding the way gratitude could relate to altruism—in fact, the two do appear to go hand in hand—but of course, they depend on a person’s ability to judge their own gratitude and altruism. We can imagine someone touting himself as tremendously grateful, or the most generous person since Mother Theresa, but this could certainly be untrue. That’s why studies using these methods cannot explain why grateful people might behave prosocially. Perhaps they just feel guilty. Or perhaps altruistic people feel good when other people do well. How can we know?

At this point, we need to take an experimental approach. In one recent study, some colleagues of mine tried to understand the relationship between general prosocial tendencies and the way the brain responds to charitable donations. To start, the researchers assessed the prosocial tendencies of the participants using questionnaires. Then, they supplied participants with real money and put them in an MRI scanner that measures blood-oxygen levels in the brain.

In the scanner, the money could go to either the participants themselves or to a charity, such as a local food bank. Sometimes, these gifts were voluntary; sometimes not, so that it was more like a tax than a donation. This distinction was important, because in the tax-like condition, the participant doesn’t get to feel good about a charitable choice—only about the charity getting money. As the money transferred, my colleagues focused on reward centers of the brain—the regions that give us a dose of feel-good neurotransmitters—in order to compare the brain’s response to these various conditions.

The result? My colleagues found that the more prosocial participants felt far more inner reward when the money went to charity than to themselves. They found something else interesting: The older the participant, the larger this benevolent disposition—suggesting that, with age, your brain may reward you more when you see good in the world, rather than when you yourself get some benefit.

Stepping back from results like these, we are left to wonder about what makes someone grateful or altruistic in the first place. Is it a matter of the right dose of prosocial genes? Or is it a lifetime of experiences or family socialization that encourage both gratitude and giving?

My colleagues’ study answered some big questions, but also left some unanswered. One of these big questions involved the link between gratitude and altruism. Do they go hand in hand? Does gratitude actually encourage altruism?

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Do today’s philanthropists hurt more than they help? 10-11

Do today’s philanthropists hurt more than they help?

As philanthropy enters a second golden age, real social change is getting lost in the hype of market-based giving.

In one of his short stories, “Counterfeit Money,” Charles Baudelaire describes a fictional encounter between two friends who come across a beggar in the street.

In this short piece, the narrator and friend offer the beggar spare change, but the friend offers a much larger coin. The narrator commends him for his generosity. The friend accepts the compliment and then adds, once they’re out of earshot of the beggar, “It was a counterfeit coin.”

The narrator is astounded. Not only has his friend duped the beggar on purpose, what’s worse, he feels self-congratulatory for his gift. His satisfaction lies in the fact that the beggar doesn’t realize that he has been duped. The narrator sees that his friend’s “aim had been to do a good deed while at the same time making a good deal; to earn forty cents and the heart of God; to win paradise economically; in short to pick up gratis the certificate of a charitable man.”

Baudelaire’s story was written in the latter half of the 19th century, a time when industrialists such as Andrew Carnegie and John D. Rockefeller Sr. began channelling their vast fortunes into some of the greatest acts of philanthropy ever known. From Carnegie’s spending on public libraries to Rockefeller’s investment in biomedical advances, their giving helped to shift charity from the dispensing of alms in a largely unsystematic manner to a business in itself, overseen by paid philanthropic advisors.

Many did not feel grateful for the robber barons’ generosity, however. In his essay, “The Soul of Man Under Socialism,” Oscar Wilde berated the tendency of benefactors to use their charity as a bulwark against redistributive demands.

“The best among the poor,” Wilde wrote, “are never grateful. They are ungrateful, discontented, disobedient, and rebellious. They are quite right to be so … Why should they be grateful for the crumbs that fall from the rich man’s table? They should be seated at the board, and are beginning to know it.”

As philanthropy enters a second golden period, with the gifts from benefactors such as Bill Gates and Warren Buffett rivaling those offered toward the end of the gilded age, sceptics are starting to ask: Are Wilde’s and Baudelaire’s concerns still relevant? Are today’s philanthropists knowingly dispensing “false coins?” Are they trying to “pick up gratis the certificate of a charitable man?”

In most cases, the answer is a firm no. Charity is dispensed in good faith, with empathy toward close and distant strangers. And yet, at the same time, a new trend is growing: philanthrocapitalism, a more muscular philanthropy that seeks to combine profits with poverty alleviation. The effort to do a good deed while at the same time making a good deal is the driving impetus behind the new philanthropy. Another question Baudelaire raised still lingers: Who benefits more from charitable acts, the giver or the receiver?

At the forefront of the new philanthropy is the effective altruism movement, something upheld as radically different from earlier philanthropic approaches through a purportedly novel emphasis on measuring the results of giving. A pioneer in the movement is Peter Singer, the controversial bioethicist who has praised Buffett and Gates for being “the most effective altruists in history.”

His praise rests on the magnitude of their giving rather than evidence of their effectiveness. It’s true that in dollar terms, their generosity is jaw-dropping. Joel Fleishman points out in The Foundation that Buffett’s 2006 announcement of a gift of $31 billion to the Gates Foundation represented, in 2006 dollars, more than Rockefeller Sr. and Carnegie gave away combined.

But as a proportion of the overall U.S. Gross Domestic Product, the size of today’s foundations pales next to their predecessors. The Ford Foundation’s endowment in the early 1960s represented more than double the share of U.S. GDP in comparison to the Gates Foundation 50 years later. Ever since the 1970s, overall charitable giving in the U.S. “as a share of GDP has rarely strayed far from 2 percent,”Suzanne Perry points out in the Chronicle of Philanthropy, “despite the huge growth in the number of charities and fundraisers and periodic crusades to encourage greater giving.”

Corporations have become far stingier. Mark Kramer and Michael Porter pointed out in the early 2000s that corporate philanthropy as a proportion of corporate profits dropped since the 1980s. Since then it’s sunk even further, from 2.1% of pretax profits in the mid-1980s to 0.8% in 2013.

Singer’s presumption that Buffett and Gates are any more effective than earlier philanthropists isn’t backed by data. Some of the Gates Foundation’s work has led to measurable gains. Vaccination rates are rising; global child mortality has fallen—the foundation’s work in global health has contributed to these gains. But in comparison to government donors, Gates Foundation grants are a small drop in the global health landscape: The U.S. government has committed over $65 billion to global HIV/AIDs programs alone. That’s double the amount of overall giving by the Gates Foundation toward U.S. education, global health, and global agriculture since its inception.

To date, there has been far more hype than hard evidence about effective altruism’s achievements; its progress often seems to be measured and underpinned by self-sustaining feedback loops. Donors privilege what critics see as low-hanging fruit: aid projects where measuring the effect is relatively easy to do.

We hear a lot about the positive effects of different programs, such as the benefits of deworming efforts worldwide that were once thought to have contributed dramatically to education attainment in developing nations, until a recent review from independent health research group Cochrane cast doubt on that link. Far less attention is paid to counterfactuals, such as the cost to welfare programs when tax revenue is lost as a result of philanthropists receiving lucrative tax exemptions for pet projects.

Today’s philanthropy enthusiasts are never short on hyperbole. An organizer of a recent effective altruism conference at Google’s Quad campus in Mountain View reportedly averred that “effective altruism could be the last social movement we ever need.” But it’s clear that rises in global giving over the past 10 years have not made a dent in reducing economic inequality in rich nations such as the United States or Britain.

Individual philanthropic foundations have grown at a fast clip in the U.S. over the past 15 years: In that span, the number of individual foundations has doubled from about 40,000 to over 85,000. But this surge hasn’t helped alleviate extreme poverty. A 2012 report from the National Poverty Center at the University of Michigan points out that within the U.S., “the prevalence of extreme poverty rose sharply between 1996 and 2011.”

One of the biggest ironies facing 19th-century philanthropy was the question of whether growing charity simply exacerbated economic inequality by thwarting demands for better wages and the right to unionize.

Carnegie published his first “Wealth” essay, in which he urged the rich to share their spoils, just a few years before the Homestead battle of 1892, one of the bloodiest labor standoffs in U.S. history, where he brutally stamped out burgeoning union efforts even while liberally dispensing charity to his workers. “Paradoxically,” David Nasaw, Carnegie’s biographer, has pointed out, “Carnegie … became, if anything, more ruthless in pursuit of profits once he had determined that those profits would be distributed during his lifetime.”

“In remonstrating that only the millionaire could be trusted to dispense his millions, and that whatever that millionaire thought ‘best’ was best,” Nasaw adds, “Carnegie was promulgating a profoundly antidemocratic gospel, almost feudal in its paternalism.”

Effective altruists insist that private charity is the best means for improving livelihoods. ‘Today’s philanthrocapitalists see a world full of big problems that they, and perhaps only they, can and must put right,’ Matthew Bishop and Michael Green write inPhilanthrocapitalism: How Giving Can Save the World, a book that’s become something of a bible for the new philanthropists.

In contrast to claims of novelty, the results-oriented approach of today’s donors is little different than Carnegie or Rockefeller, who were both outspoken about the need to give away their money in an efficient and effective manner.

And just as in Carnegie’s day, philanthropy is often upheld as justification for gross profiteering.

“I donated a total of $5,000,000 to various causes recently. Looking forward to telling you all about it,” Martin Shkreli, the CEO of Turing Pharmaceuticals who was vilified for raising the price of Daraprim by 5,000%, tweeted in mid-September.

This is a prime example of philanthrocapitalism in action: the use of philanthropy to thwart attention to business practices that hamper access to life-saving medicines. And much like in Carnegie’s time, many aren’t buying it.

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Philanthropy in India Is Taking Its Own Route -03-29

Philanthropy in India Is Taking Its Own Route

Philanthropy is the flavor of the month in India: Wipro chairman Azim Premji recently became the first person in the country to sign up for the Giving Pledge, a commitment by the world's richest people to dedicate the majority of their wealth to charity. P.N.C. Menon, founder of the Sobha group, has promised to devote half of his fortune to philanthropic efforts.

In Mumbai, the Philanthropic Week organized by Indian foundation Dasra brought together some key players to discuss the roadmap ahead for charitable giving in the nation. Among the key themes that emerged was the dawning realization that India must find its own path to encourage citizens and companies to donate their time and money toward social good.

Premji recently transferred 12.5% of his holding in Wipro -- worth US$2.2 billion -- to the Azim Premji Trust. He also joined the Giving Pledge campaign, which was started by Bill Gates and Warren Buffett in 2010 and now includes more than 100 individuals and families from all over the world.

Following Premji was Dubai-based Menon, who founded his company as an interior decoration firm in 1976 and grew it to a conglomerate that includes construction, engineering and information technology businesses. "I don't think you should keep all of [the wealth you have created] for your family," he said after making the pledge, according to Arabian Business. "A large portion of it should go to society. I have decided that 50% of my wealth should go to society."

In Menon's statement lies one reason for the different trends in philanthropy among different societies and nations. Some would say that though his wealth amounts to a comparatively smaller US$600 million, Menon's gesture means more than Buffett's because Menon could leave the entire amount to his family. Buffett can't: The estate tax in the U.S. has a top rate of 40%, while countries like India and China have no such provisions. (Estate duty was abolished in India in 1985, but current finance minister P. Chidambaram has been making noises about reintroducing it.)

Nearly sandwiched between the announcements by Premji and Menon was the Dasra Philanthropic Weekend (DPW). There were no big-ticket announcements at the DPW, but none was expected. "Through DPW, Dasra is building a [platform] for different stakeholders to come together and work on the most scalable and sustainable ways to improve the lives of people in India," says Radhika Nayar, head of the Indian Philanthropy Forum at Dasra.

 "The week brought together a broad range of stakeholders -- social entrepreneurs, family and corporate foundations, corporations, impact investors, government leaders and philanthropists -- to learn about the most effective ways to solve India's social challenges and begin the essential work of collaborating with each other."

Is Compulsory CSR the Way Forward?

Amid all this, a debate was going on about a government proposal to make it compulsory for companies to spend 2% of their net profits on corporate social responsibility (CSR). The proposal -- part of the Companies Bill that has cleared the lower house of Parliament and is awaiting the assent of the elders -- has been diluted somewhat to make it more acceptable to businesses.

The different views were aired in January at a seminar in Mumbai a month before the DPW. 

Leading NGO (non-governmental organization) Child Rights and You [CRY] held a summit on corporate responsibility "to bring together key voices on the corporate responsibility debate in order to build greater convergence between stakeholders". CRY has only a peripheral role in the debate, which has recently acquired new dimensions.

But the debate on CSR has no easy solution. To start with is the question: What is CSR? "Various definitions of CSR have been making the rounds for much too long," notes Bhaskar Chatterjee, director general & CEO of the Indian Institute of Corporate Affairs, which has been mandated by the Ministry of Corporate Affairs to develop a clear definition. "The CSR provisions of the Companies Bill seek to create an enabling, catalytic environment wherein corporates can harness their core competencies and business acumen with the freedom to think through and decide their own CSR initiatives."

Chatterjee adds that the new policy "is likely to create a telling positive impact on the development sector landscape in the country in the years to come. [The Bill] will allow the CSR juggernaut that is imminent to acquire a decisive objective and purpose."

But so far, the government's initiative has left many unanswered questions. For example, the Tatas run Jamshedpur, which started as a corporate township 100 years ago and now has a population in excess of one million. It wasn't initially conceived as CSR, but it could be argued that running what is now the most populous city in the state of Jharkhand should qualify under a modern definition of the term.

Dileep Rangekar, co-CEO of the Azim Premji Foundation, supports the CSR provision with the proviso that "When organizations and individuals don't do something willingly, the State steps in. In the long run, a practice of setting aside a percentage of your profits to societal good would be useful as long as it does not come across as coercion."

But Rohini Nilekani, philanthropist and chairperson of Arghyam, a foundation she set up with a private endowment to work on water and sanitation issues in India, says she has been "against the 2% rule from the beginning" because "I don't think government should outsource its governance. And, secondly, making it mandatory is going to straightjacket [CSR] in a way that may not necessarily yield the best results. But now that it's been done, we just have to make the best of it."

"Philanthropy comes from the heart with its associated passion," adds Ajay Kela, president and CEO of Wadhwani Foundation. "I am skeptical that forced philanthropy will work. This forced CSR has the other downside of spending valuable corporate resources to document or game the CSR rule."

According to Nilekani, provisions should also be put in place to "ensure that the focus remains on the company's overall real responsibilities inside its fence. Companies get away with a lot of things, like pollution of water sources. There is no use doing charity outside if you cause some of the problems yourself. I would say that the media and public pressure has to remain on inside-the-fence corporate practice."

The CRY summit discussed the 2% solution and also featured a talk by John Elkington, an author, thinker and creator of the term "triple bottom line," or combining the three goals of a socially responsible organization -- financial, social and environmental. Elkington told India Knowledge@Wharton that the India picture is mixed "with some very sparkling companies doing great things." He emphasized the importance of environmental sustainability as part of CSR effortseakes a couple of points. First, most people tend to ignore family businesses. . "It's not just the financial, social and ethical aspects," he said. "CSR has also got a very strong environmental aspect. I think even the Tatas have tended to downplay the environmental aspect."

Corporate India had been waking up to environmental issues, but the growing number of protest groups, which had become more pronounced over the past few years thanks to crusading federal environment ministers, have been a rude awakening. Environmental concerns have throttled several major projects in the nation recently. The Times of India reports that Prime Minister Manmohan Singh has called environmental clearances the new "license-permit-quota raj." Meanwhile, the Supreme Court has banned mining in several parts o the country, including the entire state of Goa.

Lavasa, a huge township project being developed by the Hindustan Construction Company (HCC), is in trouble because of environmental concerns. Environmental activists have blocked South Korean firm Posco's US$12 billion steel project in Orissa. In the same state, U.K.-listed Vedanta Aluminum is in limbo because its allotted mines are said to be located on a tribal religious shrine. The government has offered a different source of aluminum but that has not stopped activists from protesting. In Mumbai, plans for a second airport have been ruled unlikely to disrupt the natural habitats of flamingos and other wildlife but the project is now being held up because of a few mangroves. The project was first proposed at least two decades ago.

A Closer Look at Giving

All of these developments are philanthropy related, but in many ways, they have very little in common, providing an example of how the issue is coming to a head on several fronts.

From a Western point of view, India is a parsimonious country. It has a World Giving Index rank of 133, the worst in the region and even below that of Bangladesh (109) and Nepal (115). Gates and Buffett recently visited India to promote the Giving Pledge and encourage wealthy Indians to give more. They were met with smiles, but little support. According to a Bain report on Indian philanthropy, private charity contributions as a percentage of GDP are only 0.4% in India, compared with 1.3% in the U.K. and 2.2% in the U.S. The report noted, however, that "India is recognized as a nation of givers. But we have a tradition of being quiet givers." A more recent Bain report, which was unveiled at the DPW, said that "achieving congruence on results-related issues can help increase the impact of philanthropy in India".

From an Indian point of view, giving is something that everyone does. Ashok Advani, publisher of Business India and a participant at the Dasra seminar, wrote in a signed editorial that "For centuries, the richest people in the country have given money to causes... Giving has been a way of life -- seva, daan, zakat, charity or philanthropy -- by whatever name in vogue."

Indians also give to religion. The richest temple in the world is the Tirupati temple in Andhra Pradesh, today run by the Tirumala Tirupati Devasthanams (TTD), a trust whose members are appointed by the government. Only the Vatican is ahead of it in wealth. 

Tirupati is the most visited religious site in the world; the number of pilgrims can reach 500,000 on special days. Many make donations of small gold items. In February 2011, the TTD deposited 1,175 kilograms of gold (worth US$64 million at current prices). This type of deposit is derived from the temple's collections of small donations by devotees. The bigger items -- such as the 3 kilograms of gold donated by liquor baron Vijay Mallya on his 57^th birthday recently --  are not included in this.

"Religion has been a big driver for philanthropy throughout history and across the planet," says Lynne Smitham of the U.K.-based Kiawah Trust, which partners with Dasra in its philanthropic endeavors. "Temples and churches have been thought of as trustworthy and benevolent." According to Nayar of Dasra: "Indians give significantly to temples, but this giving is ad-hoc, short-term and most significantly, does not prioritize impact."

"I do not agree with the premise that India does not have a strong culture of philanthropy," adds Poornima Dore, program officer at the Sir Dorabji Tata Trust. "Religious giving is probably the largest component, but there is a lot [taking place outside of that] as well. There are foundations such as ours that have been in this domain for over 75 years across the country and that is clear evidence of a strong culture that has been institutionalized." The Tatas have been deeply involved in philanthropy -- from hospitals to institutes of higher learning and sports to culture. The Tata philanthropic trusts control 66% of the shares of Tata Sons, the holding company of the US$100 billion Tata group.

While the main debate centers on finding the right philanthropy model for India, other issues are also clamoring for face time. The net result is a certain amount of confusion as talk about CSR steps on the toes of impact giving or charity grapples with for-profit philanthropy. So what did the DPW, which is considered the most high-profile of the meetings on the topic, achieve? "DPW brought together over 500 stakeholders," notes Nayar. "Dasra disseminated knowledge, facilitated discussions and announced key partnerships with the aim of inspiring collaboration among participants."

"It is difficult to measure the success of an event and I am not going to try to do it since we could not be there for all of the days," adds Dore. "Dasra has definitely grown over the years as an organization. I think the turnout was good." Smitham says that "for me it was immensely successful. It was a week of extremely important, relevant and urgent meetings on Indian social issues and a chance to listen, learn and exchange ideas on effective solutions."

"Events like DPW are great platforms to raise awareness around philanthropy in India," notes Kela of the Wadhwani Foundation. "As we know, India does not have a strong culture of philanthropy outside of giving to the temples. So advocacy and raising awareness is a good thing. Also, India has thousands of non-performing and low-impact NGOs. A systemic approach to address the issue of impact is also very welcome."

Some believe that events like Dasra and CRY can lead to the development of a successful model of philanthropy. "India does not seem to have a culture or a model for philanthropy at a national level," says Kela. "I do believe that we should look at successful global models and adapt them to our needs and tax structures rather than reinvent the wheel. We should also learn from the mistakes of the others rather than repeat the same mistakes."

"All over the world, people will always keep doing charity," adds Nilekani. "That is based on empathy. You see someone in need and you reach out. And that is something to celebrate. But I think as societies become more globalized and modern, a new kind of wealth creation will evoke a new response, partly inspired by Western models. The newly wealthy are going to engage with new social issues and they are going to look more systematically at their resolution. So I am not at all surprised that we are following a new model now."

According to Dore, "Western models have their value and so do Indian ones. Rather than debating models, we should focus on how philanthropy can actually reach out to the most marginalized, or address the most pressing

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