Shashi Tharoor highlights the huge pressure on students in India to secure good grades, as competition for higher education places and good jobs is fierce. Not all students are able to cope with exam stress, which is described as a "pressure cooker situation." Some resort to cheating, and some pay people to sit their exams for them.

Now and then students take their own lives, prompting distraught parents to put the blame on private coaching institutions that "subject their children to excessive stress" - 13 hours a day, six days a week studying to pass the exam. Frustrated and depressed students have nowhere to seek counseling and psychological guidance, and school administrators do little to help identify youngsters at risk.

Indian parents - like their counterparts in China - are known for being very pushy. They devote much of their time and resources to sending their children to top schools. From a young age, they drill into their children the need to excel in maths and science, aspiring to win a coveted place at one of the 16 Indian Institutes of Technology (IITs) and a fast track to a high-flying job. Those who "do not make it to an IIT end up in institutions of varying quality, many of which do not equip their graduates for today's labor market."

Parents view "engineering as the gateway to modernity, and continue pressing their children to study it." The IIT's are excellent training institutes, and many of their engineers and computer scientists enjoy success in Silicon Valley, or they remain in India and set up high-tech companies in the city of Bangalore - their Silicon Valley. The author says, "at least there are enough engineering colleges in India to meet demand. Medicine, by contrast, is a frustratingly crowded field – and for no good reason. "

According to the author, the Medical Council of India (MCI) - the country's medical regulatory body - is an "opaque and self serving cabal." It is a powerful club and controls the medical profession, and limits "the supply of available medical college seats," - a staggering number of "only 381" - in a country of over 1.2 billion people. Its influential medical practitioners act without any fear of regulations. In recent years it has been accused of corruption in health care. Massive money changes hand in granting a licence to practise medicine or awarding a medical college seat "against 'donations,' with the wealthy essentially purchasing positions that their marks do not merit," forcing other "high-achieving students who just barely missed the cutoff.... to find alternatives – or pursue another field altogether." Those who can afford "often end up studying medicine abroad. Many do not return to India, depriving the country of their much-needed expertise."

The country "desperately needs doctors," but many leave in their thousands every year for other countries, where they can earn more. The author says "India could be graduating four or five times as many capable doctors as it does each year. Yet the MCI has been allowed to pursue its restrictive approach, depriving poor Indians of adequate health care, while augmenting the already-huge pressure on students to gain a seat in a medical college." Nearly two million children under five die every year – one every 15 seconds – the highest number anywhere in the world. More than half die in the month after birth and 400,000 in their first 24 hours.

A sea change in the way Indian society views academic success is unlikely. Parents are not prepared to encourage their children to follow other creative pursuits and be involved in sports and not make academia the only way to achieve success and recognition. Yet in terms of research and the purely academic disciplines, such as maths, physics etc, critics say India is beginning to trail in comparison not just to other countries but its own past performance.