Two weeks later, Cal and Petra were back in Cal’s hometown of Los Angeles, brainstorming their company-to-be’s modus operandi. To help, each had hired a gifted friend: Cal had chosen Durell Williams, an African-American whom he had befriended at UCLA and who had gone on to specialize in computer security; and Petra had asked Santana Ramos, a Ph.D. in psychology who had joined CNN after she’d worked in private practice for a half-dozen years.

Most important, all four people were equally competitive, equally dismissive of ethics as a limiting weakness, and equally convinced that their current challenge of curtailing medical tourism for a Fortune 500 company was an opportunity of a lifetime, and each vowed that they would do whatever it took to denigrate medical tourism. Quite expeditiously, the group had settled on a company plan of promoting patients’ fears as the best way to lower demand. Until patients were subjected to propaganda to the contrary, everyone facing surgery had strong reflex reservations about going to India or another developing country for an easily understandable complex of reasons. First was the concern of the country’s general lack of cleanliness, raising the specter of wound infection and catching any one of a number of dreaded infectious diseases. Next there was an obvious question of the skill of the surgeons and the other personnel, including nurses. In addition, there was the question of the quality of the hospitals and whether the necessary high-tech equipment was available. And finally there was the question of whether the operations that were performed were generally successful.

When the group looked into the propaganda the India Tourist Office was actively putting out, they discovered the office was clearly addressing these specific issues. Consequently, it was decided that Cal’s new company would create ad campaigns to do the opposite and take advantage of people’s fears. Everyone was certain this plan would be successful, since ad campaigns are always easier when the goal is the support of people’s existing beliefs and prejudices.

Unfortunately, no sooner had they settled on a strategy and begun trading ideas when they ran into a serious problem. They had realized that with India spending serious money and effort promoting their medical tourism, the Indian government would surely investigate if someone started doing the opposite, and an investigation of any sort would invariably cause significant problems if ad campaign claims could not be substantiated.

What had been quickly recognized was that real data were needed involving private Indian hospitals, particularly in relation to outcomes, mortality, and complications, which included such statistics as infection rates. Yet the data were not available. The group had checked the Internet, medical journals, and even the Indian health ministry, which they soon discovered was dead set against releasing any such information, even refusing to admit if it existed. In their own ads they used no data whatsoever, merely claiming their outcomes were as good as or better than outcomes in the West.

Stymied for a time, the group had suddenly realized they needed a fifth column inside the private Indian hospitals participating in the highly profitable and growing medical tourism industry. What would have been best were accountants, but the efficacy of that idea seemed questionable at best. Instead, they had hit on the idea of using nurses, mainly because Santana knew something the others didn’t—namely, that there existed a worldwide business in nurses. In the West there was a shortage. In the East, particularly in the Philippines and India, there was a surplus, with many young nurses desperately wanting to emigrate to the United States for economic and cultural reasons but facing significant, almost insurmountable, hurdles.