Bitter Medicines… 19 December 2007

Recently the World Health Organisation (WHO) conducted an international conference. Two independent pharma experts from India attended the same. They have summarised what other speakers had to say about the quality of medicines manufactured in India. Please read on.

· First the good news: Pharma company CIPLA scored 100 percent quality success.

· More than 50 percent of Indian medicines were accepted. Others failed to qualify.

· Another pharma company Ranbaxy qualified in around 54 percent of the applications it submitted. Rest failed.

· One of the Indian medicines did not show any efficacy at all. It was useless.

· Some of the Indian medicines including anti retroviral drugs used for treatment of AIDS sold in African countries were of poor quality.

· In quality, China was ahead of India (and we doubt the Chinese quality!)

Medicines which were rejected by WHO, were approved earlier by the Indian drug authorities. Why they failed to qualify at the international level? What are we hiding? Who is responsible? It is time the country did something about it. Wake up, please.

S .Gopal ….Keying in is better than idling

Negative Role Models… 18 December 2007

(about 280 words..)

They are perceived to be next only to God, because they save lives. I agree. Hence, they are role models. Everybody watches them closely, as I did when I was admitted to a hospital.

Several actions of some doctors are, however, not worth emulating. Here we go.

· A notice fixed near the door of a lift said: `only for patients’. I found doctors using this lift even though there was another working lift designated for the exclusive use of medical personnel.

· Doctors do not need a microbiologist to tell them not to roam around canteens and other places in their white coat – the attire, which they are seen with while examining patients.

· `No footwear inside’ warns a signboard at the entry to the Radiology room; you will find doctors entering the room with their shoes on, and mind you they are not special hospital slippers.

· `Keep Silence. Hospital Zone’, says the writing on the wall. White coated ones would stand and talk loudly just below the notice. Some would zoom in their vehicles.

· Once I was in an Intensive Care Unit of a hospital for a night as a patient. The doctor interns gossiped and joked all through the night while I was lying in discomfort.

· Doctors say that smoking is bad for health, but they themselves smoke in public; in my own case, a doctor who examined me in the Casualty department was reeking of nicotine and I had to inhale the passive smoke.

Who will advise those who are supposed to advise us?

S .Gopal ….Keying in is better than idling

Friend or Foe?…… 17 December 2007

This entity is both, depending on where it is found. It is Ozone.

Ozone is essential for human life. The ozone layer present at an altitude of 20 to 30 kilometers above the earth in the stratosphere is responsible for absorbing the harmful ultraviolet radiation emitted by the Sun.

On the other hand, high levels of ozone at the ground level are the cause of eye irritation and respiratory problems.

Human beings are largely responsible in both the cases:

· During various activities indulged by the humans, substantial quantities of compounds containing chlorine and bromine are released leading to the damage of the ozone layer.

· Increasing number of motorised vehicles release nitrous oxide and carbon monoxide. Sunlight converts these into ozone.

The good news: Great progress has been made by humans in reducing the use of such items, which release chlorine and bromine.

The next time you are about to take your car out, hold your breath, think about yourself, your children and grandchildren, and ask a question to yourself: Can I cover the distance on foot or take a bus?

S .Gopal
….Keying in is better than idling

`Off-Label’ use of medicines… 24 November 2007

(about 300 words)

 

The medical condition for which a medicine is to be used as well as the recommended dosage are printed on the container of the medicine and/or on a sheet of paper enclosed with the medicine.

 

The medicine manufacturers have to disclose to a government regulatory authority the contents of the medicine and for what ailment it is intended. They can market the medicines only after getting the approval.

 

Use of a medicine for a purpose different from the ones for which it has been approved by the regulatory authorities is known as `Off-Label use of medicines’.

 

Use of `off-label’ medicines is widespread. One example: Neurontin, a drug approved for epilepsy is being used for the treatment of pain.

Pharmaceutical experts have expressed several opinions on the subject. They are:

 

· Most doctors do not know the meaning of the term.

· Many doctors do not read the labels and prescribe medicines based on anecdotes (what they hear from unauthorised sources) rather than on clinical evidence.

· Pharma companies promote and encourage such use to promote their sales.

· Antibiotics (anti-bacterials) are used against viral diseases, even though it is well-known that they have no effect on viruses per se.

· Insurance companies in developed economies like USA do not pay for the `off label’ use of medicines.

· Many a time `off label’ use of medicine becomes an important alternative when approved medicines fail to produce medical benefits.

· There are examples of many drugs which started as `off-label’, but were approved later for clinical use.

· There are are lakhs of prescriptions coming to pharmacies all over India. It would be impossible to monitor even a fraction of them for `off-label use’.

 

S. Gopal

….Keying in is better than idling

Nexus-doctors and pharma companies 15 November 2007

(more than 200 words)

I share with you some data published in the United States. This exposes the shameful and unholy nexus between pharma companies and doctors in the United States (a country which boasts to be the most civilised nation in the world) to the detriment of its patients. I hope doctors of Indian origin are not involved in this.

This is happening in India as well, but statistics are not available.

State of affairs

• Pharma Industry spends more than US Dollars 20 billion a year on marketing, about 90 per cent of which goes to doctors to influence them to prescribe medicines which it wants them to prescribe. This is equivalent to US Dollars 13 000 per doctor per year.
• Doctors get
  • free pens to free lunches
  • sponsored to conferences, compromised medical education programmes and unaffordable holidays

The effect

• Doctors enter into a quid pro quo arrangement with the pharma industry and they tend to prescribe such medicines the pharma companies ask them to. They
  • ignore cheaper alternatives
  • prescribe unnecessary medicines
  • put medicines to off-label use (for indications that the regulatory authorities have not approved them).
  • The patients are taken for a ride and cheated. Their health is endangered by the doctors to whom they go for cure.

What United States is doing

• The government is bringing out a legislation to make it compulsory for pharma companies that produce medicines and medical devices with a turnover of more than US Dollar 100 million to reveal the amount of money they give to doctors to influence their prescribing patterns.
• Many medical institutions are not allowing medical sales representatives inside their premises.
  

S .Gopal
….Keying in is better than idling

Taking medicines…some guidelines.. 14 November 2007

Notes:

• Most of the information has been taken from the Patient Information Card of Columbia Asia Hospital, Bangalore.
• These are guidelines; always consult a doctor whose advice is the best.

Medicines are taken to cure illnesses. Some guidelines while consuming them:

• Follow the instructions and pay attention to the warnings printed on the medicine container or on the sheet of paper that accompanies the medicine.
• Do NOT
  • stir medications with food
  • take capsules apart
  • take vitamin tablets with medicines
  • mix with drinks warmer than room temperature
  • take medicines with alcoholic drinks
• Avoid coffee if you are on medication for Asthma
• Avoid alcohol if you are on Aspirin or on any medicine for common cold
• Reduce intake of salt if you are on medication for hypertension
• Never break a tablet to reduce its potency; half 10 mg tablet is not equal to one 5 mg tablet because all tablets are not homogeneous (all contents of the tablet are not uniformly distributed in it).

S .Gopal
….Keying in is better than idling

Therapies Galore…. 1 November 2007

Apart from the various medical systems – allopathic, ayurvedic, homeopathic, and unani – practised in India, there are many types of therapies advertised or announced in the Press. I have listed some of them below.

Dance therapy

Music therapy

Vipassana Medidation

Yoga therapy

Breathing Exercises (Art of Living)

Water therapy

Laughter therapy

Naturopathy

Aroma therapy

Massage therapy

Lifestyle change

Reiki

Pranic healing

Accupuncture therapy

Quite a few of these therapies work on the basic premise that the root cause of many medical problems is stress and tension associated with modern living. Each therapy claims to attack the root cause and ensure a happy living.

While all these therapies may result in some benefits, I wonder whether

• these therapies will stand the test of scientific scrutiny of replicability in identical conditions.
• commercial motivations of the practioners of these therapies have overtaken the noble ideals of those who discovered these therapies.

S. .Gopal
…keying in is better than idling

Gold matters… 25 October 2007

Value for money

Is the gold you are buying as pure as being promised by the trader? It is estimated that impurity in gold sold in India ranges from 11 to 39 percent. Indians consume 800 tonnes of gold annually and lose about Rupees 7 500 Crores due to impure gold. Hallmarking is the process of certifying the purity of gold. Hence buy only hallmarked gold.

Will you like to cause injury to others?

In the traditional method of making jewellery, silver or copper is used to solder gold. Many jewellers have now switched over to cadmium due to its good fluidity during the soldering process. Jewellery made using this process is known as KDM jewellery.

The unsafe side of KDM jewellery is that the toxic fumes given out during the soldering process (using cadmium – classified as heavy metal by scientists) are injurious to the health of the jewellery workers. There are about 80 000 jewellery workers in Karnataka and many of them children.

Will you still say `yes’ to non-hallmaked or KDM jewellery?

S. .Gopal
…keying in is better than idling

`Branded’ & `Branded Generic’ II of II 19 September 2007

Some more information on the subject:

• It has been found that many-a-time there is not much difference in the ‘Maximum Retail Price’ (MRP) of `Branded Generic’ and `Branded’ medicines.
• The whole purpose is defeated as the poor patients are not benefited in any way.
• It has been suggested by experts that the government should intervene and ensure that the MRP of `Branded Generics’ are atleast 30 percent lesser than that of `Branded’ medicines.
• We need to get educated on this aspect and educate others.

Two examples are provided below:

Company Brand name and MRP Rs. Branded Generic and MRP Rs.

 

———– for 10 tablets for 10 tablets

Biochemical name

Cadilla Fludac Cadfkow

——— ——– ———–

Flouxetine 20 mg 37.26 28.00

—————————————————————-

Cipla Alerid Cetcip

——— ——- ——-
Cetrizine 10 mg 35.31 25.00

Note: The company’s price of `Branded Generics’ to the superstockist is, on-an-average, just one-fifth of the company’s price of the equivalent `Branded’ medicine to the same superstockist.

Gopal

…..keying in is better than idling

`Branded’ & `Branded Generic’ I of II 18 September 2007

Note: This piece is just to make you aware of an important aspect which touches us in our daily life. However, please check with your doctor before taking any action. This is Important.

In the highly profitable business of pharmaceutical products, medicines are categorised as “Branded” and “Branded Generics”.

In theory,

• `Branded’ and ‘Branded generic’ medicines have the same composition, quality, and efficacy
• `Branded’ medicines are usually manufactured and marketed by large reputed companies under popular brand names
• `Branded Generics’ medicines have less name recognition and are sold by the superstockist or retailer
• Since the expenditure incurred in marketing `Branded Generics’ is hugely less, it is supposed to cost less to the consumer compared to `Branded’ medicines

In practice,

• In many cases, both forms of medicines cost the same to the consumer
• The consumers are not aware of these two types of medicines
• Many doctors are not well-informed on this subject; the chemist shops do not educate the customer

Gopal

…..keying in is better than idling