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Kool's Commentary : Jan 25 PR DT Note pg134 (Page 97)

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sashashyam

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Posted: 16 February 2013 at 1:50pm | IP Logged
Kalapi,

It is nearly 2 am here, so I will be even briefer. Of course you mean 'cures' (
@red) (unless that was a Freudian slip!), but I was not aware that there are already cures for AIDS and cancer, neither of which  would I call a common ailment.

As for
@blue, you are endorsing what I have been saying at much greater length, that Big Pharma only goes into niche areas where it can collar markets and maximise profits. And if the market has to be niche, the prices have to be that much higher. Big Pharma would not be interested in affordable anti-AIDS drugs for India or Africa. On the contrary, it would try its best to stifle such cheap drug availability, by hook or by crook.

As for the Indian lower middle class and the poor, it is very clear what would benefit them, and it would not be Big Pharma and its niche formulations, which are clearly
not meant to promote the greatest good of the greatest number. Why would they make a thousand Tata Nanos when they can make the same profit on a single Ferrari? But can Ferraris ever solve the transport needs of the urban middle class? So  we in India need a Ratan Tata, not an Enzo Ferrari.

Shyamala


Originally posted by Kalapi

Shymala, liking this debate, but have to run somewhere soon, so I will be brief'.

Well, what can I say, the drug that got my Dad final cured the first time around was by using a branded antibiotics that Merck manufactures and sells all over (he is doing fine now, thank you). It was expensive, costing 3000 rupees per day, but can we not expect Merck to recover the cost of discovering the drug in the first place. If the company doesn't recover the cost, where will it find the money to go after novel target let along pay it huge employees?

Secondly, it might have been 20 yrs back that Big Pharma only went for markets that were large. No, any more dear, time has changed with Science coming a long way. We already have curses for all common ailments like TB, polio, dengue, AIDS and even cancer. The market that is still not covered has high competition, so that to even be able to control the market or profiting from it, the company has be first mover into the space. No the competitive landscape has changed and now Big Pharma spends billions to conquers niche markets and diseases only with limited sales. Recently, J&J TB drug got approved for a TB drug in the US that will only bring very small amount in sales if ever it break-even. As for the R&D cost of drug discovery being a one time affair, you just have to look up the life that a drug takes to develop, the time the patent is approved and then when the drug hits the market. Then you have to consider the length that a patent is there, before generics takes over. A patent is applied the moment it is declared a NME, and sometimes even before, for the fear of being lost to the competition. The initial development could then run into a decade and then of course the endless clinical trial follows to show safety and efficacy ' that my dear runs into another 5 to 7 yrs. So at the end a drug might only enjoy exclusivity rights of say 5 yrs when it is in the market without a competition. Also, only a handful of drugs can attain the status of the blockbuster meaning attain total sales of more than $1billion / yr.

Now about which side of the argument AK was in that debate. It was as one my friend emailed and asked (of course, he never got back). Why does he and everyone in the film industry, are against piracy of film? Why does he and other campaign against the release of pirated DVDs, when a new movie is released? What are his motives? Why campaign against piracy when a cheaper DVD can entertain a poor much more easily then spending 200 rupees per head for a family of 4? Can't he see that entertainment is as important for the wellbeing of the poor as is the drug he takes?  Common, don't give me the argument that one is movie, the other is the drug, for in both cases, the money invested didn't grow on trees.



Edited by sashashyam - 16 February 2013 at 1:45pm

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Posted: 16 February 2013 at 2:16pm | IP Logged
I would not give Indian medical treatment any status coz my experience of it is very very bad . I firmly believe that gaffes r there everywhere but in India there is almost no way to make a medical gaffe accountable .

My sister died on the operating table when she was in for a simple uterus removal procedure due to gross negligience by doctors .  The anaesthesist had given her far too much anaesthesia  and she could not recover consciousness as the reversal injection was given .

The other doctors only tried to cover up for the anaesthesist and were tight lipped . We enquired and enquired and were told that the only punishment for such a serious gaffe was that the doctor's name would come in some medical journal and he will be admonished by some board of doctors ...then life would go on as it was for him .

So after breaking our heads and knowing that we would never win in a civil court  as the doctors refued to testify against each other, we went to the consumer's court as we wanted those doctors to pay . We finally won there but guess after how many years ? 12 years . By that time my sister's son , an only child had graduated and was earning .

My mother was discharged from the hospital after some sickness and the blood thinner wafarin was not written down in the list of medications she was given as other medications made her blood thicken . This was an overlook error . Well , she had a brain stroke , suffered brain damage and died due to this unpardonable gaffe . 

No possibility of holding the hospital accountable and getting back to the US  was a prority ...as schools had already begun .

It is much easier to hold such medical gaffes accountable here ...in India there is no way of getting any justice . The corruption in hospitals is apalling . My mother's prolonged illness , my sister's death and my brother's stay many years ago [ he was in hospital for 6 months]have given me a horror of the hospitals there .

But this is my experience and my POV.  

Speaking of PR ...Onir making the swap or agreeing to wifi's plan of the donation is highly unethical and he would lose his license here .


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Posted: 16 February 2013 at 6:03pm | IP Logged
One of my friend's elder Jitu is in hospital last stage of Lung cancer which was diagnosed just abt couple of months ago.  Now in coma for last 10 days. He is an ex pilot for air india. So under their med insurance.  Every 5 days someone has to go turn in paperwork personally to continue his benefits.  No fax, email etc allowed only personally .  Man lives alone @ age of 84.  Both his sons & families live abroad. He also did not want to move to US.  It Is making it so difficult for him who lives in Bandra and the offc where the paperwork has to be turned in is in so Bombay. Poor man is in coma and may die any day now.  The corruption & red tape plus the power each level of empl hold is ridiculous.  

Now before he went in to coma said he should hv moved to US when his son had insisted.  Just bit too late.  Money is there but so hard to find the proper help is hard ..  Neways thought I share the latest what I heard from my close friend. 


What doc Onir may do for his sanskari tyaagi wifi or himself in switching babies is soo against medical ethics.  He would hv his license taken away.  What EK shows in her silly serials is nonsense.


Edited by Dabulls23 - 16 February 2013 at 10:28pm

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Posted: 16 February 2013 at 6:43pm | IP Logged
Originally posted by Dabulls23



What doc Onir may do for his sanskari tyaagi wifi or himself in switching babies is soo against medical ethics.  He would hv his license taken away.  What EK shows in her silly serials is nonsense.


exactly this is what i want to say...when he thinks the dean of mittal hospital is bad...then he equally or should i say more bad...onir made wrong preggo reports and he asked dean to get actual reports of that guy...onir said dean gave wrong medical reports to guy's family then what onir was doing...onir is doing completely baby swap where as that dean just took organs from dead/dying people...

onir's medical ethics from the beginning are questionable...the way he made statements on ovi, the way he manipulated ovi...

onir's license should be taken away for good...

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Posted: 17 February 2013 at 12:25am | IP Logged

These days AIDs have pretty good treatment antiretroviral  drugs that can allow patients to live near normal life. I believe there a few cases in AID patients that the doctors are cautiously declaring fully cured. If it hasn't been for the big Pharma companies, could we even have those AIDS drugs in the first place?

As for cancer, in most cases early detection results in good prognosis. As a result regular and routine checkups are encouraged. This is preventive care that of course leads to higher healthcare cost. IN case of late stage cancer, palliative treatments becomes the best option leading to again higher heathcare cost. Also, the cases of cancer that doesn't have any defined treatment regimens are considered to be tough to crack. The market has very high competition so when and if breakthrough happens, and the latest I hear that isn't going to be easy, as the incurable ones are tough nuts to crack... the profit realized if any will be marginal. So, now if the Big Phrama companies are spending billions to develop these drugs, they will then have to file for bankruptcy after development, cause  they shouldn't be allowed to recover cost as that is unethical??

When one talk about Niche market in regard to a Pharma company, it mean diseases that are rare and occur in a small population. I think you misunderstood me. As for your argument of Niche Disease market is for maximizing profit, it basically then assumes that the consumers of that market must be millionaires so that the Pharma companies can charge them an arm and a leg, not to mention, that the disease must be life threatening so that the consumer are willing to pay for a cure. It also assumes that they is some sort of mutual exclusivity decided (which isn't legal) between the Big Phrama companies, before such drug development happen. Only under such theoretical conditions, a big pharma company can laugh to the bank. The big pharma companies are equally interested in making affordable drugs but that desn't mean it can't even breakeven or create a pool that allows research to go forward. I really find this argument hard as that if R&D (which bi no means is a one time cost for drug) stops, how will new treatments even be developed? And who is willing to work for free in a pharma company. A profit is needed just to keep the wheels moving, pay its bill, and keep R&D moving. For one phrama company to survive, many companies go under? Does AK works for free in his films or are the directors not expecting a pay or the produce not interested in a profit. But, when pharma company wants to safeguard it drugs from been copied, we become judgmental.

Lastly, a pharma company cannot just go in and do business anywhere it likes. No, that isn't that simple as making and selling a car. If and when a company plans to take their drug to a country, like China, England Japan, they have to get clearance from their federal medical agencies of that country - and that can run into years. I believe the clearing body in India is the General Medical council. Same is applicable everywhere, and each countries has its own sets of specification/rules and regulations that a pharma company has to meet and abide by. That itself might involve some more clinical trials in that geographical location (esp. true in Japan) and or fulfillment of region specific requirements. Sometime the redtaps, corruptions and bureaucracy is so bad in certain countries, not to mention patent issues, the drug company doesn't even want to enter that market - for any bribe paid by a pharma company which operated out of US is a punishable federal offense, and the prevalence of bribe just acts as a deterrent for a pharma company to enter markets like India, Brazil...

 
 
 
Originally posted by sashashyam

Kalapi,

It is nearly 2 am here, so I will be even briefer. Of course you mean 'cures' (
@red) (unless that was a Freudian slip!), but I was not aware that there are already cures for AIDS and cancer, neither of which  would I call a common ailment.

As for
@blue, you are endorsing what I have been saying at much greater length, that Big Pharma only goes into niche areas where it can collar markets and maximise profits. And if the market has to be niche, the prices have to be that much higher. Big Pharma would not be interested in affordable anti-AIDS drugs for India or Africa. On the contrary, it would try its best to stifle such cheap drug availability, by hook or by crook.

As for the Indian lower middle class and the poor, it is very clear what would benefit them, and it would not be Big Pharma and its niche formulations, which are clearly
not meant to promote the greatest good of the greatest number. Why would they make a thousand Tata Nanos when they can make the same profit on a single Ferrari? But can Ferraris ever solve the transport needs of the urban middle class? So  we in India need a Ratan Tata, not an Enzo Ferrari.

Shyamala


Originally posted by Kalapi

Shymala, liking this debate, but have to run somewhere soon, so I will be brief'.

Well, what can I say, the drug that got my Dad final cured the first time around was by using a branded antibiotics that Merck manufactures and sells all over (he is doing fine now, thank you). It was expensive, costing 3000 rupees per day, but can we not expect Merck to recover the cost of discovering the drug in the first place. If the company doesn't recover the cost, where will it find the money to go after novel target let along pay it huge employees?

Secondly, it might have been 20 yrs back that Big Pharma only went for markets that were large. No, any more dear, time has changed with Science coming a long way. We already have curses for all common ailments like TB, polio, dengue, AIDS and even cancer. The market that is still not covered has high competition, so that to even be able to control the market or profiting from it, the company has be first mover into the space. No the competitive landscape has changed and now Big Pharma spends billions to conquers niche markets and diseases only with limited sales. Recently, J&J TB drug got approved for a TB drug in the US that will only bring very small amount in sales if ever it break-even. As for the R&D cost of drug discovery being a one time affair, you just have to look up the life that a drug takes to develop, the time the patent is approved and then when the drug hits the market. Then you have to consider the length that a patent is there, before generics takes over. A patent is applied the moment it is declared a NME, and sometimes even before, for the fear of being lost to the competition. The initial development could then run into a decade and then of course the endless clinical trial follows to show safety and efficacy ' that my dear runs into another 5 to 7 yrs. So at the end a drug might only enjoy exclusivity rights of say 5 yrs when it is in the market without a competition. Also, only a handful of drugs can attain the status of the blockbuster meaning attain total sales of more than $1billion / yr.

Now about which side of the argument AK was in that debate. It was as one my friend emailed and asked (of course, he never got back). Why does he and everyone in the film industry, are against piracy of film? Why does he and other campaign against the release of pirated DVDs, when a new movie is released? What are his motives? Why campaign against piracy when a cheaper DVD can entertain a poor much more easily then spending 200 rupees per head for a family of 4? Can't he see that entertainment is as important for the wellbeing of the poor as is the drug he takes?  Common, don't give me the argument that one is movie, the other is the drug, for in both cases, the money invested didn't grow on trees.



Edited by Kalapi - 17 February 2013 at 12:25am

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Posted: 17 February 2013 at 7:09am | IP Logged
Dear Varsha,

This is a very sad case, and I would like to help the old gentleman if I can. I am PMing you my personal e-mail id and my cellphone number. If you could send a message to whoever is looking after the patient to call me, I will get all the details from him/her over the phone and by e-mail. I first thought of requesting you to get them, but this will save time and moreover I can get any clarifcations I need easily and directly.

I will then get in touch with either the Chairman of Air India or with the Department of Civil Aviation in New Delhi which is the controlling authority for Air India, and will try and get them to sort out this 'every 5 days' nonsense. I do not know anything about the Air India insurance coverage for their employees, but it should be of the same pattern as the Central Govt. Health Scheme (CGHS),  as AI, though autonomous, is a semi-govt. organisation. And in the CGHS, the period for renewal of the prescription and for the supply of all the prescribed medicines is one month. Not 5 days. So I hope this can be sorted out, and in any case I intend to try very hard to get this done.

So please look out for my PM and do ask the Mumbai contact to get in touch with me. I would also appreciate a PM confirmation that you have seen this and will be taking action as outlined above.

Shyamala

Originally posted by Dabulls23

One of my friend's elder Jitu is in hospital last stage of Lung cancer which was diagnosed just abt couple of months ago.  Now in coma for last 10 days. He is an ex pilot for air india. So under their med insurance.  Every 5 days someone has to go turn in paperwork personally to continue his benefits.  No fax, email etc allowed only personally .  Man lives alone @ age of 84.  Both his sons & families live abroad. He also did not want to move to US.  It Is making it so difficult for him who lives in Bandra and the offc where the paperwork has to be turned in is in so Bombay. Poor man is in coma and may die any day now.  The corruption & red tape plus the power each level of empl hold is ridiculous.  

Now before he went in to coma said he should hv moved to US when his son had insisted.  Just bit too late.  Money is there but so hard to find the proper help is hard ..  Neways thought I share the latest what I heard from my close friend. 

What doc Onir may do for his sanskari tyaagi wifi or himself in switching babies is soo against medical ethics.  He would hv his license taken away.  What EK shows in her silly serials is nonsense.


Edited by sashashyam - 17 February 2013 at 7:04am

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Posted: 17 February 2013 at 11:31am | IP Logged
Dear Kools,

I was appalled when I read about the horrors you and your family have gone thru because of such gross cases of medical negligence in the Indian hospitals involved. I am no longer surprised about your comments on medical treatment in India,  As I wrote to Kalapi, one goes largely by one's own personal experiences and those of one's near and dear ones, and for you, these have been awful. I am so very, very sorry, though there is nothing any outsider can say that can be of any real help in the face of such grievous losses.

I have never had any such bad experiences in India, right from our  family GP, whose flair for diagnosis was uncanny, till the time when my father, at 70+, returning from his morning walk, stepped off a pavement into the road just behind a school van which was  being backed. The driver was not paying attention to the rear view mirror, he knocked my father down, and ran over his right arm. The whole skin was peeled back halfway to the elbow, like  a banana, and there was an awful lot of blood. This was in Mylapore, in the heart of Chennai, and he was rushed to the nearest, medium size hospital, St.Isabella's. I was then at home, on a vacation midway thru a foreign assignment, and I spent most of the next 6 weeks in that hospital. They looked after him very well, the doctors were both accessible and open, and they managed to save him, for the shock and physical trauma, at that age, were severe,. They also saved his hand, though he lost most of the use of it. It was a relief that I did not have to agonise over the care he was getting.

There was no hassle over the insurance, as he had none, which made matters simple. I was not bothered about suing the transport firm,  but my cousin dug his heels in and insisted on my father signing the papers and filing a suit. I was  astonished when the case was actually settled in 4 years and a compensation of Rs. 4 lakhs paid to my father. This was an absolutely normal proceeding,  which was the pleasant surprise, for any court case in India takes ages because of the huge backlogs, and the propensity of lawyers with a weak case to wangle adjournments. I would think the  12 years you mentioned was more like what I had expected.

Most recently, when my mother fell critically ill  in mid-2011, the cardiac care she received in Pune was excellent and it pulled her back from what would have been a fatal outcome within a matter of months. I am sure there are hundreds of thousands of other contented patients  like me and my family members, especially those treated in the good private hospitals in India, which have multiplied over the last 2 decades.

So it all comes down to the handling of individual cases, good, indifferent . bad and very bad. It was such a tragic thing that your experiences all fell into the last category. That anaesthetist should have gone to jail; nowadays, doctors  here are routinely struck off the medical rolls, arrested and jailed for conducting illegal sonographies to ascertain the gender of the unborn child, which is now a criminal offence, and what he did, even if not intentional, had the same end result,  a death.

Medical malpractice suits are in the fledgling stage in India, and the time taken for a case to be disposed of is daunting, But to me the real horror is when criminal negligence has deadly consequences. I remember a passage in AJ Cronin's indictment of the British medical system in his The Citadel,  which hinged on exactly the same issue you have stressed, collusion among  the doctors to bury the deadly mistakes of one of them. A  senior surgeon in a top hospital operates when drunk - his assistants are too scared to stop him -  and he kills the patient. This is smoothly covered up, with the grieving widow gaining solace from the unctuous assurance that her husband had received 'the best treatment possible' and that the doctors had done their level best to save him but had failed. Those days, the concept of medical malpractice suits was unknown, and even it had been there, it would have failed against the wall of silence within the citadel of the medical fraternity, whence the title of the novel.

I remember that recent US report about their public health system which I had cited in my post to Varsha. It had mentioned that in 2005, 75, 000 deaths could have been averted in the US if the health care they received had been adequate. I presume that many of the families of these patients would have sued for damages. I wonder how many were won. Regardless, it is very, very sad.

Shyamala


Originally posted by koolsadhu1000

I would not give Indian medical treatment any status coz my experience of it is very very bad . I firmly believe that gaffes r there everywhere but in India there is almost no way to make a medical gaffe accountable .

My sister died on the operating table when she was in for a simple uterus removal procedure due to gross negligience by doctors .  The anaesthesist had given her far too much anaesthesia  and she could not recover consciousness as the reversal injection was given .

The other doctors only tried to cover up for the anaesthesist and were tight lipped . We enquired and enquired and were told that the only punishment for such a serious gaffe was that the doctor's name would come in some medical journal and he will be admonished by some board of doctors ...then life would go on as it was for him .

So after breaking our heads and knowing that we would never win in a civil court  as the doctors refued to testify against each other, we went to the consumer's court as we wanted those doctors to pay . We finally won there but guess after how many years ? 12 years . By that time my sister's son , an only child had graduated and was earning .

My mother was discharged from the hospital after some sickness and the blood thinner wafarin was not written down in the list of medications she was given as other medications made her blood thicken . This was an overlook error . Well , she had a brain stroke , suffered brain damage and died due to this unpardonable gaffe . 

No possibility of holding the hospital accountable and getting back to the US  was a prority ...as schools had already begun .

It is much easier to hold such medical gaffes accountable here ...in India there is no way of getting any justice . The corruption in hospitals is apalling . My mother's prolonged illness , my sister's death and my brother's stay many years ago [ he was in hospital for 6 months]have given me a horror of the hospitals there .

But this is my experience and my POV.  

Speaking of PR ...Onir making the swap or agreeing to wifi's plan of the donation is highly unethical and he would lose his license here .


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Posted: 17 February 2013 at 11:45am | IP Logged
Upcoming track will be a torture. I think Mahaan Purvi (Kool di you should call Mahaan Purvi instead of Sanskari Purvi) will give away her baby to Ovi. And initially everyone won't know that Ovi had a misscarriage. They will know that Purvi had a misscarriage. Then everyone will console her. Aaji Sulo will message her feet. Teju will be more close to Purvi. And you know guys what will happen. Mahaan Purvi will enjoy this. We're lucky Archu won't be able to console her as she'll be missing.

And then if after some years the truth reveal that child is not Ovi's but Purvi's. Then what will happen. Everyone will start again Purvi's Mahaanta song. Manav will say "How can I thank you beta? If you were not there...". And other also sing this same song.
Ultimately Purvi will enjoy each and every moment. And we'll have to bear this torture. I think from now on torture track starts.

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