Wednesday 29 April 2015

Dealing Drugs

As a dentist, one of the things one has to do, whether one likes it or not, is interact with the pharmaceutical industry.

I can already see you all wincing when you read that. Don’t worry, it gets worse.

Now, I assume we’ve all heard bad things about the pharma industry – for instance, how they would rather “invent a drug to cure an American of baldness than a million Africans of tuberculosis”, and so on. Most of these stories are broadly correct, too, but there’s a lot of other things you find out when you’ve been dealing with them for a while.

For example, you may have had the not uncommon experience of having been prescribed a medicine, but not being able to find it in any of the pharmacies you visit – although the same drug, from another brand, may be available. Or just perhaps five out of six chemists might not stock it but you’ll find it at the sixth – and only at the sixth.

This is the reason: pharmacies stock medicines on the basis of the commission offered them by the wholesalers. This commission can be as little as 5% on the retail price of a medicine, or as high as 50%. Now, of course, the retailer doesn’t fix the selling price (at least not in this country) – the manufacturer does. It’s the manufacturer who, therefore, fixes the margin of profit on the production cost. And the greater the margin of profit, obviously, the more money is left over for commission payments to retailers. And also to employ medical representatives to go around plugging their products to doctors, and to offer said doctors (highly unethical) freebies to prescribe their products.

You’ll see where this is going. Assuming a manufacturer has ethics enough not to want to profit mindlessly from the ill and infirm, he’s going to keep just enough of a profit margin to ensure he can continue in business. But this will also mean that he can’t afford freebies, medical reps, sponsored conferences, or, not to miss the point, the all important commissions which will decide which chemists will stock the drug at all. Therefore it’s the manufacturer who’s the greediest who wins the largest share of the market, makes the largest profit – and has enough money left over to try and ensure the government doesn’t ever impose any kind of price control.

Not that the current run of Indian governments is interested in imposing price controls on anything anyway.

Then there’s another way of increasing profits I’ve come across – deliberately squeezing out an effective, but cheaper, medicine in favour of a more expensive one. One ready example I can give is combinations of the antibiotic Amoxycillin. Now, a cheap and effective antibiotic combination is Amoxycillin with Cloxacillin; there’s as yet little bacterial resistance to this duo, it’s cheap, and has very few side effects as long as you aren’t allergic to it. But, lately, the combination has virtually vanished from the market – to be replaced by Amoxycillin with Clavulanic Acid, a combination whose only virtue is that it costs at least three to five times more than the combo with Cloxacillin. In my career so far, I have not yet encountered a single case which was treated with Clavulanic Acid but couldn’t have been treated as effectively with Cloxacillin. Not a single one.

I know of only one wholesaler in this town which still stocks the Amoxycillin and Cloxacillin combination – only one. And not coincidentally, the manufacturer concerned is also one whose products are priced among the lowest, who offers only a modest commission, and has no medical reps doing the rounds.

I think this manufacturer may be about to go out of business.

Then there’s something that I’ll speculate on. You see, no pharmacy waits till the end of its stock of a medicine before ordering a fresh batch. And since there’s an expiry date on the product, it has to make sure the drugs are sold before the said expiry date. So what happens if the pharmacy can’t sell off all of a stock of medicines?

It’s returned to the manufacturer via the wholesaler for a part refund on the purchase price, that’s what. So just what do the manufacturers do with the expired medication when it lands up back in their warehouses?

Destroy it? I...don’t think so.

Maybe I’m unimaginative, or simply uninformed, but I can imagine them mixing the drug with new material, putting fresh labels on it, and recycling it back into the market. So maybe fifteen or twenty percent of your pain medication or asthma spray or whatever is recycled from expired medicine.

The manufacturer’s made his money anyway, so, as they say, screw you. 

The Great Big ISIS Movie Extravaganza Part VII

Copyright B Purkayastha 2015

Sunday 26 April 2015

Operation Save Hindustan

The Prime Minister of Hindustan
and to
All other patriots.

Jai Shri Ram, Sir.

It has come to my notice that the earthquake which struck Nepal and India on 25th April was caused by one of the earth’s tectonic plates pushing against another. Apparently, these tectonic plates are floating around on top of the earth’s hot inner layers, just as our ancient Hindu sages had discovered in the past, just as they had discovered everything else.

Furthermore, I read that our country, India, that is, Hindustan, is located on top of one of these tectonic plates, which is called the Indian plate.

I know that a lot of people may find cause for pride in knowing that this tectonic plate is named for our country, but, Sir, it is nothing to be proud about. In fact, this tectonic plate is a traitorous entity and must be fought with all weapons at our command.

I shall explain.

Now, Sir, this Indian plate is actually moving northwards at the rate of five centimetres per year. Five centimetres per year may not sound like much, but think of it in the long term. In twenty years it means the difference of one metre. In a hundred years, it makes a difference of five metres. And in a thousand years, it means the difference of fifty metres!

Why is this a matter of concern, Sir? As I understand it, this Indian tectonic plate is sliding under the edge of the so-called Eurasian tectonic plate as it advances northwards. Instead of patriotically trampling down the boundaries of the Eurasian plate, and thus extending our nation’s territories north, it is treacherously slipping under the edge of the other plate and reducing the size of our nation by five centimetres per year!

I ask you, Sir, if this is not treachery, what is? Would we tolerate the activities of anyone determined to steal our land at the rate of five centimetres per year? I think not.

This Indian Plate must, I feel, be in league with such enemies of the nation as Maoists, environmentalists, sickulars, the foreigner Christians and Muslims in our midst, and all the others who constantly plot against our nation and try to undermine it and give its territories to Pakistan and China. We must, therefore, immediately tackle it on a war footing.

First of all, we can no longer tolerate it being called the Indian plate. As a traitor, it has lost the right to call itself Indian. Since it is an enemy, we should call it by the name of an enemy, and thus refer to it from this moment on as the Pakistani plate.

But just changing its name will achieve nothing, because the continued northwards movement of this Pakistani plate will mean that our country will keep getting smaller and so the enemy will win. Therefore, we must immediately take all measures to punish it and force it to stop its northward movement.

How should we do this? Our ancient Hindu sages, as with all other things, knew the answer. Sir, we must at once drill deep shafts all along the boundaries of this Pakistani plate, and explode nuclear bombs inside them. This will force the plate to stop its northward movement, and to understand the consequences of stealing sacred Hindu land. And it will also find a use for the nuclear bombs e have and provide a reason to manufacture more bombs.

We can carry out the project as in this diagram, only much deeper.

You will have noted that part of the boundaries of the Pakistani plate are on the territory of other nations, such as the so-called country of Pakistan. These inferior countries will, of course, refuse to let us drill shafts inside their territories. But that is something that must not be allowed to stop us, for this is a fight for our national existence. Sir, we must immediately send our glorious Indian Army and conquer these countries, which in any case were all sacred Hindu land in the past and must be made so again. 

And once the territory is under our control and the required number of nuclear bombs are ready, we might as well round up all the Maoists, environmentalists, sickulars, Christians, Muslims, and other enemies of the nation and force them to dig these shafts. After all, what else are these vermin good for?

I realise that your political opponents will make noises about this, but, Sir, all that means is that they, too, are in league with these enemies and you should get rid of them as well. Set them to digging shafts, it will teach them a lesson and also give you a free hand politically to advance your policies free from interference.

It is also true that these nuclear explosions may cause some more earthquakes, and kill some millions in the process. But blood sacrifices are necessary to achieve goals, and are in the tradition of our glorious Hindu civilisation, as you know. And, once the task is over, all Hindu women can be ordered to produce at least ten children to restore the population.

I would suggest that you consider giving the project an appropriate name, like Operation Save Hindustan.

With humble sincerity, and urging you to take quick steps in this matter,

Jai Bajrang Bharat SuperHindustani.

P.S. There is no time to lose! Every year we waste means a loss of five more centimetres of sacred Hindu soil. Never forget that.

Quake News

This is for those of you who know of my geographical location and the earthquake that struck Nepal and Northern India yesterday: yes, I’m all right. And, yes, I did feel it.

I was at that time talking to a specimen, whose teeth I’d just done checking. All of a sudden I started feeling queasy, as though I were seasick. This was very strange since it started with no warning, and I didn’t know the reason. I was sitting down, so it wasn’t as though this was the result of postural hypotension – the phenomenon when you get dizzy when you get up suddenly because the blood flow to your brain is temporarily reduced. I continued speaking to the specimen as this nausea continued, for the better part of a minute. And then, all of a sudden, I realised that it was an earthquake – only not one like I’d ever felt before.

Hereabouts, earthquakes are extremely common events, since it’s one of the world’s most seismically active zones, what with the Indian tectonic plate ramming itself under the edge of the Asian tectonic plate, thus pushing up the Himalayas. We’re all very used to quakes – once when I was a teenager we had four earthquakes in the course of one evening, with a power cut on top of it. However, those quakes are totally different, generally a fast approaching rumbling noise followed by a few seconds of hard shakes. This is the first time I’ve ever felt an earthquake which made the entire multi-storey building where I have my clinic rock from side to side on its foundations like a ship on the sea. And it was all in complete silence, which for some reason made it even more unnerving.

What did I do when I realised that it was an earthquake? Nothing. There was nothing to do. By that time the shaking was already slowing down, but even if it hadn’t, there was nothing I could have done. If the building was going to come down, five upper floors would have crashed on my head long before I could have made the open. And it was raining hard anyway.

What did the specimen do, you ask? Nothing. She was one of those spaced out types, and I don’t know if she even noticed the quake.

It was only afterwards that I heard about the huge quake in Nepal. Obviously, we felt the margins of that tremor, which seems to have set the crust of the northern Indian subcontinent to quivering like a jelly. If the epicentre of the quake had been closer, they’d have had to scrape me off the broken masonry with a spoon. Just under my clinic’s floor is the basement parking lot, supported by pillars which would snap like twigs.

And this is a major problem. Earlier, construction in this seismic zone took into consideration the phenomenon of earthquakes – one of which destroyed this town in 1897. Houses were built of light materials, mostly wood, wattles and corrugated tin roofing. They’d ride the waves of the quake rather than resist and be smashed. Even if they did fall, they were so light most people had an excellent chance of emerging from the debris largely unscathed. But that kind of house is almost extinct now. Everyone’s building concrete monstrosities with all the chances of a castle of cards if a hard quake comes along.

What is the government doing about it? Nothing – unless you count taking bribes to look the other way when over-rich fatcats ignore building regulations and build anything they want, any way they want.

Here are some pictures of the aftermath of the quake, from Nepal:

I am, incidentally, somewhat surprised that this news has made the major international media. After all, this didn’t happen in Warshington Dee Cee.

Incidentally, owing to things happening in my personal life, I've not had the time or inclination for writing or drawing these last few days. I hope and expect those things will be cleared up in the next few days. Until then, keep living.

All the best to you all.