No Regulation, No Penalties
One issue that gets minimal media coverage in India is that of ‘paid news’. The trading of awards, honours and gushing media coverage in return for fat sponsorship fees and advertisement campaigns is already very brazen, but it does not bother the political establishment at all. However, with general elections around the corner, even politicians are worried about the new round of demands that will be made by media houses for favourable coverage or for orchestrated hit jobs and sting operations. Yet, the 47th report of the standing committee, which looked into the paid news menace, had nothing substantive to offer, other than some seemingly tough talk.
The report openly calls the ‘increasing trend’ of paid news and talk shows as a ‘serious fraud’ on innocent viewers and readers. It observes that some sections of the media even distribute rate cards and packages for positive coverage as well as hit jobs on opponents and that media houses resort to vindictive action when a politician refuses to fall for their ‘extortion/blackmail’.
What is ironic is that the committee lists the plethora of regulatory and professional bodies that ought to be looking into the scourge of media blackmail and paid news, but don’t. The list includes: the Press Council of India (PCI), News Broadcasters Association (NBA), Indian Broadcasters Federation (IBF), Advertising Standards Council of India, Electronic Media Monitoring Centre (EMMC—established by the ministry of information & broadcasting), Editors Guild of India (EGI) and several unions and associations.
There is also a clutch of statutes with specific guidelines covering media behaviour. Apparently, nothing works; so the standing committee merely urges the ministry of information & broadcasting to ensure strict adherence to existing regulations until it chalks out a comprehensive action plan to deal with the menace. Shockingly, even on something as dramatic as the tussle between Jindal Steel & Power (led by Congress MP Navin Jindal) and Zee News where top editors of the group were arrested based on Jindal’s allegation of extortion, the committee only notes that the entire regulatory structure is pleading helplessness and shirking responsibility on the plea that the matter is sub judice. What does this really mean? Well, if the ministry of information & broadcasting and multiple regulators are powerless in such a high-profile case, it is safe to say that it will be business as usual for ‘paid media’, with plenty of hagiographies and hit jobs, as we head for the 2014 elections. Is this why the mainstream media, badly hit by the economic slowdown, are pushing for early elections?
Evidence is accumulating to show that most 'negative' studies, which otherwise would have changed the face of medicine, are rejected by the peer review system
More than half of what doctors do is not based on their own evidence; even the other half has only a shaky base which cannot be assessed. Evidence is accumulating to show that most ‘negative’ studies, which would have changed the face of medicine, do not go through the infamous peer review system! One estimate is that 97% of what goes on is not scientific. Would one like to get into a plane which has a 97% chance of crashing? What then is saving mankind, despite this shoddy science of medicine?
When a patient is given more than three drugs a day, the compliance is as low as 23%. So, out of the 97% risk of dying from the treatment, 77% are saved. The body treats every reductionist chemical drug as alien to the system and sends it to the liver for destruction. In the bargain, the chemical does damage to the liver. Little do we realise that this is an indication that a large part of the administered drug is rejected by the body. This is one of the main reasons for non-alcoholic cirrhosis of the liver. It is not surprising that adverse drug reactions (ADRs) are so common and constitute one of the leading causes of death. If every reductionist chemical is rejected by the body, how do we get some good results with drugs?
Recent studies have clearly shown, with very sophisticated technology of using the novel MRI studies of the brain, that any drug given for any disease has an effect MAINLY because of the placebo effect. The use of a new MIT chip by an American scientist, Douglas C Wallace, showed that almost all the reductionist chemicals were rejected at the mitochondrial level but holistic herbal drugs are treated as food and are directly absorbed without having to go through the so-called ‘first pass effect’! David Wootton, in his book, Bad Medicine, has shown that millions survived in the old days of bloodletting because they could not pay the high fees of ‘big’ doctors of those times. The poorest of the poor cannot access modern medicine facilities and are, thus, saved from the all-pervading ADR deaths.
A study of the Massachusetts Medical Society records showed that pharmaceutical companies fund studies which are usually ‘positive’ and are being presented at medical conferences in preference to other studies. This is only a small part of the lifelong brainwashing of the medical profession by the drug lobby. The financial incentives given to thought leaders drive sales of drugs throughout the medical field.
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study of treatment outcomes in diabetes had shown a higher death rate in those whose blood sugar levels were very tightly controlled. This has created a lot of confusion in diabetes treatment. One of the reasons put forward is that some of the drugs used might have been responsible, especially Metformin. However, a re-analysis did exonerate insulin as the cause of increased deaths in this group.
Despite this information, drug companies educate doctors to keep the sugar levels as low as possible, unscientifically, resulting in higher mortality. The same holds good for high blood pressure. The hypertension optimal treatment (HOT) study showed significantly higher mortality when the pressures were brought down significantly.
The vested interests, though, would want the same rotten science to continue for the good of their business. Professor John List (of the Chicago University’s economics department) came to the conclusion that humans in business are homo-economicus and not homo-altruisticus!
For the future of sickness-care delivery, we need a better, less expensive system. That can only come from combining the best in all systems of sickness-care today, including the quick-fix emergency treatments. The large majority of illnesses are minor illness syndromes which have only a limited timeframe for the immune system to allow the body to recover. Understanding anxious patients and giving them the best diet and advice to rest would work wonders. The pinnacle of medical-care is when two human beings come together—the patient and the doctor.
Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.
Post the new price control regime, several essential drugs are simply vanishing from medical shops. The patient is advised to check with the concerned physician if a replacement, mostly generic drug, can be medicated
While patients welcome the price control for essential medicines, covering 348 drugs, the manner with which it is being done has put them in a quandary. Many essential drugs are off the shelf and have simply disappeared. Shopkeepers tell the patients that there is "no supply" from manufacturers. According to media reports , this essential list include anti-biotics, anti-infectives, diabetes drugs, skin, heart-related, respiratory, neuro- and gastro-intestinal medicines. It is not clear if blood pressure (BP) related medicines are also being brought under control, but in the market, most of them have gone off the shelf.
It appears the National Pharmaceutical Pricing Authority (NPPA) notified revised medicine prices over the last three months and, after receiving this, the manufacturers have been given 45 more days to effectively withdraw the old and replace with new drugs. Essentially, this meant that the medicines were/are to be supplied with the new, revised and presumably lower prices, with the effective date of implementation. The NPPA has not announced the "effective" date for public to know.
It is not clear, as to why the drugs have to be removed and be replaced by new ones. Most of the drugs have a shelf life of at least two years or more; all that needs to be done is to make a public announcement that, to cite an example, "XYZ medicine, priced Rs20 for 10 tablets will now cost only Rs17.50". The revised price list must be properly displayed in shops authorised to sell the medicines.
In reality, however, the medical storekeeper simply tells the patient that the company has "stopped" supplies and has no clue when it will resume supplies. Unless the patient is educated enough to demand an alternative or generic equivalent, the druggist does not take the pains to give information on his own. Even then, the patient is advised to check with the concerned physician if a "replacement" (generic drug) can be medicated.
Let's take specific cases relating to patients with high BP. Non-availability, and sudden withdrawal, ironically, has caused the blood pressure to go up for BP patients. A few months ago, branded item, Plendil went off the market, necessitating the patient to seek urgent appointment with the doctor (on payment of fees, of course), have a consultation and seek any other suitable medications. This has been followed by Losar-50, and these are being used by the patient for last 15 years or more!
In all such matters relating to patients, it is imperative that notifications are made well in advance so that the patients seeks and obtain alternative medications to carry with them if they are travelling. In new places of visit, a strict druggist will not give medicines that require a recent prescription from the doctor.
As it is, most medicines are priced high, and unless the patient (or buyer) demands a senior citizen discount, it is not given voluntarily; the shopkeeper may give if one is a regular customer. Why not the manufacturers themselves print a senior citizen discount rate on the package? Likewise, all the druggists must keep a reference book for generic medicines so that the patient is able to get additional information in the shop, which he can always double check with his physician. It would be even more helpful if doctors writing prescriptions gave alternative generic medicine details in the first instance itself, to make this work less troublesome?
Moneylife has published an article on buying medicines at a steep discount, thanks to www.medguideindia.com, a website launched by Vinodkumar Memorial Charitable Trust. This website helps one to compare and buy medicines at a significant discounts compared to the branded ones of large pharmaceutical companies. This site even allows one to first search by the brand name and then provide active ingredients (generic) used in the medicine. Read more Get your medicines at 60% discount!
(AK Ramdashas worked with the Engineering Export Promotion Council of the ministry of commerce. He was also associated with various committees of the Council. His international career took him to places like Beirut, Kuwait and Dubai at a time when these were small trading outposts; and later to the US.)