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Monday, September 19, 2011

The Path of Least Resistance 
The BBC radio recently broadcasted A 30 min long radio program on the ABR problem, with reflections of Dr David Livermore of HPAProfessor Otto Cars of ReAct, and Chief Medical Officer of UK Dame Sally Davies. The Audio of the radio program is available here.

Wednesday, September 7, 2011

Why Subir Ghosh left a  pharmaceutical company ??

Subir Ghosh spent the first three years of his professional career in sales and marketing of a pharmaceutical company. Then he left it and opted for other carriers……….WHY ???????

Subir Ghosh stumbled upon liked it and expressed his wish to join IIMAR.

When I realized that Subir Ghosh had worked with a pharmaceutical company once and because of his experience at the company, is deeply concerned about antibiotic use or really to say ANTIBIOTIC MISUSE, I requested him to contribute something for us.  He suggested a piece from his site We have edited it suitably to make it fit here.
We will welcome any other similar contributions.

While Subir tells us a story from his life, the same trend exists all over the world. And corrective measures are required all over the world, then and then only there is some salvation. Let us hope the stakeholders in this area become awake and do something remedial.

Over to SUBIR………

…………….When I was in XXXX pharmaceutical company  in 1988, the compnay had just reintroduced its phenoxymethyl penicillin. A wonderful drug to start with. But the company would simply not meet the demand, because at that time it had already launched norfloxacin, and was on the verge of launching ciprofloxacin. And for other things there was always cephalexin (at that time).

Shortly after I landed in Agartala towards the end of 1988, some seemingly philosophical questions confronted me. ..…This was, after all, my first job and I intended to retain it. Come hell or high water. The issue of a philosophical dilemma was posed because I was a simpleton, and hadn’t still lost my innocence. There was reason for me to be upset over the question of what was right, and what wasn’t.
It was still early in one’s life to throw away ideals to the winds. So I started off as ethically as I would. Within weeks it dawned on me that I was living in a fool’s paradise. I was in Tripura as a medical representative, to sell drugs for a leading pharmaceutical company. Here you couldn’t meet your sales targets if you behaved like a gentleman. For, everyone else around wasn’t. A gentleman, I mean. From the doctors to the retailers, from the stockists to the company warlords. It didn’t matter how you sold your medicines, as long as you did.
After the first month (when I failed to meet my target), I decided to hard-sell. From the doctors to the retailers. I tried every trick in the trade. …… I didn’t give a damn, and neither did the doctors. My targets were the young docs there, of my age; they took to me well. I started doing relatively well for myself. My company’s products did well too. For me it was a job, it was a question of livelihood. Till one fine day……
That fine day was an early morning when the 1988-89 winter days were in their last throes. Morning OPD hours would always be chaotic. If I was there, the young docs knew it was fun hour.
Till I threw a poser at the boss of the lot. “You sure my products figure in your prescriptions”, I smiled with a glint. The friendliness may have been there in my smile, but not in the eyes. This particular boss and all his understudies were in my pocket. I had befriended them, then bought off their allegiance with my unending samples and overflowing gifts. And so this animal, proceeded to prove his loyalty. The patient he was examining was a young and pregnant tribal girl. Young, very young to be a mother. Still in her teens, I still am sure. The doctor scribbled the prescription and showed it off shamelessly. To yours truly. It took me a moment to realise what he was asking this girl to ingest over the next few days. It was norfloxacin, 2 tabs TID, for five days.
If you are not in the business of drugs, then you wouldn’t know what it meant. So, let me explain to you as briefly as I can.
That was the time when antibiotics were becoming drugs of the past, antibacterials were in. The first to hit the market big time was this antibacterial called norfloxacin. It was potent, and it was expensive. During those days my company sold it at Rs 8 per tab. Of course, over time prices dropped drastically as the demand skyrocketed. But then, coming back to the drug itself. This was reckoned to be a powerful drug for many reasons, one of them being the fact that its half-life was on the higher side. In other words, it would remain in the bloodstream longer. For this very reason you did not require too much of it, and not certainly so frequently as you had to swallow the earlier-day antibiotics. If the girl to whom this was prescribed followed the regimen, at the end of the course she would have little other than norfloxacin flowing in her blood. No, she wouldn’t have died. But this was something that, to me, was simply not done.
I looked at the girl again. She seemed resigned to fate. She stood there without uttering a word. All the monosyllabic speaking was done by the gnarled old man. Her father he was, obviously; one who too seemed resigned to fate. They were tribals. …. The girl’s pachra and risha (skirt and blouse, to us) were wearing out. A look at the two and you would know they did not live off more than Rs 10 a day. I looked at the girl, into her eyes. She was staring at the prescription, a semblance of hope in her eyes. Her gaze sapped something inside me.
No, this is just not done. The prescription is an overkill for a urinary tract infection (UTI), dangerous in fact. I was furious with the physician. The banter went to hell, and I made the man rewrite the prescription, making him drop my product and opt instead for a much mild antibiotic. The doc didn’t like it a wee bit; this after all I had made him do in front of his juniors. The bonhomie between me and the doctors ended then and there.
On my part, I made up my mind that whatever happens or doesn’t, I am not going to make a career out of selling medicines. Then on, I hated the pharmaceutical industry. It was ruthless, it was powerful. Without scruples. And it did the dirty job through callous medical representatives.
I did work as an MR for a short while again because I needed a job. But I couldn’t do as well as I had earlier. You can’t sell medicines if you play it straight. The pharmaceutical industry was rich and influential. The MBBS folks did not know so much about drugs as the B Pharms did. There was nothing called a level-playing field. And MRs would do anything to meet targets. You coaxed or armtwisted pharmacists. You cajoled or bought off doctors. …. the pharmaceutical industry was on a roll. If there were losers in this coldblooded game, it were the patients. The people. The people have no idea how much of gunieapigs they are being reduced to. Pharma companies actually control our lives more than you would believe ……... Reality is scarier.

Tuesday, September 6, 2011

On behalf of and with encouragement from IIMAR, Mohini Adke, Assistant Professor, KTHM college, Nashik, Maharashtra, India, has started the cause - STOP- Antibiotic Resistance on `facebook`. Please join the cause here