Yousuf Raza – Exploring the Oxymoron Wounded Healthcare
AI: Summary ©
The conversation covers healthcare systems and mental health professional issues, including the need for policy research and education, the complex journey of medical college, and the importance of evidence-based medicine. The speakers emphasize the need for research and education to avoid double spending, the importance of avoiding double or triple spending, and the need for transparency and transparency in the industry. They also discuss the challenges of creating artificial drugs and the importance of marketing and advertising to encourage doctors to prescribe medications. The conversation ends with a brief advertisement for a teleaged session.
AI: Summary ©
Okay.
everybody.
This is Yusuf Raza and we are back
with another episode of Psych.
My apologies for not being able to do
this the last time around.
We had to delay this uh for um
there there were certain personal issues that we
had to attend to that I had to
attend to.
like we announced at the end of our
previous episode and as was advertised as well,
this month of the next 4 weeks or
so, we're going to be talking about the
wounded healthcare system, right?
specifically, but also generally, doctor doctor
is not the only part of the healthcare
system.
we would want for that to be as
good as possible as convenient as possible and
we were we are people we are the
community that serves the larger health interests of
the society or at at a to a
very large extent corruption and other
incredible.
There's no other word to put it illnesses
illnesses cancers that the healthcare system.
they would.
worsen the health of the society.
hospitals.
you're looking for an you're looking for a
cure you're looking for better treatment better management,
but if getting that treatment is complicated further
if that complicates matters further for you.
and is that even worth it for when
that does come.
Of course, that's that's one of the most
important issues of our society.
This is not to criticize any particular person
or body or political institution or political party
or anything like that this falls on all
of us.
I want to start by saying that there
are problems.
There are huge problems.
And of course, there's a lot of good
things as well.
That's that's that's given we don't take that
away.
There's a lot of benefits a lot of
good people a lot of good stuff coming
out from the healthcare system as well, but
precisely because it is the healthcare system.
It is not good enough and there are
some things which are so bad that it
is embarrassing.
It is flabbergasting as to how the providers
of health are actually incredibly sick in so
many ways and nobody's talking about those sicknesses.
So we want to talk about those sicknesses.
We want to talk about those sicknesses not
with the intent to criticize not even with
the intent to immediately have those sicknesses addressed.
We'll get to realize the problems are so
deep rooted and so prevalent and so global.
It is preposterous to think that there can
be any immediate solution for all of those
problems, but precisely because they're so deep rooted.
They're so deep seated.
They're so prevalent.
They're so global.
We want the conversation to get started.
Let's be honest, the conversation has gotten started,
but it is not getting the requisite attention.
There's people talking about it.
There's journalists talking about it.
There's doctors talking about it.
There's a lot of people talking about it,
but those people are not heard.
A lot of what we say is not
going to be heard immediately either, but we
hope with your help, with our audience's help,
we can reach the right corridors.
We can reach the right people so that
the conversation to fix this, to fix it,
to improve situation as best as possible, the
policies that need to be brought in, the
changes that need to be brought in.
What are those?
Those conversations need to start.
Predominantly, let's face it, when we talk about
the illnesses of the healthcare system, there is
one illness that trumps them all, and that
is the big pharma.
The involvement of pharmaceutical companies in our medical
practice.
There is good in it.
Of course, there is.
Good is not all that there is.
There is some shocking level of bad and
evil even that we want to bring our
attentions to.
For that reason, we have, and we did
this before, I had a conversation on big
pharma, and we realized there is so much
more that is necessary.
We are dedicating an entire month, and we
brought together a team of very committed doctors
to talk about this issue with us, to
research this issue with us.
I will quickly go ahead and introduce them
to you.
Foremost, we have Dr. Arooj Ramzan.
Dr. Arooj Ramzan is a medical doctor, graduate
of Rawalpindi Medical College, now at Rawalpindi Medical
University, and she is also a mental health
coach in telepsychiatry Pakistan with me.
Thank you so much, Dr. Arooj, for being
here.
Assalamualaikum, sir.
Thank you for inviting me over here.
No problem at all.
So moving right along, also a graduate of
Rawalpindi Medical University, Dr. Asma Zia, I believe
a batchmate of Dr. Arooj, and also with
Dr. Arooj settled in Australia right now.
She is a mental health ambassador for us
at telepsychiatry Pakistan, one of the most committed
researchers for our Big Pharma campaign, for our
Wounded Healthcare campaign, excuse me.
It was supposed to be the Big Pharma
campaign, and we turned to realize that there's
so much more than just Big Pharma here,
but yeah.
Thank you, Dr. Asma, for being here with
us.
You're most welcome, sir.
Assalamualaikum.
Walaikumassalam.
And last but definitely not the least, Dr.
Ghulam Murtaza, who is a graduate of University
College Lahore.
Did I get that right?
That's it.
And he's also a doctor and a prospective
psychiatrist, one of the most committed and active
researchers for this campaign, and an ambassador for
telepsychiatry Pakistan.
Thank you for being here.
Okay.
So, gee, before we get into the nuts
and bolts, I want to ask, when all
of you jumped on board and started working
for this particular campaign and the research, the
very meticulous research that all of you did,
can you explain what you felt or the
realizations that you came through?
Let's start with Dr. It's very hard to
explain it in a few lines, but I
will try to summarize it and just, I
won't say that it's a journey that started
here.
Basically, when we enter into the medical school,
the background is that with the parents pressure,
they come, some are for some particular monetary
reasons, but there are some others, very few,
who are coming into this profession because of
the passion they had for human service.
And I was one of them.
I still try to be one of them.
And medical college's journey is, due to our
educational system, I would say complicated, you won't
think about anything else.
But once you get into the house job,
and you think, now this is this, this
is what I dreamt of my whole life,
and you start working there, and you realize
that this is not what I dreamt of.
This is entirely different.
There is service going on, but with that
service, the trauma for the general public, the
suffering for the general public, when you come
to this school, you have to relieve people's
suffering.
And when your actions, or the system you
are working in, because of that system, the
suffering for the general public, then you can't
be satisfied with yourself.
You try to resist, you try to raise
voice, but you are told that this has
always been the case, so nothing can be
done.
Still, you try to take some steps, but
you realize that this is a spider web.
You can't do anything.
There are people who are trying to do
all that already, but still, even with their
help, I was not able to do anything.
There were times when I would come back,
I had a call, and I would come
back, and I was not able to sleep,
because I knew that there was something, or
there should be something, that we could have
done for someone, but we were not doing
that, not because we were not able to
do that, but because the system was that.
Now, after that, it was a long journey
from the public system, I shifted to the
private system for some time, and I thought
that things would be better in the private
system, there would be less rules and regulations,
there would be less complicated mafias, which are
of government servants, but I realized it's even
a bigger spider web.
There, the motto is, I'm not criticizing the
private service, but for most of them, the
motto is profit and waste lives, and that's
how, I guess that is coming from the
big pharma itself.
The big pharma, which we are going to
discuss today, you feel it the most there.
I remember people who will be coming, who
will be working with me, and who would
be making double or triple amount of their
salary, just because of the incentives to big
pharma.
So, who is paying for that?
Public patient.
So, it's a very complicated discussion.
I will try to summarize it and present
it in an easy way.
The thing is, when I started working on
this with our team, then I realized that
what we have seen so far, that was
just the tip of an iceberg.
The things are so complicated.
When I think about it, I guess that's
a necessary side effect of this.
I don't know what I'm going to do
if any of us get sick in this
health system, and are we ever going to
trust it again or not.
So, I guess things will get clear once
we start discussing it, but all of us
will realize that things are so deep-rooted,
and I realized this, like you said, that
whenever we are researching a topic, we will
find a solution for it, but there was
not any solution or a single solution for
it.
So, I realized that if we want to
do something for it, the first step would
be to raise awareness, that the public should
know about it.
Once they know about it, then we might
be able to do something.
Thank you.
Thank you for sharing all of that.
Just a couple of things.
As medical students, as doctors, all of us
experience that.
To retain that sensitivity, somewhere along the way,
it's lost.
Somewhere along the way, that sensitivity, that concern,
that care is lost.
Our selfish interests take precedence.
And then we realize that if we want
to survive in this system, then we have
to do the same.
And we have to remain silent.
Let what is happening happen.
Don't let what is right happen.
Do your part and go home to your
family.
So, it's kudos to you to be able
to retain that sensitivity and still be here.
Thank you for sharing that.
Dr. Asma, sentiments, feelings, going through this, all
that research that you did.
Paranoia.
I'm like, now that I'm not there in
person, I'm like, it is,
it's a shame that you can't trust them.
And, after that, overall, our perception is that
doctors are the ones that are responsible.
Because they are at the front of healthcare.
Your nurses are there.
So, all the blame, all the policies, all
the working, the public doesn't know that.
They see the doctors.
That also is the fault of doctors.
So, I think this campaign is going to
bring a lot of knowledge to the common
man.
Because every time a scandal comes up, So,
I think this campaign will help in bringing
up a better understanding, proper, big picture.
So, they can properly identify that this person
or this entity is responsible.
It's not always the doctors.
Sometimes, yes, doctors are the ones that are
responsible, but not always.
So, I think this is what I'm hoping
to achieve.
Great.
Thank you.
Thank you so much.
And I'm completely on board with you.
The paranoia that coming to know all of
these truths, these facts, that what's going on,
how dirty it is, then it's clear.
That trust, leaving, getting up, and let's be
clear, we're very aware that by putting this
kind of awareness in the public, and by
talking so openly about these things, we may
be creating these negative sentiments in people.
That if we don't go to the doctor,
where do we go when we get sick?
Where are we going to go?
At the end of the day, that's the
only option we do have.
All the more reason that this is important.
See, what the Zainab incident did for child
sexual abuse, these things have always been happening,
and are still happening, but at least, after
getting so much public attention, something or the
other happened.
Somehow or the other, people started taking preventive
measures, there was a movement in the media,
in the political circles, you know, the motorway
incident, it had a similar effect.
The trust that people have for police, or
the lack thereof, all that came out.
But towards a particular end, something needs to
be done.
Things are not okay the way they are.
So yes, the side effect of our raising
awareness may be that people start becoming paranoid.
We are aware of that side effect, but
the situation is such that we have to
take that risk.
We have to go ahead and open these
Pandora's boxes, to see if in the long
run, some good can come out of it.
It's about time.
It's about time.
Thank you.
Thank you, Dr. Asma.
Dr. Ghulam Murtaza, how was your experience finding
out all that you found out?
I think we're very aware of all these
problems while working, especially during house job.
But going through the data, when you're faced
with actual evidence, it hits you differently.
And the other thing is, we're not always
doctors.
We get sick as well.
Sometimes our loved ones get sick, and then
you're on the other end.
That's when these problems come to light in
a very real way for you.
Because now you're on the opposite end.
You're on the receiving end of it.
I think going through the data, it wasn't
shocking.
It was basically things that we're very aware
of, but seeing the data, it just had
a completely different effect on me.
Some of it was really depressing.
I think we talked about it with Dr.
Asma and Dr. Arooj.
We started feeling negative about our own professions.
The other thing is, there's a pandemic going
on, and doctors are fighting against COVID.
Some are losing their lives.
We did not want a negative stigma against
doctors to grow.
We wanted instead to start these conversations.
Our intention is not to chastise anyone.
We just want to explore these issues, and
I think it's about time.
One of the reasons why I asked this
question, or why I started off this question,
when we were having internal meetings and discussions,
I remember Dr. Murtaza making this comment before
he started his presentation.
Because we share that sentiment, I felt bringing
some of that out is called for.
Let's dive straight in.
I'll start with Dr. Murtaza.
What is polypharmacy?
What is polypharmacy?
Why is it so prevalent?
First of all, polypharmacy is basically long prescriptions,
exceeding 5 medications on a daily basis.
5 different medications.
So, it's becoming really common, and it's such
a burden on patients, it's such a burden
on our healthcare system.
A long list of medications is written.
One is not readable.
It's difficult to understand.
Finding them is difficult.
You go to the pharmacist.
One medication's name is something else.
You're basically confused.
As a layperson, you have no idea what
to do.
Then you have to remember when to take
it, where to take it, all its costs,
and that contributes to a thing called pill
burden.
That's why you give up, and you don't
take medications altogether.
Polypharmacy is very prevalent, and there are some
legitimate reasons for it.
Number one, it's possible that someone has multiple
diseases.
One medication won't work.
Second, this is a worldwide problem that our
elderly population, as a proportion, is increasing.
As age increases, diseases also increase.
Long-term medicines also have to increase.
So, those are some of the basic reasons.
In our setup, if you go to a
doctor and they tell you to lose weight,
to exercise, they'd be like, we don't need
you to tell us this.
We know this.
They expect you to get quick relief, which
makes sense from their point of view, obviously.
As a result, doctors have to prescribe excessive
medications.
One reason is that we treat symptoms.
We don't try to find cures.
Similarly, the list of medicines keeps increasing.
On the shadier side of things, which is
our main focus, I guess, big pharma plays
a role.
They're always offering incentives and this occurs at
every level.
It starts at the clinical trial level, at
the decision-making level, that will we lose
customers?
Will we lose lifelong customers?
That's the sort of thinking.
Because before ethics, financial considerations come up.
So, there's a problem with decision-making.
After that, clinical trials at every level have
big pharma's influence.
They hide some of the side effects over
a period of years and what that results
in.
Then they promote these drugs to doctors.
Obviously, we're not aware of all.
We're only as good as our information.
So, what happens is that we start prescribing
those medications without a very good idea of
certain side effects, without a good idea of
drug interactions, for example.
So, that's what happens.
This problem keeps increasing.
Lists keep getting longer and it becomes a
torture for the patient.
Thank you for clarifying that, Dr. Murtaza.
Dr. Murtaza, when I and Azam had a
meeting, we spoke about how polypharmacy, especially in
psychiatry or in any other field, patients don't
even realize which medication is for whom.
Which is a necessary medication.
When you prescribe 5, 6, 7, 8 medications,
one or two of them are genuinely life
-saving.
They keep the disease in mind and are
necessary for the patient's life.
But when they become 7 or 8, then
which one is just a useless vitamin which
is not even needed, which is often not
needed.
And which is a medication to keep your
blood pressure down, which is a medication to
keep your blood pressure under control.
The patients have no clue.
For them, each medicine is equally important or
equally unimportant.
Like you said, the pill burden, what it
does to them.
And I can say for psychiatry, for most
psychological problems, even a diagnosis is not necessary.
Most psychological problems.
For most psychiatric diagnoses, which are not more
than mild severity, medications are usually not necessary
and should not be recommended.
In the moderate and severe category, psychiatric illnesses,
even there, one or two medications are most
usually recommended in the most severe of illnesses.
Even if not two, go for three.
Most severe of conditions.
But where there is resistance, no response, understandable.
But even then, the situation doesn't call for
seven or eight medications.
Five or six.
What happens even in mild illnesses?
Forget about illnesses.
Psychological problems and challenges that don't even warrant
a diagnosis.
Medications are far-fetched.
Even mild illnesses are far-fetched.
In them, five or six medications are given.
That is downright corruption at the part of
the psychiatrist.
That's pure evil.
There's no other way of looking at it.
And it's there, it's happening.
People do that.
And they call themselves psychiatrists, they call themselves
humans.
They have their justifications, but it's...
This is how bad it gets.
And then we say that these recommendations are...
How do doctors distinguish themselves?
Doctors distinguish themselves from Desi Totke on the
basis of evidence.
That we practice evidence-based practice.
And this is our...
Coming from that field, knowing that evidence, I
know that the practice that is going on
is not evidence-based.
The evidence does not say write eight medications
or nine medications for something that doesn't even
warrant a diagnosis.
The evidence does not say that.
But having said that, what is this evidence
-based medicine, Dr. Murtaza?
It's this idea...
We've sort of garbed modern medicine around this
idea that doctors are clinical scientists by definition.
And as a scientist, you're only as good
as your information.
So that evidence includes clinical trials, it includes
our personal experiences, it includes patient data and
references.
That's so-called EBM, evidence-based medicine.
But having delved into Big Pharma's influence, we're
starting to doubt the validity of such evidence.
Because it starts from the higher levels or
publications, promotions.
A lot of it is in their hands
and it should not be the case.
And so many bogus studies are published every
year and it's become...
When it enters the pool of knowledge, that's
when patients suffer a loss because we're going
in blind.
Okay, so there is evidence that evidence-based
medicine is not based on evidence.
Can we say that?
Oh boy.
So moving right along from here, we talked
about pharmaceutical companies, influencing the evidence-based medicine,
influencing the research and what affects it.
We thought that pharmaceutical companies' investment is in
creating genuine evidence so that people's lives can
be saved.
Dr. Arooj, is that the case?
Is that always the case?
Unfortunately.
Unfortunately, no.
I used to feel the same.
I guess all of us team members felt
the same.
We were very, very particular about this evidence
-based medicine, about all the researches that are
coming.
But when we looked at it in detail,
when we went into this web, we realized
that the pharmaceutical companies' approach is not limited
to doctors.
It's not limited to pharmaceutical products.
It's not limited to evidence-based medicine, research,
and the decision about what kind of medicine
to make and what not to make.
It's their decision now.
Usually, it's predicted that if a type of
disease is becoming prevalent or if the death
ratio is high, pharmaceutical companies should invest more
in it, research it, and make medicines.
But when there is a lot of scientific
evidence which scientifically proves that, let's suppose, in
this time, we take antibiotics.
Antibiotics, although infections are not as common as
they used to be, but when they do
happen, they are as severe as they used
to be.
And the death rate increases.
There is a research study which says that
7 million people these days, 7 million people
every year die due to some infectious cause
which can be treatable if we have a
drug for it.
This is predicted that by 2050, it will
be 10 million.
But this is a data which tells us
how prevalent this disease is.
In comparison, we were expecting that pharmaceutical companies
should do research on these medicines, on the
drug resistance and to tackle all these infections,
they should make new antibiotics which will target
all the viruses and bacteria.
But when you look at it, the pharmaceutical
companies made the antibiotics in the 1980s.
After that, if you look at it, there
are no new antibiotics.
There are the same types and modifications but
no new antibiotics because they have reduced the
research on it.
Ultimately, it is predicted that they are going
to stop.
But now, if we compare it with the
disease ratio, it has reduced a lot.
What is the reason?
This concept that you have to take a
pill every day and that will be the
most beneficial for the pharma profit.
But when you take an antibiotic for an
infection, for how many days?
Usually, it is 5-10 days.
If there is a lot of resistance we
go for 14 days.
This is an antibiotic made by the pharma
company which the patient will take for 14
days and that's it.
Let's suppose if you cure it well and
remove all the hygienic measures, then ultimately the
infection rate will reduce.
But when you go towards blood pressure medications,
cholesterol blocker medications, birth control pills, although these
are prevalent diseases in this time, but not
as rare as antibiotics.
Pharmaceutical companies are investing in this direction.
Why?
Because patients will take that pill for the
rest of their lives.
Where they get a profit of 14 days,
they will get a profit of 20, 30,
40 years.
There are some sayings by pharmaceutical companies, CEOs,
and managers which say that antibiotics are not
a profitable business.
So, for whom is it not a profitable
business?
For the pharma.
But who has to suffer?
Patients.
So, when you analyze this in different aspects,
then you realize that big pharma has a
motto that is profit vs lives.
Initially, they used to do all those researches
and clinical trials for the purpose of saving
lives.
But now when you see this trend, it's
just profit.
There is no public service or there is
nothing going on for the sake of patients.
I should make that.
And that makes good business sense.
Right?
Wedding dresses have to be really expensive just
to justify.
Because sales come in.
And whether it's a wedding dress or any
other dress or medicines, it's the same thing,
right?
This is the problem.
Sir, why do you think that this is
a lawn branch?
Why is it a lawn branch?
The problem is this.
We started running our healthcare on a business
model.
And that's where the problem actually started.
Okay.
So, now we are getting to see this.
Our healthcare system for us to provide effective,
efficient healthcare system models from economics and models
dealing with economic theories are more relevant to
us than we were given to understand.
What economic models or what theories underpin the
business models that are driving the pharmaceutical industries
and how deeply tied in that is with
us.
But we don't want to study anything other
than anatomy, physiology and biochemistry.
What do we care about economics?
What do we care about all those fields?
But they're doing what they're doing to us.
As a result, our ignorance continues.
Okay.
So, this big pharma, is it only limited
to these medications?
Life-saving or continuously is that all there
is?
Or do they influence their involvement beyond that
in any way?
Yes, definitely.
That's, I guess, the other half of this
big problem.
Dr. Murtaza basically did an evidence-based medicine,
which we practice and it's like a sacred
holy thing for us doctors.
But when we start studying about it, where
does a disease come from?
When research is done on it, it is
considered a disease.
Medicines are prescribed for it.
Ideally, who should have done all this work?
Healthcare body, doctors, a medical experts team.
But when we see some diseases which are
becoming very common and almost everyone knows that
this is inside me.
Dr. Google has told them that this is
inside me.
When we see where they have come from,
then we realize that behind that, behind introducing
that disease, big pharma has played a very
big role.
Let's suppose, this concept is called disease bongering
or medicalization and when we started doing research
on it, we thought no one would know
this much and we wouldn't have much data
on it.
But there is a whole book written on
it in 1992.
At that time, a whole book was written
on it by a scientific writer, his name
was Len Pair and he introduced this concept.
Now it is 1992 and today it is
2021 so you can imagine to what extent
this concept would have become prevalent.
So what happens is, I will explain this
with an example.
Let's suppose, in 1980s, a pharmaceutical company made
a drug which is called paroxetine and they
saw that people who have social anxiety, when
you go to a public gathering, you start
talking and you get a little shyness, this
paroxetine controls that anxiety.
So they introduced this drug for social phobia.
Now that's a good thing because social phobia
is a genuine problem.
Some people have it to a very severe
extent where we can't consider it normal.
But that ratio of people was very low.
Now, what did they do to promote this
drug?
In newspapers, at that time social media was
not so common, newspapers were more prevalent.
In all this, they started promoting it that
imagine being allergic to people, how it feels
to you, imagine you go somewhere and you
cannot talk to people.
So you have got this social phobia and
we have the solution for you.
So normally, those who had a little anxiety
to go in front of people, they labeled
themselves as social phobia.
And the research says, after this campaign, the
rare disease of social phobia became the most
common disease of that century.
You can see the effect of this.
A very common example which I think we
should discuss is of cosmetics.
Cosmetic problems.
There is a very good scientific evidence in
this that it is baldness.
Now, in this era of hair transplant surgeries
and advances in hair transplant, baldness is a
very stigmatized kind of and it's a disease.
Now it's a disease.
Before the introduction of the treatment for baldness,
it was not a disease.
It was a common aging process which was
usually expected in an age time frame.
You expected that your hair would fall, some
people's hair would fall and this baldness would
come.
But pharmaceutical company made a drug called Minoxidil.
And they actually made it to control blood
pressure.
But they saw that in side effect, hair
growth in the body was increasing.
So they introduced this medicine as a treatment
for baldness.
Now, baldness was not a disease.
People did not want to take it.
To make it a disease, they wrote papers
on it.
They were pharmaceutically funded papers which were written
by medical experts.
And they were published They linked that people
who have baldness, their job prospects are very
less, their emotional health suffers a lot, their
relationships suffer a lot.
All sorts of things.
Now, the person who never thought that all
this is happening because of my baldness, ultimately
he started linking all of this to that
baldness.
And it became a disease.
Initially, there was a treatment Minoxidil.
Now, there are a lot of advances in
hair transplant surgeries.
And from there, all the cosmetic surgeries, anti
-aging treatments, whitening treatments, if you go into
the history, you will find that it was
not a disease.
It was a normal human phenomenon to make
it a disease.
How much work did the farmers do?
How many journals did they fund?
And nowadays, the biggest thing is social media.
What was not funded on social media?
And then that disease was introduced.
So now the big question is that the
disease you think of is actually a disease
or not?
And where is the concept of the disease
coming from?
Is that a medical evidence?
Or is it the result of pharmaceutically funded
advertisements that it is becoming a disease?
So I have a lot of examples, but
I don't have time to explain them all.
But this thing is really serious.
When we are medicalizing then obviously the anxiety
we are trying to tackle is increasing.
Thank you for sharing that, Dr. Urooj.
Again, it's not far-fetched to imagine that
if these are trends, if this is how
they have operated in the past, it may
well be that when there is a surge
in optimization, they go and ask Google what
problems people search for the most.
If they go and see that problem, what
are the most searched topics, and develop a
good diagnostic label for it, make a medicine
for it, popularize that label, and when people
have to ask Dr. Google, those who have
10% of the symptoms, after reading that
article or that blog post, they will become
30-40%.
If there is anxiety about that, they will
become 40-50%.
That's what anxiety does.
The Google Syndrome.
I have a medicalization of a model.
It's called the Google Syndrome.
Exactly.
And that happens precisely because you're on Google
and you're looking for diagnostic labels and you
think that there is a pill that can
solve all your problems and all your issues,
and that's not how life works.
Oh God.
You will also get evidence for this.
Normally, when medicines are very expensive, you ask
why they are so expensive.
The answer is that clinical trials require a
lot of money.
Research requires a lot of money.
There is a lot of work behind making
it.
But when you see the actual figures, the
clinical trials that they are spending, they are
spending double on drug advertisement.
All the ads that come out on TV
and social media and all the other platforms.
So why are they spending so much there?
Because the sale they are making from there
will not be made from such diseases until
they make it a disease and introduce it.
The marketing budget is more.
Actual research, real science budget is less.
It is the most.
Okay.
May well be, we said that the decision
on which disease is there and which is
not should be done by a responsible board
of doctors rather than by pharmaceutical companies.
Pharmaceutical companies said, there is no problem, there
are doctors in our board.
There are doctors who work for us.
And they did the research.
But the name of the pharmaceutical company will
not be of a pharmaceutical company, it will
be of a doctor.
So how long does it take for a
doctor to sell?
Alright.
So the budget on marketing is more.
So the medicines that we buy, in that
we are also paying for their marketing.
We are not paying for their intellectual investment
or scientific investment.
So, Dr. Asma, does that have anything to
do with why there is a difference or
so much of a difference in different kinds
of medications that we find in the pharmacy?
Some medicines are very cheap, some are very
expensive.
What is going on there?
This cycle starts when the first medicine is
made.
The first of its kind medicine is made.
The original brand, which we call innovative drug.
So, if its price is more, then it
is understandable because to make a drug from
scratch, it takes up to 3 billion US
dollars.
It takes 10 to 15 years.
Obviously, when it comes to the market, it
has a patent, which is a period of
exclusivity for 10 to 15 years.
No one can copy it.
Only they can sell it.
They have to recover all their costs, save
future profits, save future research and development.
If they want investment, they recover all the
costs.
When their patent expires, the other pharmaceutical companies
get this free hand to produce a simple
copy-paste of the same formula.
They don't do research, they sell the same
formula under their name.
When they sell it, in foreign countries, it
is known as generic.
You have a branded drug and a generic
drug.
In Pakistan, the situation is different.
There is a generic brand and a branded
generic.
Here, there is a cost difference.
The cost difference is not 5 to 10
rupees.
It is in hundreds.
If you keep a medicine for 5 to
10 days, it is not a profit margin.
But if there is a drug that is
used on a daily basis, like cholesterol lowering
drugs, antihypertensives, their cost is anti-depressants.
The price difference from 20 to 200 rupees
becomes very extreme.
Why is there a price difference?
They are not doing research.
Why are they charging so much?
There are many factors.
The biggest factor is that this is not
our attempt to chastise anyone.
This is to tell you that there are
many factors that influence the final price.
First off, there are poor policies by the
Drug Regulation Authority.
There is no comparative cost analysis.
If one company is selling at this price,
the generic of the same drug should be
sold at the same price.
The principle of generic is that you have
to prove to the Drug Regulation Authority that
the drug that we have copied and pasted
is as safe and effective as your innovator
drug.
But over here, we are registering medicine on
medicine but we are not asking them to
prove the same.
The only problem is not the price difference.
If a person is getting an effective medicine,
he can pay more.
Some people can pay more.
The problem here is that it becomes double
or triple and becomes more severe because people
are paying and there is no guarantee that
the generic medicine they are using is really
effective or not.
I don't think anyone of us has ever
said in our practice that we have done
a course on the medicine you are giving
us and we did not find any difference.
First of all, our Drug Regulating Authorities do
not have any check and balance on this.
Secondly, this country is making generic medicine but
our raw materials are coming from India and
China.
Because of that import, our cost increases.
In Pakistan, we have another hobby which is
to create artificial drugs.
When we do that, let's say during the
time of infections, I remember in our wars,
vancomycin and tezobectamin were always short.
They were not available in hospitals.
We had to prescribe to people and they
used to bring it from outside.
The artificial drugs are not available in hospitals
and because of that the pharmaceutical companies sell
it from outside and the price increases further.
Where will you stop and where will you
check and balance?
If we talk about the pharmaceutical companies themselves,
they have to produce the same drug which
is beneficial for them.
If they produce simple folic acid then the
cost is very low.
But if they combine the same folic acid
with other multivitamins and we see a lot
of multivitamins in a bottle this is your
one-stop shop.
There the cost of producing those drugs is
high and the earning is high.
The spider web is such that you don't
know where to start and the things are
going to start getting streamlined.
The marketing costs add on.
Marketing is not direct to the consumer but
to the doctors and pharmaceutical representatives and pharmacies.
In that the more a doctor prescribes a
medicine at the end of the day he
can claim his share from that pharmaceutical company
that I have given you so much medicine.
Now this is my share.
Then your polypharmacy the more medicines you add
the higher the cost increases.
When I was doing this I was looking
for a stop a check-in balance which
was nowhere.
Now I don't have a guarantee that this
medicine is effective nor do I have a
guarantee that this generic medicine is safe or
not.
I am totally blind.
I am a doctor and I am blind.
I don't know that a patient comes to
me in the OPD and this happens countless
times in our households that you prescribe a
medicine and they would be like you prescribe
the medicine and they would be like you
prescribe the medicine and they would be like
and they would be like you prescribe the
medicine and they would be like you prescribe
the medicine and they would be like you
prescribe the medicine and they would be like
you prescribe the medicine Okay Dr. Asma, please
I don't know if it's safe or effective.
But I cannot do that.
And this is where we stand as as
specialists.
We can well imagine the lay person, the
common man.
I guess ignorance is bliss.
generics and we we don't have a lot
of time but we also have this understanding.
And apparently that is a setup that India
does have or is developing or has developed
to some extent.
And even the concept of it is very
novel or very new.
We are we do hear of some people
making some inroads of efforts to get that
regulation started or start making those efforts.
To find out more about that.
Direct to consumer marketing and then there's the
to doctor marketing.
It's introduction.
marketing or promotion incentives
if they prescribe a specific medicine.
It's complicated.
doctors incentives incentives
the majority of the doctors said conferences
or educational activities pharmaceutical incentives proper
gifts So, who are you going to hospital?
watches up to cars foreign trips and cars
brand reminders inconsequential
and it goes
to your sponsored trips doctors educational conferences pharmaceutical
polypharmacy there's
so much more to discuss or or
one thing that all of our audience will
have noticed is that my entire panel and
me we're fairly on the younger side of
the line all of you are in your
20s I'm in my early 30s and this
is actually representative of a trend the longer
you are in this field the more desensitized
you become to these problems I will be
hard pressed to find three professors to sit
with me and have this conversation.
I'm not saying they're not there.
I'm just saying it'll be very hard for
me to bring them together and have this
kind of a conversation and have them share
this kind of information with you the few
people that I will be able to get
in touch with I hope we will be
able to have a psych with them as
well.
This is these are deep-seated problems these
are deep-seated problems and we want something
done we want to do something we want
there to be what that something is we'll
be very honest we don't have the first
clue these spiderwebs we
present not only what we have gathered but
where we fall short and we fall drastically
short so we continue raising awareness talking about
all of these issues talking about we've only
touched we've only scratched the surface here right
this is just the tip of the iceberg
definitely I
don't want to okay thank you all for
being here thank you all for watching we've
done what we could and we will look
to do more but this is where we
ask you to help propagate this so that
it shakes the right corridors it creates the
ripples where it needs to create the ripples
and people start feeling the intensity of the
situation for what it really is don't wait
for an incident even though those incidents are
happening just me people are dying as a
consequence of what this corruption is talking about
do you want me to get more explicit
than that people are dying every day as
a result of the problems that we spoke
about without any exaggeration and there is no
data give a kid man they can we
say we can say categorically give a boss
so it is literally a matter of life
and death and so we take it up
thank you all for watching we will be
seeing you around there's a lot of material
that we're sharing from our telepsychiatry pages on
our social media related to all of what
we touched upon to see if we can
water down simplify understand thank you all
for supporting us in this