Yousuf Raza – The Big Pharma
AI: Summary ©
The conversation covers various topics such as social media, medication, and mental health issues. The speakers emphasize the importance of avoiding activities related to the pharmaceutical industry and finding the right doctor for a mental health patient. They also discuss the importance of medication management and faith-urance in improving productivity and utilization of medications. The speakers emphasize the need for evidence-based medicine and a credentialing process, as well as the importance of finding the right medication for a patient. They also touch on the issue of drug abuse and the need for more transparency in healthcare. The conversation ends with a brief advertisement for a future show.
AI: Summary ©
Go live.
As-salamu alaykum.
Bismillah wa salatu wassalam wa ala rasool wa
ala aalihi wa ashabihi ajma'een.
As-salamu alaykum people.
As-salamu alaykum Azam.
Wa alaykum as-salam Yusuf bhai.
Why are you wearing an upper?
I'm feeling cold.
You're in the middle of the world.
Which part of the world are you in?
Which part of the world are you in?
I'm in Islamabad.
In Margalla Hills.
Okay, okay.
And I was unwell, okay?
I had flu, I have allergies and I
just came from outside, which is why I'm
late, which is why I'm sorry that we
started late, but we're here now and we're
going to begin.
Azam, what fights have you waged on social
media?
Huh?
Fights?
Yes, I've heard you tag big online medical
practices and businesses and highlight their corruption.
What are you on about?
So, what happened?
I got an email from Olladog and I
don't think I have an account on Olladog.
I don't know where they got my email
ID from and it had all the details
that we have developed an internal mechanism that
if you send our patients to these labs,
which they had written in the codes that
they are high quality labs and they have
selected them.
So, if you send 20, then you will
get a discount on the same labs for
you and your family.
If you send 50 patients, then you will
get a 20% discount.
So, I posted that on Facebook.
I did it from my private account.
I didn't do it before my page.
And I tagged that company, Olladog.
I tagged them and the very next day,
I got another email from them.
And that email was that they misunderstood our
message yesterday.
We want you to...
And they had written a line in it
that this is good for the practitioner as
well as for the patient.
So, we are admitting somewhere that this is
also good for the practitioner.
And that we want you to...
With high quality labs, like we don't know
who high quality labs are.
And the discount they had given on it
so that we have a strong relationship with
high quality labs.
So that the relationship doesn't break.
So, they sent another email that it was
misinterpreted yesterday.
And...
And the interesting thing is that in the
first email, there was a line at the
end.
I didn't take that line before.
I took a screenshot.
For any queries or questions, please contact this
email.
And that was financemanageratolladog.com Something like this.
So, if you have any questions about the
high quality labs, please contact our finance manager.
So, what's wrong with this?
They want so much good for the doctors.
The patients will benefit.
They will be referred to high quality labs.
What's wrong with you?
So, absolutely.
This is how it is.
And I don't care about this.
even our doctors have a very familiar argument
that we have to prescribe a medicine we
have to send it to a lab so
if we prescribe the same medicine from where
we are getting a cut, what's wrong with
that?
or if we prescribe the same medicine from
where we are getting a cut, what's wrong
with that?
so there is nothing wrong with that just
disclose it we are disclosing it today there
is nothing wrong with that absolutely and that's
why see, if we look very broadly pharmaceutical
companies do they have relations with doctors?
yes, they do and you can say that
there are a minority perhaps I would say
if I am being very generous 5-10
% doctors who do not have relations with
pharmaceutical companies absolutely and I am being very
generous saying 5-10% is probably less
than 1% and the prescriptions that we
get to see especially in psychiatry in others
too but what is done with psychiatry the
medicines of psychiatry which are prescribed by non
-psychiatrists prescribed by medical practitioners the corruption that
we see in that the unnecessary prescriptions that
we see if that is not being if
that is not the direct outcome of these
illegitimate relations of these illegitimate relationships then what
else is that?
these people are not stupid the doctors the
clinicians, the psychiatrists these are the cream of
your of the lot of your educated population
who become doctors hardworking, intelligent you name it
they know what medicines should be prescribed what
should not be if they don't know then
their own psychology their own potential for self
-deception their own what it can lead for
them to do that's something that they would
probably be unaware of so it's not it's
not that they don't know they know and
which medicines I mean who has the evidence
who doesn't but these big rationalizations justifications it's
mind-boggling it's mind-boggling and this is
not just about money we know examples where
you will be offered you will be offered
you will be given a key that sir
this car is yours and as long as
you keep writing these two medicines we will
keep paying for it when you stop writing
medicines we stop giving and there and this
even for a good person it becomes a
very big temptation because they would typically target
you at the beginning of your career that
you have come in a house job or
you are a PG trainee or a medical
officer you are starting you haven't paid off
the debts that you had taken as a
medical student or after getting married and you
know you are barely making enough 40,000
-50,000 salary if at all and that's
what you are operating on that's when they
will zoom in and they will swoop in
and they will try to make you all
of these offers gradually it starts with a
tissue box right ball points, tissue boxes keychains
and notepads and what we see in our
government hospitals in the wafers they are in
every room necessarily if I am writing with
a pen that has a pharmaceutical company's name
on it now that name is registering in
my head more I don't know if that
medicine is necessarily better or not but I
will remember it more it is always in
front of me I am more likely to
write that than any other medication right but
before we go into all of that let's
talk about our own personal interaction with pharmaceutical
companies from being a medical student to being
a psychiatrist do you have any personal involvements
with pharmaceutical companies that you want to disclose
so if I talk about interaction the first
interaction was in my house job and in
the house job what happened was we had
a call and I am sitting on a
call in the doctor's room so a lab
I still remember both of them their initiative
was that they are the owners and all
that they came to me and said if
you sell this to us in the lab
we will give you a 20% cut
and we did not refute them and we
said yes we will see and all that
but yes I can admit during my training
I have used pads a lot not pads
not pads and I have never offered money
in my training but one thing the group
trips the ward trips of the doctors I
think 2-3 times 3 times I guess
I have hotel 1 and PC board 1
the trips and I seriously regret that I
was thinking should I talk or not or
should I talk but in the training I
will not say I did not know it
was wrong but it is more of a
peer group from the ward and seniors and
it is not that I could not refuse
at least 2-3 times I refused 2
-3 different trips so you can see in
my 4 years of training at least 5
-6 trips were in the ward so I
went on 2-3 trips and on 2
-3 trips I did not go and I
never bluntly refused I remember my aunt is
coming from England I have to spend time
with her I have to take her but
yes it happens in training a lot I
remember particularly my first encounter would be we
were in first year and my friend said
there is a conference in Bhurban of some
speciality so let's go so I said it
was okay to stay in PC Bhurban I
did not tell him that I stay in
PC Bhurban for 2 nights he said don't
worry we were first year medical students we
did not know much he said it will
be done he is rich rich dad, good
practice doctor everything I don't know let's go
so after going there I realized this is
a conference sponsored by pharmaceutical company maybe at
that time it was not clear and I
had nothing to do with that conference I
was nowhere near that speciality I was in
first year I did not know anything about
that you were in first year you did
not know the conference I went I stayed
there for 2 days and even while staying
in that hotel I did not know which
hall it was I never went in we
used to go out in the morning and
come back in the evening we used to
have food and play cards there is absolutely
where actual lectures are happening academic activities in
front of which everything is happening nobody is
there presenter is sitting pharmaceutical people are sitting
in the audience presenter and panel experts and
their colleagues who have come to support them
so if 4 panel experts maybe some theatre
students are sitting in the back thinking that
we will learn something here and they are
actually sitting there now I am not why
am I doctor's family I am not that
doctor why is the company paying I am
sure 50-60 thousand of how much time
I am going to spend there and all
the facilities that I am going to use
for me where will this money come from
this is going to come from the pockets
of people buying that medication or those devices
which will be used in theatre etc.
that's where this money is coming from we
will come to that later my second interaction
will probably be but what you said one
thing I cannot get around this that how
will this happen that in our country our
government or our scientific agencies they don't support
any such activities financial support because for them
to exist money is needed 100-150 participants
are coming they want water, tea, food and
you want at least something presentable in a
place so for that like 1-2 months
or I think 2-3 months later there
was a conference in Lahore where all the
psychiatrists of Lahore used to gather and they
discussed some cases and all that or maybe
some presentations so for that what should be
done one obvious thing that comes to my
mind is that every medical college has an
auditorium these things can be done there and
even if there is an auditorium one day
from morning to afternoon till 1-1.30
pm then even a tea biscuit can do
the job all of us doctors are so
many that we eat food from home and
go home to eat even if you have
to do a lot you want to give
a meal you can give like you can
give pulao kebab you eat it yourself so
if you get that at a conference like
this what's the big deal the idea is
that the activity you can do in 10
-15 thousand right that activity is in 15
-20 lakhs 15-20 lakhs patients have to
give if this is the case then in
my confessions I will add that monthly every
2-3 months there was a conference in
Lahore which was local but there was lunch
served in a posh hotel but on that
everyone had to go let's be very clear
those will be relatively better interactions with pharmaceutical
companies if we have to talk about academic
conferences and genuinely academic activities even if they
are in a posh hotel those are still
relatively better activities I mean what is the
relation of families what is the relation of
family trip Dubai trip literally I remember as
a consultant I started out at one of
the private medical colleges one of the pharmaceutical
company representatives came to me and he is
like your family has to go somewhere you
have to go to Bhurban even sir you
have to go to Dubai I was literally
shocked that this much like how can he
so bluntly and shamelessly come into my office
and think that he can get away with
making these offers and I regret to this
day that I didn't tell him anything I
regret that I didn't go to Dubai because
you talked about Dubai and visit so I
think 2 or 3 years ago a new
medicine was going to be launched in Pakistan
for psychiatry or it was palipiridone or something
like this Britalex in Britalex the new 2
or 3 years so the launch in Pakistan
ceremony was they from Pakistan different departments or
famous people and in Pakistan the launch of
the medicine was in Singapore on a 2
day trip they all went to Singapore from
Pakistan they all went for psychiatry absolutely so
I remember that interaction medical school as a
consultant I do remember as a PG trainee
in the hostel senior PG called me to
have food and then my senior PG said
he is from that company you have to
remember him while writing and that was again
something that took me by surprise and then
in the ward whenever there was food I
wanted to eat I think I can successfully
I was able to successfully evade 90%
80-90% of them and that too
was very difficult the rest of the PG's
would be making faces at you like you
are crazy you are saying you are saying
that we are eating Haram I wouldn't say
that I know how difficult it is and
majority would be participating in those consultant's birthday
pharmaceutical people I mean what is academic about
that and what's going on over there right
but yes 10-15% of the times
when I had to be as my position
of academic registrar or administrative registrar we had
to organize these academic activities then your hands
are tied and it would take a whole
lot of strength to take a stand and
say no I don't want to do this
as a PG training there is only so
much you can do and there is that
so just breaking it down for our audience
as I am guessing obviously we don't have
exact stats with us but guessing if one
pill is 20 rupees so what proportion of
that would you venture would you guess what
is the cost where is that 20 rupees
going how many medicines are there the whole
production of course it varies from person to
person but generally speaking the imported medicines as
they are imported their cost is more so
in that the margin for doctors is less
hmm strangely the local companies they give more
margins to doctors hmm they don't just give
to doctors it's not just doctors it's also
the pharma rep who has trapped the doctor
the pharma rep's senior manager who is overseeing
there is his share in that pill the
pharma rep pharmacies get pharma rep one pharma
rep is the doctor's one pharmacy's pharma rep
when you go to pharmacy and say I
want this medicine they say it's not this
you will get this pharmacy's pharma rep also
has a cut and it's not just the
you know the profit margin it's more than
that and of course the pharmacy's pharma rep
from where he is getting more cut he
will promote that medicine more if he is
getting 10% from one medicine and 30
% from another of course he will say
you can purchase this medicine and that makes
it all the more difficult that we as
psychiatrists if we write generic medicines generic means
we don't write the brand name we don't
write the company's name we write the actual
medicine which is called salt we write its
name then it is very likely that when
the patient will go to the pharmacy to
the pharmacy the pharmacy has to give that
brand from which he has the most margin
then we are setting the patient up for
that level of exploitation so Yusuf then what
should a patient do?
the real question is what should the patient
do?
this one which we talked about from another
name and it goes with the name butcher
people already know that so what should the
patient do?
how does one spot that here something is
going wrong I think it's a good idea
that when you are going to a consultant's
office you will get to know that on
his table there is a tissue box there
is a pen there is a watch which
company do you see the most?
Yusuf I think it's a little more aggressive
and that is the people who are listening
are the ones who know how to use
the internet because of course we are doing
this on the Facebook so whatever medicine your
doctor gives you look at look at it
on the internet what is it for and
if you feel that I don't need it
ask him directly why are you giving me
this medicine and as a general rule if
a psychiatrist is giving you more than three
medicines, if he is going on the fourth
medicine I am saying three in severe cases
and of course I am not saying three
medicines in a day I am saying three
different medicines which can be used in the
morning and evening if he is going more
than three different medicines and it is going
towards the fourth medicine then ask him why
are you giving me so many medicines and
this is also a very severe case it
is not for mild or moderate cases even
in mild cases our psychiatrists first of all
they don't have to give but if they
have to give then ask him do I
need so many medicines if you look at
your medicine because the amount of psychiatry we
know at maximum if you can go to
someone then one antipsychotic one mood stabilizer one
benzodiazepine if he is going on the fourth
if he is antidepressant then it means that
that person doesn't know psychiatry that he is
giving this and antidepressant or or he has
a good share exactly we are not saying
that if he is on the fourth then
he is taking a good share it might
happen but when you get the fourth medicine
on your prescription then ask him that what
is this fourth medicine for so psychiatry so
now we are coming out as you said
to science that your doctor is cheating you
or not and for psychiatry we can spell
out majority of cases if the severity is
mild they should be handled without medication majority
cases mild severity your functionality is good there
is a little bit of distress you have
gone to check if there is anything and
you should not get any medication I can
say this categorically I am seeing over 70
70-75 people a month hardly I would
have 4 or 5 of them on medication
I can say this out categorically within a
month 70-75 I am not giving more
than 4-5 medicines and that's on record
my entire team would vouch for that if
you know those of them who know where
that prescription comes for ok and my entire
clientele would vouch for it as well I
am not your slave and that's also a
mindset that asks for that to happen you
didn't give any medicine you are not a
good doctor I am going to come to
that later as well so majority cases mild
should not get medication moderate at best one
medication at best one medication if that does
not respond usual recommendation says replace the medication
right rather than adding a medication global recommendations
best guidelines best practice guidelines give 2 on
resistance in severity 2-3 like you said
but we on the first presentation we have
seen 10-10 medicines how does that make
sense how does that make sense just look
it up on internet and ask the doctor
this medicine is for this do I really
need this is this the problem and there
is no if the doctor is justified in
giving and he is giving honestly he will
never mind there is a difference between a
doctor and a faith healer if the doctor
gets angry then you should be in doubt
that I asked you a very innocent question
what is there to be angry about I
mean at the end of the day in
a faith healer who you go to get
a medicine and the doctor in them there
will be a difference that the doctor can
give you a reasonable rational explanation that you
can verify that you are from somewhere else
okay the medicine which you are not aware
of okay that's what are you going to
do about that but a doctor is going
by something that somebody else in his field
can verify that you can verify on you
can look it up obviously you are not
going to hold the internet as an authority
over your doctor but you can still ask
a question that he owes you a response
to and Yusuf by faith healers you mean
the fraud yes by faith healers I mean
even the fraud even the fraud they are
genuine what explanation will they give you because
it is an occult area of knowledge if
there is such a thing whatever that's a
separate topic maybe we open it up one
day maybe we don't but this is empirical
science we are talking about this is knowledge
that is based on evidence and experience and
experimentation you can't hide this to what level
will you hide right so one sign this
happened number of medications should match the severity
of the condition that you have presented with
and typically regardless of severity it shouldn't start
off with more than one at max very
severe very resistance okay three four nothing more
than that other than this such medicine that
you get only from doctor's pharmacy that medicine
is fake especially if it is a vitamin
and there is a question about vitamins or
supplements so supplements are tricky and they are
also comically tricky that you don't have any
gauge that you can see whether that supplement
is going into your body or not unless
there is a very obvious electrolyte abnormalities will
not come to the psychiatrist nor will he
prescribe it okay so if he is prescribing
you evidence or supplements are just
working as placebos or medical man custom to
a patient because he insisted the way they
to a man who put him
in a room so or
or and drip or normal saline or
sugar water and there's a placebo effect and
That's ADD, right?
Any damn drug works in those situations.
So, supplements, especially those supplements are okay.
There are certain conditions, you have iron deficiency,
you have B12 deficiency, some particular cases of
vitamin D.
Those won't come to a psychiatrist.
Typically, they won't come to a psychiatrist.
That's something that would usually go to a
medical practitioner.
So, all those things are separate.
Okay, you have to take supplements, you have
to take a powerful medicine, you have to
give it.
That shouldn't be more than 100, 200, 300.
It's too much.
Literally, there are practitioners who prescribe supplements which
are 1000, 1500, 2000, 2500.
Literally, there is a neurologist practicing in Islamabad
who is very well-known.
Very well-known.
And they treat psychiatry patients.
They treat their own patients as well.
They will get everyone's CT scan done, MRI
done, EG done.
Because, MashaAllah, all the facilities available in their
own clinic.
And they will give such supplements which will
give you 2, 2, 2500 supplements.
I had gone to them.
An acquaintance had sent me a prescription to
tell me which medicines to take.
Which medicines to take.
Literally, he was waiting for 12 hours for
that one medicine.
Which was a useless supplement.
Now, this is a family whose father has
suffered a stroke.
Their father is 75 years old.
They are rubbing him on the wheelchair.
They are feeling embarrassed in the rush.
They should get that 2,500 rupees supplement
from somewhere a little cheaper.
Which their father doesn't need at all.
And that is their entire day.
And that is the entire day of people
who live off of daily wages.
And the neurologist couldn't care less.
Ex-principal of a reputed medical college could
not care less.
Inside uniform, outside uniform, could not care less.
And that's the reality of it.
And I said this.
I said this in Army Medical College.
I said this straight up.
I took his name and said this.
Because he is a retired general.
And the principal got furious with me.
He said, you have taken Army's sanctity.
Army's sanctity is that if he is doing
such mischievous acts, he should be deprived of
his rank.
Army's sanctity is this.
Army's sanctity is calling him out for the
evil that he is practicing day in and
day out.
Is that Army's sanctity?
Protecting his vice.
That's Army's sanctity.
Army's sanctity should be that he should be
stripped of all his ranks and all the
privileges that he has been given.
If Army really cares about its sanctity.
Is that he's a criminal who is flaunting
his generality as retired as he may be.
And what the Army gave him.
And literally minting millions per week.
And nobody could care less.
Nobody could care less.
Poor people go to him.
And this is the medical protection.
I saw a head of department.
Who said to a patient.
That the patient's daughter has an intellectual disability.
Severe intellectual disability.
He wrote a diagnosis on his hand.
And said that she can get better.
If you arrange for a medicine.
But the medicine is a little expensive.
He asked how much.
He said that it is around 2500 per
month.
So we were also curious.
What kind of a syrup is this?
Which can cure a patient with severe intellectual
disability.
Intellectual disability for those of you who are
listening is mental retardation.
Which we usually call mental retardation.
Okay.
So the next day.
The patient's father came.
And he said that he didn't have money.
He used to drive a rickshaw.
So I asked for money.
And I brought it.
He told me to kindly write the medicine.
So that my daughter gets better.
And he gave her a brain tonic.
The big bottles.
He gave it to her.
And gave her a spoon in the morning
and evening.
And it will last for at most two
and a half to three weeks or a
month.
And that man is telling her that I
didn't have it.
I asked for a loan and brought it.
And he wrote shamelessly.
Take this.
And don't leave it.
And you will get better.
I remember we were working in child psychiatry.
An epilepsy patient came.
Who had been diagnosed for five years.
And for five years no one had told
him what his prognosis was.
How long this disease will last.
What is expected.
Nobody had told them this.
He didn't leave any hospital in Peshawar.
Public, private.
He went to everyone.
He didn't know this much.
No one told him where his illness was
going for five minutes.
And medicines on medicines.
Tests on tests.
Everything is being done.
And you are like what is going on.
I remember one of the people that I
was working with.
And that's the worst person that I have
ever worked with.
Most of the people that I have worked
with.
My senior professors.
Wonderful psychiatrists.
Beautiful human beings.
One that I really regret and hate.
His guts.
One patient.
Now obviously we have a private hospital.
But because it is associated with a medical
college.
So it has to be subsidized for patients.
For the public it can't be.
You know they can't charge like 10,000
-15,000 a night.
That 100-200 rupees per night.
A patient used to come to our hospital
for ECT.
But he was admitted to that.
That bad type of psychiatrist's private clinic.
And that.
Literally he is charging a couple of thousand
a night.
And they say to me.
I have told them to get admitted here.
But they just don't want to leave me.
What should I do?
And the words of my patient's attendant's mouth
were.
Doctor, to stay in their clinic.
We have been admitted there for a month.
I had to sell my shop.
I had to sell my shop.
Just to keep my daughter.
Who was not responding to that idiotic treatment.
Whose dissociation was being reinforced.
By something which is contraindicated.
Which doesn't have to be admitted.
And.
That's the situation.
You're just fleece.
And these are people who drive land cruisers.
These are people who are freaking living in.
The most posh areas of the city.
And.
They're.
This is how they deal with.
People who can barely afford three square meals
a day.
And no one is going to ask.
No one is going to ask.
No one is going to identify.
I would literally take all of their names
right now here.
But the only reason I'm not going to
be able to do that.
There are dozens like them whose names we
don't know.
And we can't take.
Or the names of all of us.
And that we can't do.
That we can't do.
But this is.
It is what it is.
So one sign.
Extra medications.
Not.
Compatible or not commensurate with the severity of
the illness.
Two supplements which are incredibly expensive.
Or any medication for that matter.
Just.
Specific.
I would actually be very, very skeptical.
Of.
Any lab tests that are being done from
a private practitioner.
Or any medications that are coming from the
same.
Same.
Which is the same.
There are labs in the same clinic.
There is a pharmacy in it.
I would say that you should try not
to go to these.
Clinics whatsoever.
Because.
It is natural.
Whose own.
Lab.
And whose own pharmacy.
He will write more investigations even if he
does not want to.
I don't know if you remember Azam.
Dr. Ishaar Ahmed used to say that when
he used to practice.
He was a general practitioner.
He started doing some lab investigations in his
own clinic.
He says that a few weeks passed, so
I noted that I have.
Since he started testing in his clinic.
I started writing more tests.
He says that I closed it on the
same day.
That I will not test myself in my
clinic.
Because his money is also coming to me.
Without even deliberately wanting to do that, it
is natural.
That you are going to gravitate towards writing
investigations that are not necessary.
And I would be very skeptical of clinics.
Whose investigations are also there and the pharmacy
is also there.
That's not a private practitioner that I would
go to.
And I wouldn't recommend others to go to.
Azam, any other points?
Yusuf, in all these issues.
Is the patient also at fault?
Yes, but when the patient comes and says.
That a general perception is made.
That the more the medications.
The better the doctor.
And also.
The sooner the medication works.
The more the doctor will understand.
And obviously when you give less medication.
The side effects are less.
The patient will feel less.
And we see patients.
We try to convince them.
That your sore throat is viral.
Don't take medicine now.
Let it go now.
You give us medicine.
And whatever medicine you have given.
If after eating two meals.
The effect did not come.
Then wherever he will sit.
He will say this.
That the doctor did not understand my mistake.
Absolutely.
And I know people like very good.
Well-intentioned.
Practitioner, psychiatrist or otherwise.
When they started practicing.
We used to prescribe one medicine to the
patients.
They thought we did not know anything.
He came to us again and again.
Doctor, only one medicine.
Doctor, one medicine is not enough.
Doctor, ask for more.
You don't know more.
Literally some of them would be blunt enough
to say.
You don't know enough.
Because you are not giving more medications.
They would be outright.
Clear cut.
Straight to your face.
Yusuf, one of my colleagues.
The doctor also told me.
That their private practice.
The setup is very simple.
A room and a table chair.
There is nothing special in it.
And on the same road.
A little ahead.
An OT boy.
Who is not a doctor.
And he was a ward boy before.
He has also opened his.
Clinic where.
Marbles are installed.
And AC.
They say that his fee was 500.
When I started working there.
I also kept my fee at 500.
Because his patient was already made.
So competition.
He said that a patient came to me.
And when I told him 500.
He said that 500 is bird honey.
The patient asked.
So the doctor said.
I was angry at something before.
I said that the one who is sitting
there.
He doesn't even know anything.
And neither is he a doctor.
You also give him 500.
He says that the patient says from the
front.
Have you seen the hospital?
They have an AC line.
You brought it like this.
So.
This one thing.
That the external.
And all of us.
You.
Three or four big hospitals in Islamabad.
You can take the name.
That our people will say.
That there are all thieves and dacoits there.
But.
Because of that external excitement.
We will always go.
In the same way.
I can take the names of three or
four in Lahore.
And see.
We know.
At the end of the day.
That we can say.
That the attitude of the patients is like
this.
Their perception is made.
They demand this thing from us.
But when they demand this thing from us.
They say doctor.
Give more medicine.
We give more medicine.
Then we are the ones reinforcing this attitude.
If we have to spread this awareness in
our public.
That more medicine is not more better.
It is not good.
Necessarily.
Then that's our responsibility.
These are the departments of our community medicine.
What are they doing?
In every medical college.
Other than screwing with the brain.
These are the departments of medical students.
Awareness.
They are busy pressurizing different researchers.
That's.
And that's another aspect of this.
Which we didn't even get a chance to
get to.
When we say big pharma.
Whatever we have talked about in the last
50 minutes.
That's small pharma.
That's local pharma.
That's local corruption.
These are cheap imitations.
Of real big time fraud.
That is happening in the United States of
America.
In the.
In Europe.
In the developed countries.
Which is corruption in Chitti Chamdi.
We don't even.
As freaking brownies.
We don't even come close.
To what they are doing.
Literally.
In the board meetings of your pharmaceutical company.
There is a discussion.
That making life-saving medications.
Is counterproductive.
If we.
Save the life of the patient.
And what is his name?
Sorry.
Curative medications.
Curative medications that.
Get rid of the illness altogether.
The disease of the patient gets completely cured.
That is against our business interest.
Customer saved is a customer lost.
We need medications.
Which don't even let them die.
Manage them.
Yes, manage them.
And don't get completely cured.
And.
That naturally means that.
Specialties like psychiatry.
Neurology.
For such pharmaceutical companies.
There are a lot of profitable areas.
Our.
Not taking interest in psychology.
Even in psychology.
The multiple options.
Don't explore them.
It is in their * favor.
Guess.
Neuropsychiatric.
Pfizer.
Which is the biggest company in the world.
How much was its last year's profit?
Just profit.
Worldwide.
Profit.
No idea.
Pakistan has taken a loan from IMF.
3 billion dollars.
Because we have to meet in 3-4
years.
And we say that.
Our economy.
Will start going towards improvement.
So Pfizer profited.
From just one division.
Neuropsychiatric division.
14 billion dollars.
Worldwide.
This is profit.
And now you look at this.
If this is what Pfizer is getting.
Of neuropsychiatry.
And I would guess.
Depression has a huge role to play.
Because depression is.
Close to the top.
If not the most prevalent illness in the
world.
The prediction of 2020 was that.
It has to be at number 2 or
number 1.
Now it will be.
But it is definitely number 2.
So.
There is probably a lot of depression in
there.
WHO.
WHO.
Says that mental health matters.
Speak for mental health.
And good hearted people.
Who want.
That people should seek help.
Get help.
Be provided with the care that they need.
What are they actually?
Who are they ultimately benefiting?
Who are they ultimately benefiting?
We know.
That exercise.
Brisk walk.
Is going to have the same effects.
In your brain.
That an antidepressant will.
But that side of the research.
No one will ask us even in our
FCPS exam.
And nor will he get so much project.
He will get some sponsorship.
He will get some funding.
And we are left with.
We are left with doctored evidence.
We are left with.
Fully.
You can say that the limit of bias.
To all of them.
That's being pushed in our faces as empirical
evidence.
Even the institutes.
Review boards are made.
To neutralize bias.
To bring neutral unbiased opinions.
They are also funded by pharmaceutical companies.
And the people sitting there as well.
What do we do?
What do we do?
So before people start taking this impression.
That all this corruption is only in Pakistan.
That I went to America.
And the doctors there.
See if this disease gets better.
What did I tell you?
Let's not jump to those.
Let's not jump to those.
We need to realize.
Whatever is going on there.
We don't even come close.
The level of corruption.
The level of exploitation and abuse.
Corporate abuse.
We don't even come close.
Anyhow.
Azam anything.
I think.
14 billion.
I am doubting myself.
So it's.
Confirmed.
That this is too much.
So.
Anyway.
Double check.
They can always double check.
Anything and everything that we say.
Somebody shared with me.
I didn't get a chance to see that
myself.
But Haseeb was kind enough to take a
look at it.
For us.
The documentary.
How.
Non-pharmacological interventions.
Other than medicines.
The treatment of diseases.
How is their funding stopped?
It's a long story not to do it.
How is their funding stopped?
Steps like.
Music therapy.
Aroma therapy.
Exercise.
All these non-pharmacological.
Interventions.
Research.
Science.
Evidence.
It's.
Hard to find.
It's there.
We're not going to say that it's not
there.
But it's going to be.
Literally.
Simultaneous.
Research is definitely not enough.
To qualify.
And.
As.
As systematic reviews and.
You know.
But you.
Make it clear.
That you are not arguing for.
For COVID.
Yeah.
That's I mean.
It is this corruption that gives that.
Some credence.
Credibility.
I mean.
With friends like these who needs enemies.
Whatever.
Who would take these things seriously?
But people are taking.
Pakistanis.
We're taking these things seriously because.
Let's be clear.
The white coat is tainted.
It's stained.
It's not very white anymore.
Because of our actions.
Because of our corruption.
Because of our dishonesty.
Because of our betrayal with science.
Because of that.
It's.
It lends all of these alternate.
Without evidence.
Random.
Claims.
Well marketed.
Credibility.
It's our.
It's our community.
It's our friends.
And.
That's what ends up happening.
That is what ends up happening.
Again, we are not saying I think that's
important.
We are not saying that you should not
go to the doctors.
Okay.
We are doctors at the end of the
day.
And we will also go to the doctors.
If someone in my family needs a doctor.
Then I will take him to the doctor.
We're just saying beware.
And.
Make more informed choices.
Doctors too.
Can exploit.
And.
You can get involved.
You can also get involved in spreading the
disease.
And the people who are on their own.
Be good.
Joe.
Keep.
In doctors.
Don't go for big names.
A lot of personal experience.
Doctor.
All right.
So quick.
A couple of quick questions.
I don't think there's many questions.
There's more comments.
especially in situations and conditions like dementia, I
think that's a wonderful idea.
Okay, we should probably dedicate one of our
shows to that.
Genki families can under, uh, elderly go, yeah,
even, um, not, they don't have to be
elderly, but should be all second.
Didn't go to be chronic illnesses.
Um, own car, he'll, Rick, name, Valo, K,
Joe, problems create, hospital, psychological, special attention needs
to be given there.
So I think that's a wonderful idea that
we do need to put in line as
one of our topics for the future.
GSM.
But as a, it's about me, I'm sorry.
Don't go.
Thank you.
Anything else we wrap up.
Yes.
All right, people.
Thank you for watching.
I think we've become, I don't know.
We're coming off as more and more pessimistic
and more and more problem highlighters than, than
I had expected us to be.
Yeah.
So, so by use of whatever books tell
us, which books, psychiatry books, with Joby, I'm
already major medical illnesses.
Are they treatable?
There's very few who are, which are completely
and have been other than infectious diseases.
We have, we have very little to offer
in terms of cures management.
Yes.
Management.
Yes.
So maybe at some time in some episode,
we should talk about how to come to
terms with this reality.
So there is depressive realism.
So there is, there is good reason for
that.
And it is much better to be aware
and stressed about what you have become aware
of rather than being in a bubble, a
naive optimism.
Like in that is based on ignorance.
Like in, if that is going to lead
to abuse, if that is going to lead
to more problems in the future, then I
don't think, I don't want to be part
of that campaign.
I don't want to be, I don't think
we want to be taking it there.
All right, people, thank you so much for
watching.
Thank you so much for sticking with us
all through this.
You have further questions.
You need further clarifications.
If we have created any confusions, please feel
free to let us know.
If we have created any confusions, then I
would say we have succeeded in our mission.
But we will look to clarify some of
them if we can.
All right, people.
Thank you again.
Thank you, Azam.
You were good to wrap up.
All right.
Allah Hafiz.