Barsati's Garden - Dahlias 2

We had more dahlias in Barsati's garden since my last post.

This time, the camera is that of my new Lenovo A6000.

Priorities . . .

Since the beginning of 2015, we're in the midst of a flu epidemic. Newspapers have gone head over heels to report from every nook and corner of the country. There is quite a lot of panic about the situation in the country. 

I found it quite amusing to have a young man come to our outpatient wearing a surgical mask. He had been told at his college that the surgical mask will prevent swine flu infection. He also claimed that authorities in his college had distributed about 2000 masks to students and teachers.

As of today, there have been 743 deaths caused by Swine Flu since January 1, 2015. 

I thought of calculating the number of deaths by other major causes (mainly preventable) in our country during the same period. The calculations are based on figures provided from previous year data. There should not be a more than 5% decrease from those numbers.

Cause of Death
Tuberculosis	76849
Road Traffic Accidents	18360
Malaria	27945 *
Childhood Diarrhoea  (11m and less)	13973
Childhood Pneumonia  (5 years and less	44433
Maternal deaths	6986

* This number would be certainly much less than this as it is not malaria season.

Yes, you read it right. If the news sources are to be believed, almost 10 times the number of swine flu deaths have been accounted by maternal deaths during the last 50 days. And nobody of us even noticed. 

I can only hope that the sources of my information about deaths every year in the country is wrong.

I hope we can get our priorities right . . . 

Ominous signs

Today, in outpatient, I had a 30 year old lady walking in. Her history was quite shocking. 

Diagnosed to have tuberculosis without a sputum AFB more than a year back, she was on treatment for almost 10 months with a multitude of medicines including 90 injections of streptomycin. 

The problem was that she had not felt better throughout the course of her treatment. 

Below are 3 X-Rays she had with her. 

Feb 2014

Sept 2014

Feb 2015

I await for her sputum AFB. 

I'm not sure if I would do justice to her if I just refer her to a higher center nearby. 

Earlier in the day, I had another patient who was invariably depressed. The interesting thing was that this guy had absolutely no symptom suggestive of tuberculosis. However, he was on anti-tuberculous medications since the last 2 months. The reason - - - some doctor had done a Quantiferon TB Gold Test on him and it was positive. 

Just a glimpse of the scenario of tuberculosis control in the country. 

Of course, I would be glad to get feedback on the management of the patient . . .   

Fixed Drug Combinations

It was about couple of weeks back that the store in-charge at our place informed us that a commonly used medicine - Doxycycline was not available for purchase anywhere. Instead, a Fixed Drug Combination comprising of Doxycycline with Beta-Cyclodextrin was available at almost 3 times the price of simple Doxycycline.

It was unfortunate. Along with Septran, Doxycycline is an antibiotic we regularly use. Contrary to popular thought, they are quite effective in managing bacterial infections at least in remote locations of the country. 

Today, there was this article in the Times of India about an article in The Lancet about India's Drugs Act aiding proliferation of harmful combination drugs. And of recent, me and my colleagues were debating about use of combination drugs in diabetes. To be frank, I'm yet to see even one diabetic patient treated elsewhere who is not on a combination drug. 

I'm glad that this issue has come in print. It seems meaningless to try to educate the pharmaceutical industry and the healthcare community about the vagaries of Fixed Drug Combinations. As I mentioned in one of earlier posts, the major challenge is that most doctors get information from the pharmaceutical representatives. 

I think that the only solution is to educate the public about the issue. 

Couple of other medicines with which we've had this issue is Hydrochlorothiazide, the first line drug for Systemic Hypertension and Butylscopolamine (Buscopan), one of the best drugs for abdominal spasms and cramps. Both very cheap medicines coming under the Drug Price Control. No supplier wanted to stock them as there was no margin. 

The issue is all the more serious for us since the prohibitive costs of medicines accounts for a major proportion of costs in healthcare. One can imagine about how much costs increase with FDCs when combination of doxycycline is 3 times the cost of plain doxycycline. 

One can only hope that the government takes up this issue seriously. 

Well, before I sign off, just a gentle reminder on how rich the pharmaceutical industry has grown. I quote a recent news item - 'India has leapfrogged Russia and the UK to third place with 97 billionaires, 27 more than 2014. Manufacturing and Pharma are the preferred sectors with 23 and 14 billionaires respectively. Combined wealth of the Indian billionaires comes to $266 billion. Mumbai is headquarters to most of the Indian billionaires.'

Barsati's Garden - Roses 4

And here are more snaps of roses from Barsati's garden.