हर चीज सम्हाल के रखने लायक नही होती !

पिछले तीन चार दिनों से मै सोच रहा हूँ और ढूंढ़ रहां हूँ ।जब छोटा था तब फोटो खींचना खिचाना आम नही था ,केमेरा और फ़िल्म दोनों ही मंहगे होते थे और हमारे जैसों की पहुँच के बाहर थे।फिर भी माँ बाप ने अपनी हैसियत से ऊपर उठकर हमरे बचपन के कई फोटो खिंचाये और संजोये । जब से ये ससुरा डिजीटल केमेरा आया है तो लोग बाग बेमतलब दना दन फोट खीचने की मेराथान दौड़ रहे हैं । अब मेरी उम्र छप्पन हो गई तो बनता है की मेरे भी कम अज कम हज़ार दो हज़ार फोटो तो होंगे हीं।सब का हिसाब भी तो नही है मेरे पास। कौन सा है और कौन सा गुम गया है कैसे पता चलेगा?

परसों रात को माँ के पास से उनकी आलमारी में रखे एल्बम मांग लाया और उन्हें देखते देखते बचपन में खो गया । कल पत्नी से उसकी आलमारी के एल्बम लिए और लगा की फिर से शादी कर ली ।| बचपन और शादी के बीच का समय कोरा ही था । दो चार फोटो माँ के एल्बम में और दस बारह पत्नी वाले एल्बम में थे । पिछले पन्द्रह बीस सालों के फोटो तो कई थे पर किसी को भी देख कर मन आशंकित नही हुआ । सब कुछ ठीक ठाक होते हुए भी न जाने क्यूँ मन घबराया सा था ।

आज अल सुबह ध्यान लगा कर बैठ गया और अपनी पूरी जिंदगी को फास्ट फॉरवर्ड करके देखा । बचपन की कुछ नंगी तस्वीरे थी (हमारे समय में बचपन में बच्चे ज्यादा करके नंगे ही रहते थे)। हॉस्टल में थे तो अंडरवियर में या कभी कभी नंगे भी घूमते थे पर अच्छी तरह से याद है की वैसी हालत में फोटो नही खिचवाई .जिस से प्रेम की पींगे बढाई उसी से शादी भी कर ली इसलिए किसी किस्म के लफडे भी नही थे और न उनकी तस्वीरें । अब बुढापा सर पे खड़ा है तो क्या खाक तस्वीर खिचेगी । फिर भी जबसे अनुष्का शंकर की ख़बर पढ़ी दिल कुछ ज्यादा ही धड़क रहा है । मैंने भी अपना डेस्कटॉप और लेपटोप दुबारा देखा , अपनी जीमेल की बढती हुई डिस्क स्पेस देखी, पिकासा एवं फ्लिकर पर अपलोड किए हुए एल्बम देखें । सब एकदम ठीक ठाक ।

फिर मेरे दिमाग की बत्ती जली । मैं एक साधारण इंसान और वो एक सेलेब्रिटी।जैसे बिना बेईमानी किए कोई भी व्यापार में इफरात पैसे नही कमा सकता वैसे ही साधारण से असाधारण बनने के लिए भी हट के करना पड़ता है। ये बात अलग है की अपनी ऐसी किसी हरकत को सहेज कर रखने की मूर्खता सिर्फ़ अनुष्का शंकर ही कर सकती है ।

Suno Beta......

सुनो बेटा

दिल की दिल में
रख्खो बेटा
मेहनत का फल
चख्खो बेटा
ये दुनिया चाल
दोरंगी चलती
करना भरोसा
नक्को बेटा
जैसे तैसे गुजर जाएगी
दूजे की चुपडी मत
देख्खो बेटा
कर सको तो करो भलाई
यही नसीहत
सीख्खो बेटा
चोखा कोइ यार ढूंढना
वैसे तो मिलते
लख्खो बेटा
डरना नही अंधेरों से
कहानी जुगनू की
लिख्खो बेटा
खूब पढो आगे बढो
बैर बुराई
नक्को बेटा





अमर मलंग

I AM HAPPY !! THE GOVERMENT IS THINKING ABOUT ME.

Govt trusts pharma cos to stop bribing doctors

Rema Nagarajan | TIMES INSIGHT GROUP

In what seems to be a case of giving the fox the job of guarding the hen house, the government has decided to curb the practice of bribing doctors for promoting drugs by allowing pharmaceutical companies to self-regulate rather than have a legislation to tackle the menace.
This is despite the fact that more than a quarter of the members of the Organisation of Pharmaceutical Producers of India (OPPI)—an association mainly of multinationals which is estimated to account for 70% of the drug market in India—are subsidiaries of companies that have been penalised in the US for illegally promoting various drugs through inducements for doctors.
The latest to be penalised is the pharma giant Pfizer, which shelled out a whopping $2.3 billion in one of the biggest health care fraud settlements. Billion-Dollar Payouts $2.3 billion
Pfizer | Pays the biggest criminal fine in US history
on Sept 2, 2009 for wrongly promoting 9 drugs, paying kickbacks to doctors by wining & dining them and sending them on exotic trips $1.4 billion
Eli Lilly | Pays up in January
2009 for illegal marketing of drug Zyprexa to treat a range of ailments in elderly and kids for which it is not approved, ignoring side-effects of weight gain and diabetes $4.8 billion
Merck | Agrees to pay up in 2007 to settle thousands of cases
registered by patients who suffered heart attacks and strokes after taking Vioxx, used to ease arthritic pain. Drug was pulled out of market in 2004 Huge profit margins let pharma cos bribe docs
New Delhi: Pharma major Pfizer was recently fined $2.3 billion for promoting drugs for usages not approved by the US Food and Drug Administration (FDA) by inducing doctors to prescribe the drugs by wining and dining them and sending them on exotic trips.
Another big player, Eli Lilly, was fined $1.42 billion at the beginning of the year for illegally promoting a drug, Zyprexa, by funding continuing medical education of doctors through millions of dollars in grants to push them to prescribe the drugs for unapproved use.
Glaxosmithkline (GSK) has reserved $400 million to settle charges of promoting unapproved use of drugs and of kickbacks to doctors related to several products.
Yet another OPPI member, Bristol-Myers Squibb, had to pay $515 million in 2007 for giving illegal remuneration to physicians and other health care providers in the form of consulting fees, other programmes and travel to luxurious resorts to get them to promote BMS drugs.
Of the 53 pharma members of the OPPI, over 25% have figured in such cases in the US. This is despite the fact that the Pharmaceutical Research and Manufacturers of America (PhRMA), which includes many of these penalised companies, already has a voluntary code on interactions with health professionals which explicitly prohibits members from giving illegal inducements to doctors to get them to prescribe their products.
Many of these companies also claim to have their own stringent ethical guidelines applicable globally regarding interactions with health professionals. When stringent laws in the US, unlike India which has no laws to tackle illegal inducements to doctors, could not stop these companies from indulging in kickbacks to doctors, it is anyone’s guess how effective self-regulation can be.
However, answering a question in the Rajya Sabha on the steps taken to curb drug companies bribing doctors, the department of pharmaceuticals said it has asked pharmaceutical company associations to formulate guidelines and mechanisms for their strict enforcement.
The government appears satisfied to leave it at that despite being aware that the largest pharmaceutical associations, the OPPI and the Indian Drug Manufacturers Association (IDMA), already have codes which don’t seem to be enforced at all.
The huge profit margins on drugs allow companies to effectively bribe doctors. Small-scale manufacturers of drugs have maintained that the prices of drugs can easily be brought down by 50%. Can big pharma do that?
Bitter Tonic In Chocolate Spoons $600 million Abbott | In 2003, Abbott Laboratories pays up for its subsidiary trying to defraud the govt health insurance provider through false pricing of its products $515 million Bristol Myers Squibbs | In 2007, settles allegations from 1994-2005 of illegal promotion of Abilify (approved to treat bipolar disorder and schizophrenia) for paediatric use $400 million GlaxoSmithKline | Settles charges of offlabel marketing and kickbacks related to several products sold from 1997 to 2004, including antidepressant Wellbutrin $355 million Astrazeneca | Fined in 2003 for illegal pricing and marketing of prostate cancer drug Zoladex, the company’s best selling drug, fetching $794m globally $97.5 million Bayer | Pays in 2008 to settle allegations that it bribed several diabetic suppliers between 1998 & 2002 to convert their patients to Bayer’s products from its competitors $6.8 million Baxter | Pays up in July, 2009, for inflating the average wholesale price of drugs paid for by government insurance $4.5 million Johnson & Johnson | Fined in August 2009 for false and misleading promotion of drug Risperdal, an antipsychotic and Duragesic, a painkiller. Company did not inform of addiction risk of Duragesic and that Risperdal (more than 25% of usage in kids and adolescents) increased risk of diabetes

Don't be fooled by the title of this blog and the article quoted from " The Times of India".On the face of it ,there appears to be a contradiction.Actually there is no contradiction.My story will explain every thing.

It all started about 20 years back. My parents,both of them doctors ,got married.Marriage brought them luck and their practice picked up.They got real busy.Naturally they became the darling of pharmaceutical companies and thus my story began.

One of the pharma company was also manufacturing and marketing condoms. The local representative thoughtfully provided samples of these to my father.Unfortunately for my parents as they were not planning a family just yet and the pharma company, the sample condom ruptured and i was conceived.The repentant representative dutifully arranged all the routine supplements required during the ante natal period.Nine months later i was born. My bonding with pharma companies began even before my birth.

Although unplanned, the first child, that is i, brought even more luck. My parents became busier. It was becoming difficult for my mother to look after me, feed me and spend time with me. As luck would have it i developed lactose intolerance and spared my mother the task of breast feeding. One of the leading companies took care of my needs with their lactose free milk supplements for the next 6 months. So long as i was fed, i did not bother about the hand holding the bottle. another company dutifully supplied the diapers.

As i grew up, i found that all those things a child needs while growing up , were always available to me.I distinctly remember that unlike other kids my parents never took me to market for buying these goodies,instead they were always there in my father's hospital. I can visualize the large plastic bath tub, the tortoise shaped potty, the walker ,tricycle and what not. Those colorful nursery rhyme books,color pencils ,school bags and various tiff ins made my bond with pharma cos ,stronger.A young smart fellow with a tie and a leather bag, brought joy and goodies.

I lived in style . My journey from childhood to adolescence has been very smooth and enjoyable thanks to the unstinting support of the pharmaceutical industry. The result of all this pampering was that i became a spoilt child. I was not a very bright student and no amount of free samples of memory enhancing drugs could make any difference. My parents thought otherwise and wished fervently that i become a Doctor like them and take care of all the investment they had made in the hospital.Well as things stood it was very unlikely that i could secure admission in a medical college on the basis of merit. Here again two companies have jointly undertaken the burden of my medical education in a private medical college. They have also promised to take care of postgraduate studies. I was on cloud nine. Only two things could put a spanner in the scheme . If my parents died ,the pharma cos will not touch me with a ten foot pole.the second thing was the rumour about the government bringing in a legislation to curb pharma cos bribing doctors.
As luck would have it both parents are in the pink of health and as for the other worry you have just read the article.

There is no confusion now. Is there?

what are my options

A miracle drug is any drug that will do what the label says it will do And any substance which produces a side effect is a drug.
HOMEOPATHY?
ACUPUNCTURE/ACUPRESSURE?
AYURVEDA?
HALF? OF MODERN MEDICINE.

Does It work because the giver believes in it.
Sometimes i wonder why certain patients come to consult a doctor.Should i tell them that they require no treatment or should i admit my ignorance about the possible cause of their problems and excuse myself. I think it is more to do with my ignorance. Why should i think that a person traveling 60-70 km, waiting 4-5 hours in waiting room and paying my fees,not be suffering from a medical problem.
After thirty years in practice it is quite unnerving.

placebo effect

few days back i quoted voltaire---The art of medicine consists in amusing the patient while nature cures the disease. ~Voltaire

in support here is a link-http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect

दोस्ती पर कटाक्ष दोस्ताना अंदाज़ में

हमें भी दोस्तों से काम आ पड़ा यानि
हमारे दोस्तों के बेवफा होने का वक्त आया। हरी चन्द अख्तर

दोस्ती जब किसी से की जाए
दुश्मनों की भी राय ली जाए । राह इन्दोरी

अपनों ने नज़र फेरी तो दिल ने तो दिया साथ
दुनिया में कोई दोस्त मेरे काम तो आया । शकील बदायुनी

वो मेरा दोस्त है सारे जहाँ को है मालूम
दगा करे वो किसी से तो शर्म आए मुझें । कतिल शिफाई

मेरी खुशी से मेरे दोस्तों को गम है "शमीम "
मुझे भी इसका बहुत गम है क्या किया जाए । शमीम जैपुरी

मैं मुद्दतो जिया हूँ किसी दोस्त के बगैर
अब तुम भी साथ छोड़ने को कह रहे हो , खैर । फिराक गोरखपुरी

हटाये थे जो राह से दोस्तों की
वो पत्थर मेरे घर आने लगे हैं । कुमार बाराबंकवी

shadab lahiri ki ek gazal

हुज़ूर आपका भी एहतराम करता चलूँ
इधर से गुजरा था सोचा सलाम करता चलूँ ।

निगाहे दिल की आखिरी यही तमन्ना है
तुम्हारी जुल्फों के साये में शाम करता चलूँ।

उन्हें ये जिद की मुझे देख कर किसीको न देख
मेरा ये शौक के सब को सलाम करता चलूँ ।

ये मेरे ख्वाबो की दुनिया नहीं साहिल लेकिन
अब आ गया हूँ तो दो दिन कयाम करता चलूँ।

तुम्हारे हुस्न से जागे तमाम हंगामें
मैं दो ही लफ्जों में किस्सा तमाम करता चलूँ।

मेरे कलाम की शादाब सादगी अच्छी
अवाम सुन के मजे ले मैं नाम करता चलूँ.

enemies of uterus

Today it happened again. There was this young lass in her early thirties, referred to me for fitness. Being a physician getting patients for pre- op assessment is routine work, but lately a few things had started disturbing me. Over the years I noticed that patients undergoing hysterectomies were getting younger and younger.
Let us see, what the indications for hysterectomy are. Here are a few standard ones.

1-Uterine Leiomyomas

2-Dysfunctional Uterine Bleeding

3-Genital Prolapse

4-Endometriosis and Adenomyosis

5-Chronic Pelvic Pain

6-Pelvic Inflammatory Disease

7-Endometrial Hyperplasia

8-Cervical Intraepithelial Neoplasia, Invasive Uterine Cancer, and Other Cancers

9-Obstetrical Indications

10-Hysterectomy and Oophorectomy for the Prevention of Cancer

If you analyze the list you will see that these indications are not totally age dependent but most of these indications are commonly seen in peri menopausal or menopausal ladies. For more details about hysterectomy you can visit this link http://en.wikipedia.org/wiki/Hysterectomy

I am not very sure about the figures here at my place because we Indians are notoriously poor in record keeping. Even if we manage to keep some records they would either be illegible or inadequate. I did some mental arithmetic based on my being part of the local medical community and came up with these figures. One third of the major surgeries done here is hysterectomies and thus evolved the term Enemies of uterus. (The Term युटेरस के दुश्मन ( यूकेडी) sounds more appealing to me.)
What is happening here? Why are gynaecologists and surgeons bent upon removing as many uteri as possible? Looking around, discussing with colleagues and friends I came up with some surprising and funny conclusions. I found out new and novel indications for hysterectomy and would like to share them.

In my profession there is a phenomenon called fashion. Sometimes a drug is in fashion; sometimes an investigation or a particular therapy is in fashion. I am practicing in a small district place hence the fashions are also mundane. A few years back getting an x-ray done was mandatory, today ultrasound enjoys that status. Intensive coronary care units have yielded their pride of place to intensive care units. At present hysterectomy is in fashion at my place. It can be in various forms, TAH or total abdominal hysterectomy, vaginal hysterectomy, laproscopic or laproscopically assisted vaginal hysterectomy and you can get it done on demand.

I have already narrated the medical indications for hysterectomy, but looking for answers for this spurt in numbers I found that there are more urgent and compelling indications for this procedure than the medical indications.
The commonest indication is competition .If gynaecologist "X" has done 15 surgeries then gynaecologist "Y" must do more. Surgeon "Z" does not want to lag behind so he also makes all the efforts to equal or surpass the figure. If some one points out the need for proper work up and evaluation then the argument is --some one else will do it, so why not I? This creates a vicious cycle .Every one is pedalling furiously.

When a big industry is started, ancillary units come up very fast to support and feed the industry. Similarly here many sub-indications crop up. It is necessary to get a hysterectomy done because the family doctor in the village gets a hefty commission for referral. So he plants the seeds in the mind of the patient and the family and usually is able to convince them of the necessity of nothing less than hysterectomy even for simple cervicitis.

When medical indications are not the guiding principals then age also ceases to matter. It hardly matters that a 22 year old under goes hysterectomy and increases her risk for cardiac events. Gets early menopause and osteoporosis. Partially loses or compromises with her sexual proclivity. She may develop a sense of loss of womanhood and may develop some psychiatric problems .In India a girl child is hated even by the mother /grandmother similarly a uterus is being rejected by its very own holder. This makes me think -------

It makes me think about a society where uterus is not inborn but an option. At the time of conception you have the choice of a girl child either with or without a uterus. The conception of course being in vitro. This is possible as in future we have the option of surrogate uterus, like today we have surrogate mothers. This surrogate uterus could either be in a lab or in animal kingdom. (So far veterinarians are not enemies of uterus).Think of the possibilities. The positive side being the girl in future will be able to maintain her figure throughout without having to worry about the disfigurement caused due to repeated child births.

So what do you think?

further on the good doctor theme

The art of medicine consists in amusing the patient while nature cures the disease. ~Voltaire

A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment. ~paul dudley white.

Physicians and politicians resemble one another in this respect, that some defend the constitution and others destroy it. ~Author Unknown

Here's good advice for practice: go into partnership with nature; she does more than half the work and asks none of the fee. ~Martin H. Fischer

The doctor is often more to be feared than the disease. ~French Proverb

The fact that your patient gets well does not prove that your diagnosis was correct. ~Samuel J. Meltzer

One doctor makes work for another. ~English Proverb

Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too. ~Anton Chekhov, Ivanov




Cancer is a word, not a sentence. ~John Diamond


A half doctor near is better than a whole one far away. ~German Proverb

Until a physician has killed one or two he is not a physician. ~Kashmiri Proverb

When fate arrives the physician becomes a fool. ~Arabic Proverb

and lastly

It is a mathematical fact that fifty percent of all doctors graduate in the bottom half of their class. ~Author Unknown

Good Doctor!

A good doctor is ---- one who heals his patient. Lot of people do this without having actually studied any medicine. Can these people be called doctors?.I leave this topic open for discussion.Do chip in with your views.

On a different front a good doctor is one,who knows his limitations and refers the patient to a appropriate authority.It thus follows that a better doctor is one who constantly strives to reduce his limitations. The wise doctor knows when to stop striving!