“Plight of a Medical Editor”- an autobiography

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“Plight of a Medical Editor”- an autobiography
Feedback and Response from Prof. A. J. Khan *

My dear Shaukat

“I am delighted to see your autobiography that you had kindly gifted a copy to me which I received on my return from abroad. I had been abroad in connection with my medical treatment. I am much impressed with the book because I started reading it at about 10 PM and found it so interesting that I went on with it till 6 AM, when I had read more or less all of it. I congratulate you for having spared time and written such an outstanding factual autobiography. I have seen and read many autobiographies rather, this is my favorite subject, but I had not seen any such factual autobiography, where the writer writes factually all about everything good or bad including about himself rather than praising himself and describing mainly his personal achievements as is done in most autobiographies.
I met you first in 1968. After that I have been in contact with you off and on directly and indirectly at various medical conferences and through your medical articles in the fortnightly ”DOCTOR” International and now “PULSE International” which have always been informative and honest journalism and particularly your activities in popularizing Aspirin therapy for prevention of heart diseases. Developing your own Pakistan Journal of Medical Sciences and helping and guiding others how to bring out standard biomedical journals, which in my opinion is your great achievement.
I always had great regards and respect for your achievement and I thought that I knew you well, but after going through the book I find that how wrong I was, I did not know you so well as I thought. Similarly I think that you also did not know much about me, though you gave me almost maximum numbers of pages in your book, which I much appreciate.
I have been associated with publications and printing from very early age even before becoming a doctor. The first book that I published was in Urdu about PAKISTAN of about 500 pages in typeset and published by MaktabaJadeed, Lahore in 1951. I was a First Professional Medical student in K.E. Medical College, Lahore and was only 19 years of age. On the book you will note my full name Abdul Jamil Khan and also my photo of that time inside the book on the back of the photo of Quaid-e-Azam.I am forwarding a photo-copy of the original book. This book was printed through type setting. In those days there were no such facilities as of computer of today. Each alphabet had to be assembled together to make a words and sentences and paragraphs.
Later one has to see that the alphabets are correctly placed to make the correct words and sentences. I used to spend considerable time on correction of printing error in composition. I continued even during my professional university examinations. Luckily I always did well in the examinations. So seeing this book will give you some information about my knowledge, experience and interest in printing and publications.
You may find this book interesting, I selected this topic of the book, because Pakistan was a new country created by partition and not much information about the country and its province was available. I traveled all the way to Dacca, Karachi and Peshawar (Lahore where I was studying and Baluchistan from where I came, I did not find need to go to collect information) for collection of information which was an arduous work, which I did successfully and produced this book when I was still a First Professional Medical student.
Regarding JAMA, it is the most important and prestigious weekly medical journal with the largest circulation of any medical Journal in the world which is about 1.5 million copies per week published by AMA (American Medical Association) from Chicago. Subscription to JAMA was expensive and the delivery would take months. Therefore it was not possible for most doctors in Pakistan to subscribe to it. Therefore after taking necessary permission I started the Pakistan Edition of this Journal. From the four weekly issues I myself used to select articles suitable for Pakistan. Before final printing the proofs were always shown to me.A meeting of the Editorial Board to JAMA was held every year at the AMA office in Chicago, where being a member of the Advisory Board of JAMA I always participated by invitation and met people connected with editing, peer-view and publication of the Journals.
The publisher in Karachi was of course a local publisher an advertising company who bore the cost of printing and paper. The advertising company, who would no doubt also made some money through advertisement but provided the Journal free of cost or at nominal cost to all those members of the medical profession who showed interest in receiving the copies of this journal.Similarly I was closely associated with some other medical journals like the Pakistan paediatric Journal, Pakistan Medical Forum and Dow Spectrum. I am sending photocopies of some of these Journals for your examination. In those days the standard of printing was not as good as today and editing and publishing was not easy as it is now days.
I must also mention that our Ayub Medical College Journal, Abbottabad where I was the Principal, was the first medical college to have published a medical college journal in Pakistan 27 years ago. The journal of Aub Medical College, Abbottabad has remained an outstanding medical journal till this day. It was recognized by PMDC from that time. Other medical colleges including K.E & Nishtar and Khyber etc. did not have a medical journals of their colleges at that time.
Further if I may say that I have been the founder of two important govt. medical journals; one the GAZETTEER OF PMDC giving to its members details of activities of PMDC. The second one was PAKISTAN DRUG INFORMATION, which gave information about the drugs registration, good or bad effect and side effects, toxicity of certain drugs and the cost and prices of drugs etc.All this I write to say that I had and experience in printing and publications and I knew the difficulties faced by the publishers in bringing out magazines and journals and especially a biomedical journal.
I went into a little detail about some of my publications just to show my interest and experience in printing and publication throughout my life. This was the reason that I was appointed chairman of the Journal Committee of PMDC. Unfortunately when I met you during a meeting of the Journal Committee perhaps I was not able to contribute much because I was the Federal Minister of Population Welfare of the Govt. of Pakistan and I had also to be present in another meeting with a foreign delegation from the WHO and were waiting for me in my office inspite of that I still came to PMDC to attend this important PMDC meeting where as expected your contribution was substantial and I managed to get recognized the maximum number of good medical journals whose recognition was pending for quite some time.
I feel proud that as DG Health of Pakistan I managed not only to maintain the prices of drugs within the easy reach of common man, but in many cases reduced the price of many drugs, which included 50% reduction in prices of essential life saving drugs used in the treatment of Malaria, Tuberculosis and Dysentery. I also to dealt with the complaints about the prices and quality of drugs sold in Pakistan. Because of my knowledge about the Pharma Industry, having spent sometimes with BAYER, I was able to devise a clear and scientific system of fixation of prices based on the cost of raw materials used, cost of packing materials, cost of labor and profitability of the manufacturer. When I took over as DG Health there were more than 10,000 drugs formulations were registered. Some of these were discontinued in the country of their origin and some were found to be toxic or with bad side effects.
From these 10,000 drugs, the registration of 2000 such drugs was cancelled and the list of cancelled drugs was published as advertisement in the Daily Pakistan Times at the cost of the companies who were marketing those drugs in Pakistan. All these resulted in improvement of quality and reduction of prices rather than increase as had been done in the past and even today.
There were actions accepted by the industry and the prices of most drugs remained more or less stationary rather in many cases prices of drugs were reduced. Similarly no increase in prices of imported drugs were permitted to rise inspite of the fact that the prices rupee against the dollar kept on falling like always.This I have cited as you had mentioned about a meeting with the Pharmaceutical companies with whom I did not remain very popular.
Here I would like to mention an interesting incidence when I was the D.G. Health of Pakistan. One day in the afternoon I received a phone call from the Prime Minister (Mr. Mohammad Khan Janejo) that a certain foreign pharmaceutical company had complained that the government is not permitting increase in prices and the company had to import funds from the parent company in Switzerland to the extent of 60 million per year. Before I could say much, the Prime Minister told me that the company representatives will come to my office at 10 AM the next morning and desired that I should listen to them and deal appropriately to their satisfaction.
It was around 4 PM at that time and the officers were closing. Hurriedly I contacted Drug Control department to help me. We took out the file of that company to find how much raw material was imported and at what prices. At the same time I contacted a friend in Switzerland giving the names of the components and requested if he could find and send to me the cost of raw materials in the Swiss & international market. Luckily there was four hours time difference between Pakistan and Switzerland, my friend managed to obtain the prices of raw materials and sent these to me through a telegram (in those days there were no computers or e-mail) also mentioning the names of manufacturer especially of Switzerland.We,myself and the staff of the Drug Control Section kept on working till about 4 AM and by that time we had prepared a good report to be able to discuss the subject of pricing with the Swiss company representatives.
Exactly at 10 AM the President of the company from Switzerland, local Managing Director and the Marketing manager of the company arrived in my office. I let them talk and present their case to their satisfaction and then I took out the telegram and showed them that they had imported a particular raw material of a particular item with large sale in Pakistan, at the rate of 103 Swiss Franks per gram while it was available at only 7 Franks per gram in the market and that too in Switzerland.Then I told them the calculations that the raw materials worth 60 million rupees, they had imported for 180 millions. This caused a tremendous loss to the shareholders and also loss of foreign exchange to the Government of Pakistan and requested them that they should rather return the 120 million rupees to its share holders in Pakistan. They did say that other manufactures do not use or maintain the high standard of their products, to which I told them that these quotations were from Swiss companies who are known to maintain always high standard. I further mentioned that in this one case the price charged from Pakistan was almost 100% higher and their prices of other raw materials sent from Switzerland were also very high.
They did not expect that the Health Ministry had kept a record of imports of their raw materials consumed. Such details and what worried them most was the telegram, which had come from Switzerland giving the prices of same raw material at much lower prices in international market and in Switzerland.The president who was an elderly Swiss gentleman of about 75 years of age became pale and very quite. I became worried in case he might have had a heart attack. I changed his seat from the chair to the sofa lying behind and looked at his pulse, I found that it was okay, I arranged a good cup of tea for them. They did not have much to say about the low prices allowed to them; I gave the telegram to verify on their own.They went away more or less satisfied. I narrated the incidence to the Prime Minister, which he much appreciated and enjoyed and no complaint about low prices came from the company again.
This incidence I have mentioned in a little detail because I know that you also have a good knowledge of how Pharma companies are working in Pakistan.This reduction in prices of drug did not make me much popular with the Pharma Industry and that was perhaps the reason about the incidence that you had mentioned in your book of my meeting with Pharma Industry as Director General of Health, Govt. of Pakistan, where you had mentioned in your book that I did not like your participation.This is not correct at all as a matter of fact I had desired your participation in this meeting and invited you to this meeting as I had great faith in your frank writing and your knowledge about the Pharma industry. Further I have never been rude to anyone in the whole of my life and what to say of to you to whom I have always considered a good friend and respected you as a good friend.
I really admire your book and this is perhaps the reason that I had written to you such a long letter which I hope you will find time to read.
With all good wishes for your further successes and good health and happiness,”

Yours Sincerely,

Prof. Emeritus Dr. A. J. Khan
Principal,
Frontier Medical& Dental College,
Frontier Institute of Medical Sciences, Abbottabad.
October 12, 2015.

* Prof. A. J. Khan is a former Director General of Health who also served as a Minister of Population Welfare in the Federal Cabinet for some time.

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