Cost Effective
Medical Treatment

All over the world, cost effective medicines are used but in Pakistan costly medicines are used depriving patients and country of their meager finances. it is illustrated of a case history of a patient. One of my patient –a well placed businessman from Islamabad went to New Delhi, India for a complex cardiac operation of his son at a top cardiac facility. The operation was performed successfully.
The businessman sought his own cardiac check up from a top cardiologist at New Delhi .While reviewing the prescription the cardiologist noted the patient was using a foreign brand of amlodopine which was costing Rs 26.0 per day dose. The cardiologist according to the patient is one of the richest doctor of India enquired from the patient –why he was using such an expensive brand of amlodopine while the local brand was available at the fraction of the cost of the foreign brand. Likewise he made same observation about other medicines contained in the prescription. He further remarked that it may not matter to the patient but the extra profit is taken away from the country by the multinational companies in the form of foreign exchange and the native country’s economy suffers. The patient observed that in Indian hospitals local brands and essential drugs were being used which were available everywhere unlike Pakistan and also at a very low price .It is worth noting that the local brand of amlopodine 10 mg costs Rs. One hundred and 30 paisa in Pakistan meaning that the foreign companies brand is ten times more expensive than local brand. He also noted that irrational drugs were not used in Indian hospitals.
Drugs like anti-hypertensives, anti diabetics ,lipid lowering and many others are evaluated easily in a short time even by the patient by measuring the outcomes of their actions like BP, glucose, lipid levels without involving any complex procedures. I may mention that a very well to do surgeon and philanthropist, chairman of multibillion charity foundation at Islamabad is using the cost effective amlodopine costing 1/10 of the multinational brand for last thirty years achieving same results as of the expensive multinational brand .In Pakistan so many drugs of multinationals for common diseases like anti hypertensives, anti-diabetics, lipid lowering ,anti platelet, anti depressant and many other including irrational ones not registered in scientifically advanced countries are used by the medical profession. They are awarded enormous prices by the Ministry of Health. These acts mostly based on massive corrupt practices, loot and plunder of the heavily indebted nation’s financial resources. Even the public hospitals getting finances from taxing the poor people are using expensive drugs depriving many people of even life saving drugs and the poor nation of its mega finances that too in the form of foreign exchange. One can note the thinking at New Delhi, a country which has over 300 billion dollars in reserve and the third largest economy in the world.
I may further mention that the national health service in the UK is using generic drugs.Unfortunately we ourselves are the enemies of our people and the country. It is high time that we change our attitude and help in saving precarious economy and the country. Without economic independence there can not be political independence.

Lt Gen [R] Dr. Mahmud Ahmad Akhtar
43 Race Course Road
Rawalpindi. Pakistan

Lack of original research
 work in Pakistan

It is after several years that I have been prompted to write to you on going through your concise but comprehensive regular “Of the Record” column on “Lack of original research work” published in October 15th 2013 issue of Pulse International.
It was probably in 1966 that Sir James Cameron the then President, Royal College of Physicians, Edinburghhonored us by participating in a conference organized by Pakistan Cardiac Society. He spoke on ramifications and intricacies of research in developing countries. He concluded that research in developing countries revolves round reproducing what has already been thoroughly studied and reported and after a few years when the west disowns and contradict their earlier conclusions,the developing countries start beating on the newly trumpted theme by more vehemently by challenging their own studies. Research is a whole time avocation needing motivation, dedication, understanding and wide knowledge of the subject and truthfulness and discipline which would give order and credibility to the conclusions.
It is futile to expect any credible outcome from borrowed data which is certainly not compatible with our genetic, environmental, social and nutritional background. Teachers of medical colleges and universities in Pakistan are too busy with their material pursuits that they callously ignore their commitment to their students and patients. There is little love for academic pursuits to imbibe detailed knowledge and clinical wisdom which are prerequisites for intuition in research which comes only to a prepared mind. Research is an expensive pursuit which needs dedication irrespective of the outcome. It needs an unbiased mind. If you wish research and progress, the institutes of excellence should recruit the carefully chosen staff well experience in research methodology and understanding. Such noted doctor-scientists should have open and unbiased mind. They should be provided what they need for their, laboratory, a team of dedicated assistants, paramedics and a well-stocked library. They should have access to International conferences on their chosen subject of interest sponsored by Government and Universities. I recall, as you will also agree, Mr. Editor how difficult it is to elicit written contributions for our Journals even from the speakers of the conferences. They shy away to commit into black and white what they uttered in clinical and scientific conferences.
It is futile to expect research in our setup with a plethora of ever-expanding spectrum of health science institutes staffed with super annuated teachers interested only in their salaries with the only objective to make money. Research demands sacrifice of time, energy and leisure and above all material gains which Pakistani medical profession can ill-afford. You are carrying out a sacred war to reshape and improve the thinking of our medical profession.
Finally I admire your noble mission of promoting medical journalism steadfastly and carrying on your dedicated commitment by your impartial, unbiased and constructive comments and columns to improve and brace up the fast degenerating and decaying art of clinical medicine which is fast becoming a slave to ever-expanding but highly expensive medical technology which our poor country can ill-afford. The physician patient rapport a cornerstone of human relief and satisfaction is fast evaporating as a useful and effective therapeutic modality.You are carrying out a sacred war to reshape and improve the thinking of our medical profession.
I pray to Allah that He listens to your earnest, sincere and noble calls full of compassion and human touch. Good luck! Do not lose heart. When the time of an idea is mature, even the world’s greatest army cannot stop it!

God be with you, Ameen!

Ali Muhammad
197-B, street 14, EME sector D.H.A
Multan Road Lahore - Pakistan.

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