CONTENTS
I am shifting the order of appearance of the contents to be more in line with a good meal. We start with some quick bites, go into the main course and then leave after second helpings.
➡️ Blending humanities with Medicine - synergy for compassionate healthcare
➡️ Navigating the paradox of loneliness in a hyper-connected, fast-paced society
➡️ LEAD ARTICLE: Fooled by Pharma
➡️ Second helpings - good reading from the web
Blending humanities with Medicine - synergy for compassionate healthcare
Matthieu I, The Conversation. January 2023
🆃🅻;🅳🆁 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖
Irène Mathieu's exploration of the interface of humanities and medicine reveals a unique synergy required for compassionate treatment. Medicine, which has historically been seen as a scientific discipline, develops depth and empathy when combined with the humanities. This combination promotes narrative competency, a skill emphasised by physician and academic Rita Charon that entails understanding and acting on patient tales. Such expertise not only improves empathy but also tackles health inequity, allowing doctors to better comprehend varied patient perspectives. A crucial component of this method is reflective writing, which assists medical professionals in critically engaging with their personal experiences as well as the larger sociopolitical circumstances impacting patient care. Mathieu's path exemplifies the transformational potential of integrating humanities into the healthcare industry, improving the clinician-patient interaction and developing a more humanistic approach to treatment.
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“The good physician treats the disease; the great physician treats the patient who has the disease.” – William Osler
“Narrative competence is the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” – Rita Charon
Navigating the paradox of loneliness in a hyper-connected, fast-paced society
Volpe A, Vox. January 2023
🆃🅻;🅳🆁 𝕄𝕪 𝕥𝕒𝕜𝕖-𝕒𝕨𝕒𝕪𝕤 𝕗𝕣𝕠𝕞 𝕥𝕙𝕚𝕤 𝕒𝕣𝕥𝕚𝕔𝕝𝕖
At no time in history have we had such an abundance of tools for communication. Loneliness transcends time and age; it's always been there. yet is often exacerbated in today's fast-paced, digitally-driven society. This thoughtful essay offers understanding and hope by examining the many social, emotional, and existential aspects of loneliness. Even though loneliness is a frequent and complicated feeling, it may also serve as a spark for greater community ties and personal development. The article provides helpful insights into how cultural factors, such as social media, affect our sense of identity and presents proactive methods that communities and people may use to build meaningful relationships and get over feelings of loneliness.
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“Loneliness and the feeling of being unwanted is the most terrible poverty.” - Mother Teresa
“The greatest thing in the world is to know how to belong to oneself.” - Michel de Montaigne
LEAD ARTICLE
"Fool me once, shame on you; fool me twice, shame on me."
We're there for you. Our tolerance for pain and discomfort decreases steadily as we become more affluent and prosperous. The Pharma business hops right in as a source of support. "A pill for every Ill?"; "Absolutely." says Big Pharma. It's no secret that the industry has the largest return on capital of all players in business, ranging from highs of 56% to 12% for the top 10 Big Pharma companies.
Not our problem. The pharma industry shrugs off its responsibility towards enduring proper usage of its products, placing it squarely on the medical profession. There is some truth in this; the medical profession shows no notable degree of discipline and restraint in prescribing practices.
A surfeit of choices. The Indian pharma industry is a wild frontierland. At a rough guess, there are over 20,000 registered companies with formulations in the lakhs. No other country has this dense overgrowth of drugs.
The 2022 National List of Essential Medicines put out by the Union Ministry of Health in India, based on the WHO recommendations, includes 384 agents in all. This list will cover all contingencies for health care in the country, ranging from common conditions to very rare and occasional ones. About a couple of dozen may be all that is needed for the bulk of day-to-day disorders seen in our country.
Scoffing the law. The laws regarding the manufacture, distribution, and sale of allopathic medicines are comprehensive and well-written. The problem lies in our near-total inability to enforce the law. Stand at the counter of any small or medium-sized pharmacy in your neighbourhood for a few minutes. You will be astounded by the amount of dispensing that occurs after patients describe symptoms to the pharmacist (often an uncertified person) with no prescriptions from a doctor. The drugs doled out range from vitamins and tonics to advanced-generation antibiotics.
In this post, let's look at three areas for potential harm from common practices in drug prescription.
1. Fixed drug combinations (FDC)
This is a commonly used strategy where a single preparation contains two or more compounds, each in a fixed dose. It is assumed that a reduction in pill burden will lead to better compliance with prescribed regimens.
This line of reasoning is valid for situations like the treatment of TB or HIV, where it is mandatory that each of the several drugs that form part of complete treatment be taken without any one or more being omitted. Dropping out any component of the regimen will result in a marked decrease in treatment efficacy and the promotion of resistance to the drugs.
The number of situations where this route of delivery is valid and proven is small and clearly listed by organisations like the WHO.
Stretching the truth. This seemingly sound argument gets distorted by the pharma business's desire to package and push a huge number of combinations, almost all of which lack scientific proof of efficacy.
The real reason. There is a little-known fact that lies behind the pharma business preference for FDCs. Individual components of an FDC can be sold only at prices that are fixed by the government. Most often, they leave the drug company with very slim margins. However, combinations of drugs can be registered as patented products and sold at much higher prices. A common example is a combination of paracetamol and ibuprofen. Both drugs, of proven efficacy, are very inexpensive. Combine them as an FDC, give it a catchy brand name, and the company can sell it for huge profits. There are any number of examples of this sleight-of-the-wrist trickery.
The downside.
When side effects and toxicity occur with FDCs, it's difficult, if not impossible, to pinpoint the specific compound that caused them. The same side effect can occur with several of the constituents.
Quite often, FDCs contain doses that are smaller than the prescribed amount—subtherapeutic doses. Combining agents seldom results in lower doses being as active as the full amount. Effectiveness is decreased.
Irrational combinations are legion. One of the most common is FDCs given for conditions where there is bleeding as a symptom: piles and uterine bleeding being common conditions. A mishmash of compounds, mostly in minuscule doses, with no scientific proof of efficacy, are packaged and sold with high-pressure marketing. Margins are huge. The medical profession merrily goes along with this strategy.
Many countries have banned the sale of FDCs except for the small, permitted list.
2. Similar-sounding agents.
Two drugs with entirely different actions and indications may have very similar-sounding names. Inadvertent ingestion can be dangerous. This is particularly true of brand names, which rarely give an indication of what the compound does.
Here are some examples. (Brand name with chemical name in parentheses)
Tibitol (Ethambutol) - Used in the treatment of TB | Tobitil (Tenoxicam ) - Used for pain relief in musculoskeletal disorders
Pronim (Nimesulide) - Used for pain relief in musculoskeletal disorders | Pronil (Fluoxetine) used for treating depression
Celib (Celecoxib) - Used for pain relief in musculoskeletal disorders | Celin (Vitamin C)
Dan (Diclofenac) - Used for pain relief in musculoskeletal disorders | Dax - (Cefadroxil) - A powerful antibiotic
Eltocin (Erythromycin) - An antibiotic | Eltroxin (Thyroxine) - Thyroid hormone preparation
Azoo (Azithromycin) - An antibiotic | Azox (Alprazolam) - For sedation and reducing anxiety
Acein (Enalapril) - For reducing blood pressure | Acem (Clarithromycin) - An antibiotic
This list is a tiny sample. It's nowhere near complete or exhaustive. Considering the thousands of brands that are strewn around Indian pharmacies and hospitals, the danger of mistakenly taking a similar-sounding but wrong drug is widespread.
Ban brand prescribing. One way around this dilemma would be regulations enforcing prescriptions by generic (chemical) name and banning brand name prescribing. The most vocal opponents of this recommendation are the doctors themselves. They make many specious arguments against this practice, most of which are self-centred and unscientific. In recent years, the government has been increasing pressure on doctors to switch to generic names. Many responsible and ethical institutions do so, but the practice is still rare.
3. Date-expired drugs.
Patients are always cautioned about checking the date of expiration of a prescribed medicine before taking it. It's much like grocery shopping, and the same fear of consuming unwholesome food is extended, by analogy, to medicines.
A powerhouse of information on drug expiration dates comes from a US military study. It showed that 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.
The expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use. It's true that the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. This is true of tablets and pills but may not apply to vaccines and other liquid preparations. Placing a medication in a cool place, such as a refrigerator, will help the drug remain potent for many years.
Is the expiration date a marketing ploy by drug manufacturers to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way, although most people would be unwilling to take a chance and side with the manufacturer.
Worldwide, the pharma business is a wealthy, powerful lobby that remains refractory to placing ethics before profit. Consumers should, however, be aware of tactics that are not in their best interest.
SECOND HELPINGS
Good reading from all over
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Life is hard. Art helps | Video
If money doesn't make you happy then you probably aren't spending it right
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