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Book review: The Truth Pill by Thakur & Thikkavarapu

Posted on by Anand Philip
Table Of Contents
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An Important book written in ALL CAPS

Topics covered in this book:

  • How approval for new drugs, new fixed drug combinations and new generics are supposed to work and how they actually work
  • What are the quality standards and monitoring mechanisms in place for scientific medicine, as well as AYUSH.
  • Laws governing AYUSH, scientific medicine and the production of drugs in India.

What I liked about the book:

  • Thorough research into how things are supposed to work in the area of drug regulations in India and an even more detailed research and experience into the million ways in which it is failing to work. Seriously, these two know their drug regulation problems.
  • Thorough understanding of the main players, organizations, lobbies etc. involved in this messy situation
  • Stupendous amounts of cred as far as I am concerned due to being a whistleblower as well as a RTI crusader/activist and all the litigation they have tried.
  • Focus on transparency, access to information, rights to quality
  • Documentation of various types of issues and the corruption in different bodies
  • Clear-sighted tracking of the bureaucratic games and political shenanigans around drug laws in the country.

What I learned from the book

  • We have a lot of outdated laws regulating drugs and other allied health products. These are exploited and used by both the governance people and the drug companies to push a lot of outright shitty medicines to the public
  • There is a LOT of corruption, incompetence and lack of transparency in the organizations that are supposed to be watchdogs and regulators
  • Successive governments and bureaucracies have generally found ways to pass the buck, do ass-saving paper pushing and pandering to sentiments rather than make any substantial and scientific changes.
  • We have a lot of under-equipped and underfunded drug regulators and inspectors
  • The quality of drugs produced in India is for all practical purposes at the mercy of the individual pharma company that does the production and there’s very little if any, real oversight or really punishment for even serious lapses.
  • Every month somewhere in this country, at least one pharma company is shown to have produced sub standard drugs and even then the judiciary seems to think harsh punishments are not needed. I mean, people have died and the dudes who made those meds never saw jail time.

Problems with the book

The whole book is narrated by someone who is shouting at YOU AND ALL THE IDIOTS WHO RUN THIS COUNTRY AND ALL THE CORRUPT DRUG MANUFACTURERS, THE INCOMPETENT JUDICIARY, THE CLUELESS LAW MAKERS OF NEWLY-INDEPENDENT INDIA WHO DID NOT HAVE 21ST CENTURY VALUE SYSTEMS OR KNOWLEDGE AND DRUG RIGHTS ACTIVISTS WHO ARE ALL CORRUPT TOO.

My blood pressure was measurably higher when I was reading this book. Seriously. There’s like four people the authors have anything nice to say about from 1923 -2023 (and two of them are dead). Oh, and the USFDA. They LOVE the FDA and the way things are done in the United States. 

<sarcasm> I mean, I don’t blame them, they’ve been fighting the good fight all their lives when literally everyone else in India is asleep, incompetent and corrupt. </sarcasm>

I get it, though, one of the authors has been constantly targeted and harassed by various government agencies and big pharma. So I get where the tone is coming from, I know righteous indignation, I used to have a lot of it. Now I just have reflux and indigestion.

But the roid-rage-hulk-smash tone of the book made me want to put it down and stop reading about fifteen times. I stayed the course only because they did thorough research, and what is an activist without some righteous rage, really. 

The other issues are that the policy and legal recommendations made in the book without fail made me wince, flinch and facepalm. The authors forget just how poor this country is, and just how many people there are.  The authors also don’t know a damn thing about the practice of medicine in the real India. They are operating from an america-centric and america-learned model of how health should be dealt with.

The most important implied recommendation of this book seems to be BURN IT ALL DOWN. 

Throughout the book they mention the dozens of parliamentary and other committees that have looked into these problems, and how so few of these reports see the light of day and fewer still get anything changed. Because the suggestions are not useful, or due to the unwillingness of the governance system to make any real changes.

This book has the same problem.

For eg.

  • They repeatedly suggest stronger laws, after describing just how poorly existing laws are implemented.
  • They suggest that online pharmacies will solve the supply chain problem (omg i cannot even)
  • They suggest that small pharmacists who are found to have bad drugs should be punished heavily.
  • They repeatedly recommend increasing the legal pressure on smaller players in the supply chain.

You cant improve state capacity by making tougher laws.

You can’t fix corruption in high places by punishing the small guy.

Some medication is most definitely in many many cases better than no medication, talk to a doctor, any doctor.

You cannot copy-paste quality standards designed in USA and Europe to solve for India.

That’s not how anything works. 

Would I prefer my patients got 40mg of  Telmisartan every time they buy a drug, YES.

Do we need to improve the capacity of drug inspectors and dis-entangle the regulatory nightmare, HELL YES.

But do we do it by shutting down everyone who only has 20 mg of telmisartan in their 40mg tablets, heavens no. The 20 mg the patient gets at 0.05 Paise a tablet is worlds better than the 0 mg he will get at 2 rupees a tablet.

In the words of the y00ths I interact with, the authors desperately need to touch grass.

The Devotion of Suspect X By Keigo Higashino – Book Review

Posted on by Anand Philip

The Devotion of Suspect X

I asked to review The Devotion of Suspect X by Keigo Higashino in spite of not being a fan of modern murder-mysteries. Here is why “…..won the 134th Naoki Prize , the 6th Honkaku Mystery Grand Prize, 2006 Honkaku Mystery Best 10 and Kono Mystery ga Sugoi! 2006, annual mystery fiction guide books published in Japan, ranked the novel as the number one”(Wikipedia). I’ve read only serious books for a while now and thought an international whodunit would make a good change.

This novel is part of a detective series in which an assistant professor of physics, Manabu Yukawa, nicknamed “Detective Galileo,” helps his college friend, Detective Kusanagi of the Tokyo Police, in his investigations. Manabu is portrayed as a hard-core scientist, a genius whose ability to logically solve problems is unmatched. Yes, a gainfully employed Japanese Sherlock Holmes without the flair and cocaine. The story is a cage fight between a physicist and a mathematician, and what happens when unforseen variables are introduced into an otherwise perfect equation.

In this story, he stumbles across his college friend Shinji Togashi, who is somehow involved in the latest case.

It is a short, absorbing read, even though not as “thrilling” as a western murder mystery would be, nor as laid back as Poirot was. Yukawa is a brooding-brilliant man and Detective Kusanagi is a sharp typical copper.

The story begins when, Yasuko Hanaoka an ex-hostess accidentally kills her abusive ex husband who had been stalking her and threatening her daughter. Togashi, who is her neighbor and has a crush on her hears the ruckus and comes over and helps them clean up the mess. He tells them that he would “take care of everything” and they just had to do as he said. Togashi who we later discover to be a mathematical genius spins a “perfect formula” to ensure that the police cannot catch Hanaoka for the crime.

The police and Professor Yukawa come into the picture when an unknown man’s body washes up on a nearby river’s bank and some snooping by the police reveals its connection to Yasuko and later, Togashi. The author has done a fantastic job at leading us on, unraveling a mystery we think we already know an end to.

The clue-deduction chain is almost perfect, yet mysterious enough to leave us guessing till the end, when Yukawa makes a crucial decision about his friend’s guilt based on a passing remark by Togashi. That was a leap of faith and far too crucial for the story to be taken lightly, and it almost spoils the ending, but a twist upon a twist that the author delivers, even if predictably melodramatic, saves the ending.

In all, it is a well written story, good detection, a few plot-holes but saved by drama. Not extraordinary, but above average.

Note: I received this book from Blogadda for review.

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Too crowded. A book review

Posted on by Anand Philip

Title: A Calendar Too crowded

Author: Sagarika Chakraborty

A calendar too crowded by sagarika charobarty book review

I’ve been putting off writing this review,  because  I don’t like what I want to say about the book. I don’t like being harsh and the book should be read widely, but I am harsh in my review and now, getting ahead of myself.

Sagarika Chakraborty is a lawyer and student at ISB. Her début book is “a collection of stories and poems woven around the theme of womanhood”. Throughout the year there are a few dozen days set apart for women and issues surrounding gender. As is usual, we hear a lot about these issues on the special days and then go back to routine stories for the rest of the year. She outlines her purpose in the introduction:

The attempt is to delve deeper and analyse whether it is merely enough to rely on statistics and be complacent in the knowledge that the numbers indicate a better society in the making, or whether there is an urgent need to look beneath the covers and realize that despite all such dedicated days, there are 300 days when there is nothing special that life has to offer.

The first story is narrated by a girl who has been blamed for everything that went wrong in the lives of people around her, right from when she was in her mother’s womb. At the end of the story, there is just no way not to feel immensely sad about how women are blamed all around us for anything that goes wrong around them.

I kept reading on and half way through the 3rd story it stuck me; I’ve read these stories before. Every single one of them. In fact, most of what I’ve heard about women in India are these stories.

The aim is to bring forth the bruises hidden beneath each lavishly draped body that needs to be highlighted even on days that are not dedicated to campaigns against domestic violence.

I’ve seen symptoms of these problems in my clinic, and the books and blogs I read constantly highlight them. I kept reading on, hoping for a “look beneath the covers” but all I could see was the nudity that I am already all too familiar with.

This made me sad. Not the sadness of facing the harsh truth about womanhood, but the fact that Sagarika falls short on her promise to talk about hidden realities.  News and media outlets constantly highlight stories of dowry deaths, female infanticide and rape.  While Sagarika’s stories don’t read as news does, they do sound overtly familiar, and sometimes follow stereotypical paths. There is the wife who is blamed for everything, the girl pushed into prostitution, the successful woman who is a prey to her own success and even a retiree who finally finds love in an old age home.  Let me be very clear here, these stories are not caricatures. Every one of these characters can be found in our neighborhood or families.

In spite of their familiarity, in many of these stories there are hidden, beautiful nuances of culture and social norms that are often ignored but are significant contributors to the oppression of women. Hidden, I say,  because while the author has great insight into the human condition, the nuances can barely be heard over the righteous indignation that her characters throw at me.

By the end of the book, I felt preached at and even a little manipulated.

There is a reason we refer to extreme imagery associated with development work as “poverty porn”. In their quest to draw the attention of the world to the horrors poor people suffer, they end up robbing the poor of dignity. As far as fund-raising goes, photographs of hungry naked kids do work, but at what cost?

I don’t want to label the whole book as womanhood-porn, not all her protagonists are helpless and undignified, but many are and most seem helpless victims of circumstances, societal injustice and of the supreme bad luck of being born as women.

The reason I am being so harsh is that a quick look around confirmed my great fear: that the those most receptive to what these stories stand for dont really need these stories. They know this already. And those who don’t,are going to be overwhelmed by the loud voices of Sagarika’s characters, and will miss hearing the soft voices and subtle realities that she tries to make accessible.

I hope her next book, for I sure do hope there are others, finds the right audience and the right voice . It would be a shame to see someone with Sagarika’s depth of insight and skill to get caught in the trap of  self-congratulatory writing aimed at the “un-emancipated” and read by the “emancipated” that  is unfortunately too plentiful in my world.

This review is a part of the Book Reviews Program at BlogAdda.com. Participate now to get free books!

Book Review- Transforming Capitalism by Arun Maira

Posted on by Anand Philip

Transforming Capitalism by Arun maira, review by Dr. Anand Philip[dropcap style=”3″]T[/dropcap]he last decade has seen a rise in philanthropic businesses and big businesses investing in the society. The worldwide depression brought on by the wall street, stricter laws about environment, and the rise of laws about corporate social responsibility have contributed to this. There is also a growing awareness among businesses large and small that screwing over people and the environment is bad business in the long run.
Arun Maira, in his book Transforming capitalism, improving the world for everyone, makes the case that

  1. Capitalism, if practiced laissez-fair, is harmful for everyone involved.
  2. Businesses can and should do the right thing from a moral point of view when dealing with people and
  3. People/businesses with a lot of money should see themselves as custodians or stewards of their money and resources and so should help people with it.

Arun Maira is a journalist, for a large part of his life he was a business manager. Over the past decade, he has written in most of India’s top business magazines, as well as in the magazine Civil society about the various ways in which businesses can, do and should help people beyond the narrow confines of material profit. This book is a collection of these articles. This is probably why, though the book is divided into four sections, a clear progression or continuity cannot be felt in the writings.
This is not a progressive apologetic, this is not a case for marrying socialism with capitalism either, this is a cross section, through the writings of someone who has been in the field long enough to know what he is talking about.

What I like about this book the most is that instead of preaching or a prescriptive style of writing Maira exhorts. he points to what is happening, suggests gently and with authority that instead of formulas both sides have, what is needed, foremost is dialogue open, honest and constant dialogue. this behavior is quiet uncommon in columnists these days who are eager to preach, eager to repeat over and over how their ideas are the best and why the world will go to the dogs if they don’t follow their brilliance.

It would be foolish to think that leaders of environment killing or people-hurting businesses don’t realize that what they are doing hurts people, but a fundamental belief, a one in the free market ( and some healthy greed) keeps them and everyone down the chain chained to their course. They believe that the free market, which enables everyone to take part equally in wealth creation and ultimately in the pursuit of ones happiness without the state directing what one ought and ought not to do is the best way to eradicate poverty. And lets face it,free market creates wealth. Anyone who has lived through pre and post liberalization India can attest to this.

But what apologists of capitalism often forget to preach is that when it comes to creating wealth for the ultra poor, the trickle down effect is often like eating leftovers from a rich mans table. with our new humanist understanding of human rights, I don’t think it is acceptable anymore to knowingly let people suffer based on one’s belief in the market. The non-profit groups or the civil society who typically are the champions of the poor operate under a completely different set of beliefs. To many of them the idea of making profit for the sake of profit is abhorrent. And practically all of them believe that human beings cannot be trusted to do the right thing in an unregulated system. Their idea of regulation of course is not peer regulation but strict almost socialist regulation. What Mr. Maira does very well is explain why both sides of this divide need to have a sustained conversation that helps us achieve the goals of alleviating poverty,social justice etc.

To me this is probably not a book written for the CEOs of Fortune 500 companies. This is also not a book for someone who has been following the social business/enterprise sector for the last few years. This is the book for the MBA student or the new manager, for the young Indian who wants to enter the markets but still stay good.

A recent survey showed that the worlds highest number of social businesses or socially minded businesses of the last few years have started in India. This is a clear sign that a lot of young people in this country are interested in doing good and Mr. Maria’s book can serve as a good starting point showing that it can be done.

The only worrying thing is Mr. Maira’s adoption of Gandhian ideas about wealth and businesses.

This review is a part of the Book Reviews Program at BlogAdda.com. Participate now to get free books!

Innovation, Artemis Fowl & Dawkins; What I have been reading

Posted on by Anand Philip

The Other side of innovation by V GovindarajanOne of the things that have been holding my attention for quiet a while now is innovation in healthcare, and what a pleasant surprise to discover Prof. Vijay Govindarajan on HBR, where he talks about his idea of reverse innovation. Prof. Govindarajan was kind enough to send me a copy of his book for review and I must say I was blown by it. I have read quiet extensively on innovation, but almost none of the authors I have read so far give a structured, rational, and scientific approach to implementing of innovation. In his book The Other Side of Innovation: Solving the Execution Challenge he has given us a great field guide on how to go about ensuring that the innovative idea doesn’t die on the drawing board. I will be posting a detailed review later, but to get an idea of what the book is like you can read his latest post on HBR  10 Tips for Creating Distinct-but-Linked Innovation Groups.

Related to, but not inspired by his idea of reverse innovation is this initiative by Open Source House, a team that conducted a competition for an open source house based on eight design principles. Interestingly prof. VG and Christian sarkar recently wrote about a 300 dollar home. His design wont win any competitions in its present form, but its a stimulant and so are the comments.The Art Of innovation by Tom Kelley

Not a co incidence, but I also managed to lay my hands on the classic The Art of Innovation by tom kelley of IDEO. as reputed, its an amazing read and reads like a lovely travelogue of a creative journey fueled by innovation.

I dont think I have said this before, but I LOVE Artemis fowl, who cares that its supposed to be teenage fiction. And so I was as delighted to come across the latest book The Atlantis Complex. it is written in the usual pan-novel humor style that Eoin Colfer is loved for.  The story is that

Artemis is suffering from Atlantis Complex, a psychosis common among guilt-ridden fairies – not humans – and most likely triggered by Artemis’s dabbling with fairy magic. Symptoms include obsessive-compulsive behavior, paranoia, multiple personality disorder and, in extreme cases, embarrassing professions of love to a certain feisty LEPrecon fairy.The atlantis complex by eoin colfer, an artemis fowl mystery

Unfortunately, (obviously) Atlantis Complex has struck at the worst possible time, a badass fairy is going to destroy the REAL Atlantis (don’t you love the coincidences and puns?).

While i loved the book, it is worrying that over the years Artemis is gradually becoming less and less devious, and I hope Mr. Colfer doesn’t forget that we love Artemis because of his dark side.The lone genius crusader with a borderline psychotic personality and the right tinge of pink is what made this teen criminal mastermind special. So Mr.Colfer don’t forget the criminal part of “criminal mastermind”, we cant have Fowl turn chicken can we?

Dawkins delusion a book by alister mcgrathI am yet to read Dawkin’s God Delusion, so I will not say too much about this one, but reading “The Dawkins Delusion?: Atheist Fundamentalism and the Denial of the Divine” by Alister McGrath was an enlightening experience. while the book was more of a brief review of Dawkin’s book, it made me realize that I want to read both Dawkin’s book and McGrath’s full length and better book on the topic.

Decoding Intolerance - hindu muslim riots in india a history and evaluationFinally, now I am reading Decoding Intolerance: Riots And The Emergence of Terrorism In India by PK Lahiri. I have only started reading the book, which documents the history, mechanism and possible solutions to the bloody wars that are called religious riots, but it seems like a good read.

Medical prosthetic arm from london of the 1800s

To finish of with, here is some steampunk-esq medical prosthesis goodness for you from the late 1800s. Medical Prostheis from 19th century London