Amit Thadhani

General surgeon, social activist, trekker, author, occasional guitarist, part time farmer. Views are personal. Abusers will be blocked or replied to in kind.

[Amit Thadhani @amitsurg]

Linking this tweet series on loot of our temples by politicians and Secular governments, with the current one. https://t.co/UgL9YkfFMt

[Amit Thadhani @amitsurg]

Anyone who has studied this subject will not be surprised at all. Politicians, bureaucrats have captured our temples and are looting them. https://t.co/4LJUSj5JXI

[Sanjeev Sanyal @sanjeevsanyal]

And none of the founding fathers had a sense of direction ..... they were under the impression that they had reached India

[Sanat Dixit MD FACS @sdixitmd]

As a neurosurgeon, let me tell you how frightening this injury actually is - an occipital compound depressed skull fracture treated with a WIDE craniotomy (outer staple line).

What's scary isn't the fracture; it's what's adjacent to the damaged skull. The axe blows (that tree-branch scar at the center) hit right over the posterior superior sagittal sinus, a large vein that runs lengthwise between the 2 cerebral hemispheres and carries blood from the brain to the heart.

Penetrating injuries to the sinus can carry upwards of a 40% morbidity/mortality - partially because a transection of the sinus can be difficult to repair and can result in extreme blood loss, venous air embolism, or thrombosis - all of which can be fatal.

There's scary, and then there's the "you go to elevate the fracture and risk unroofing the sinus, losing 2 liters of blood in a minute" scary.

The surgeons likely had their hands full and did an amazing job. Divine providence called many heroes into service that day. Damn fine work.

धन्यवाद

[Malt News @maltnewss]

𝗔𝗳𝘁𝗲𝗿 𝗟𝗼𝘀𝗶𝗻𝗴 𝗘𝗹𝗲𝗰𝘁𝗶𝗼𝗻𝘀 𝗘𝘃𝗲𝗻 𝗩𝗶𝗮 𝗕𝗮𝗹𝗹𝗼𝘁 𝗣𝗮𝗽𝗲𝗿 𝗦𝘆𝘀𝘁𝗲𝗺, 𝗥𝗮𝗵𝘂𝗹 𝗚𝗮𝗻𝗱𝗵𝗶 𝗗𝗲𝗺𝗮𝗻𝗱𝘀 𝗡𝗲𝘅𝘁 𝗘𝗹𝗲𝗰𝘁𝗶𝗼𝗻𝘀 𝗕𝗲 𝗗𝗲𝗰𝗶𝗱𝗲𝗱 𝗯𝘆 𝗥𝗼𝗰𝗸-𝗣𝗮𝗽𝗲𝗿-𝗦𝗰𝗶𝘀𝘀𝗼𝗿𝘀.

[Piyush Goyal @PiyushGoyal]

Zero Check Karlo Bhai! 😂

#MLCElectionResults #BallotPaper

[Amit Thadhani @amitsurg]

@drvipulbothara @AnkurSingh @bijlanirajesh Sir salamat toh pagdi hazaar 🙂

[Hillel Neuer @HillelNeuer]

BREAKING: Switzerland suspends funding to Doctors Without Borders after it failed to report that its staff exploited refugee women and girls for sex—in exchange for aid, jobs and money. Previously, 🇨🇭 called MSF “a source of best practice and inspiration.” https://t.co/p8NopVkGuG

[Amit Thadhani @amitsurg]

And this.

[Amit Thadhani @amitsurg]

The problem restricting innovation and trials is not Indian Pharmas not wanting to put in money or the court freezing margins. It is the health ministry’s dysfunctional approval process for trials, and the peculiar market situation in India wrt pharma. 🧵

1. Ethics committee approval is mandatory for trials. But try forming an ethics committee if you’re a healthcare institution. It may take years to get permissions if you get it at all. Of course you can go to a committee that already exists. But the time taken, number of queries raised and conditions put are sufficient to deter the bravest of researchers even if it just a simple observational study with zero patient risk. Hospitals and pharma companies are still waiting for approvals of trials proposed over two years back.

2. The business model of Indian pharma is low cost production and high MRP to pass on maximum margins to sellers. To capture market space, Indian pharma companies keep printing higher and higher MRPs. No international pharma giant gives the kind of obscene margins Indian companies do, they focus on their brand image and pitch product quality instead.

3. For example: Before it’s MRP was restricted under DPCO, the same brand of a higher generation antibiotic (meropenem) made by a good Indian pharma company was sold with printed MRPs ranging from 600 to 3500 depending on what the buyer wanted, the supply price was the same: 300. The hospital pharmacy could then supply it to a rich delux class patient at 3500 and less affording general ward patient at 600. Something akin to bottled water being sold for MRP of 20 in stores and MRP of 60 to 100 at airports and cinema halls due to different captive audience at the point of sale.

4. The problem therefore is not Indian companies being restricted by price control hence not getting funds for research. They can very well readjust their pricing to make provision for research, this remains unrestricted. Their selling price to distributors matters to them, not the printed MRP decided by the buyer.

5. In fact, Indian pharma companies are putting in substantial efforts at research and have brought out some original research molecules that are doing well. It’s a late but good start. Even low cost drug giants like Mankind now have hundreds of scientists engaged in research. India also has not less than 128 startups doing dedicated research into new drugs. Over 1000 new drugs by Indian companies are currently in various stages of trials. So it is a myth that Indian companies are not doing research. The problem is not them. It’s the health ministry.

6. These trials will remain stuck if there is no one to give approvals in the first place. Look at the sad condition of the National Medical Commission. For over two years, all seats on NMC panels were lying vacant and the entire organisation was virtually defunct. Some but all vacancies have still not been filled after SC pulled them up for it. This is the body responsible for medical research and ethics in India and even today, most of the posts at the autonomous board for medical ethics and registration are lying vacant. UG and PG Medical education boards too are lying vacant. Is it not the responsibility of the health ministry to at least have the NMC functional at all times?

The solution to the pharma research conundrum is lying in plain sight. Processes that work need functional govt departments. MoHFW Naddaji really needs to get his act together and pull up his socks and his subordinates to get things going.

[Amit Thadhani @amitsurg]

1. There is really no justification for it. The huge margins offered by drug manufacturers are due to market distortion. Manufacturers view the purchasers and prescribers, ie hospital and doctor, as their clients, not the patient on whom the medicine is used.

2. Controlling the margins on these drugs won’t affect research as claimed by manufacturers, since they are still free to fix their sale price to distributors. Only the subsequent exorbitant margin gets capped. However, corporate hospitals will certainly take a big hit and by and large their overall profit margins are not good enough to fully absorb this impact.

3. Bed charges, even in highest category of rooms, are well below the infra and running cost per bed of the hospital. It is a fact that hospitals cover the cost of stay and treatment primarily from high margins on pharmacy.

4. If margins from pharmacy and consumables too are cut off, you may find that hospitals substantially increase other charges to offset this substantial loss of income. We have seen this happen in coronary angioplasty - when margins on stents was capped, the procedure charges were increased to keep package cost the same.

5. Unfortunately in India, as of now services are not valued as much as products. Most patients are willing to pay 1 lakh for an implant, stent or medicine a lot more readily than giving the treating doctor 50k for his expertise. Additionally in oncology, the fear of cancer is a big incentive for people to spend any amount for medicines in the hope of cure. It is a sad reality that manufacturers, hospitals and doctors do exploit this situation. It is not a grand conspiracy, each of them is in it for their own reasons.

6. Even though I’m not a fan of overarching govt controls, in some situations such as this, the govt does need to step in and correct market distortions. I reiterate that for antibiotics too, rampant misuse due to high margins is causing scarily high rates of antibiotic resistance. The margins on all antibiotics must be made so low that there should be no incentive at all for misuse.

7. My opinion is that it is better for medical professionals to charge directly for services rendered, than rely on such indirect and somewhat unsavoury sources of income. People too should also get used to paying their treating doctors well for good, clean and timely services and treatment.

[LawBeat @LawBeatInd]

🚨 SUPREME COURT | “Can you show any justification for this loot?”

A cancer patient’s husband, a medical distributor, told the Supreme Court that an injection available to him at a dealer price of ₹11,000 was allegedly priced at ₹1.30 lakh by a reputed hospital, which refused to administer the injection he offered.

“Why this difference? Where does the money go?” Justice Sandeep Mehta asks the Centre.

[Amit Thadhani @amitsurg]

The problem restricting innovation and trials is not Indian Pharmas not wanting to put in money or the court freezing margins. It is the health ministry’s dysfunctional approval process for trials, and the peculiar market situation in India wrt pharma. 🧵

1. Ethics committee approval is mandatory for trials. But try forming an ethics committee if you’re a healthcare institution. It may take years to get permissions if you get it at all. Of course you can go to a committee that already exists. But the time taken, number of queries raised and conditions put are sufficient to deter the bravest of researchers even if it just a simple observational study with zero patient risk. Hospitals and pharma companies are still waiting for approvals of trials proposed over two years back.

2. The business model of Indian pharma is low cost production and high MRP to pass on maximum margins to sellers. To capture market space, Indian pharma companies keep printing higher and higher MRPs. No international pharma giant gives the kind of obscene margins Indian companies do, they focus on their brand image and pitch product quality instead.

3. For example: Before it’s MRP was restricted under DPCO, the same brand of a higher generation antibiotic (meropenem) made by a good Indian pharma company was sold with printed MRPs ranging from 600 to 3500 depending on what the buyer wanted, the supply price was the same: 300. The hospital pharmacy could then supply it to a rich delux class patient at 3500 and less affording general ward patient at 600. Something akin to bottled water being sold for MRP of 20 in stores and MRP of 60 to 100 at airports and cinema halls due to different captive audience at the point of sale.

4. The problem therefore is not Indian companies being restricted by price control hence not getting funds for research. They can very well readjust their pricing to make provision for research, this remains unrestricted. Their selling price to distributors matters to them, not the printed MRP decided by the buyer.

5. In fact, Indian pharma companies are putting in substantial efforts at research and have brought out some original research molecules that are doing well. It’s a late but good start. Even low cost drug giants like Mankind now have hundreds of scientists engaged in research. India also has not less than 128 startups doing dedicated research into new drugs. Over 1000 new drugs by Indian companies are currently in various stages of trials. So it is a myth that Indian companies are not doing research. The problem is not them. It’s the health ministry.

6. These trials will remain stuck if there is no one to give approvals in the first place. Look at the sad condition of the National Medical Commission. For over two years, all seats on NMC panels were lying vacant and the entire organisation was virtually defunct. Some but all vacancies have still not been filled after SC pulled them up for it. This is the body responsible for medical research and ethics in India and even today, most of the posts at the autonomous board for medical ethics and registration are lying vacant. UG and PG Medical education boards too are lying vacant. Is it not the responsibility of the health ministry to at least have the NMC functional at all times?

The solution to the pharma research conundrum is lying in plain sight. Processes that work need functional govt departments. MoHFW Naddaji really needs to get his act together and pull up his socks and his subordinates to get things going.

[Rajeev Mantri @RMantri]

Government of India is arguing that innovation is important in biotech and drug development - and Supreme Court of India is pontificating against it, forcing government to include drugs in price control orders!

The Court inserts itself into policymaking randomly, and plays to the gallery.

Then we ask, why don’t Indian pharma players invest in R&D? Here is your answer.

Any random entity (this time it is the Supreme Court) can wake up, and tell you what to do! They can create havoc in an industry.

[Amit Thadhani @amitsurg]

@rkr8531 5-star hotels will always cost less than 5-star hospitals because they don’t need to have nurses, ward boys, resident doctors, specialists etc on payroll. Running cost of a corporate hospital is over 50k per bed day. Their profitability at those tariffs is quite moderate, 10-15%.

[News18 @CNNnews18]

#BreakingNews | Wildlife tragedy in Madhya Pradesh: A cheetah cub dies, with five pellets reportedly recovered from its body.

The discovery raises questions about the circumstances of the death and the safety of wildlife in the region.@Elizasherine @Srish__T with details

[Amit Thadhani @amitsurg]

@janatakadoctor Difficult. Time taken for a procedure doesn’t determine it’s complexity. A surgeon can take longer for an epidermal cyst removal than a cardiologist does for a coronary angioplasty.

[Chetan Mudrabettu @chetanmudrabett]

Truth bombs 👇
Most patients don't mind paying for pharmacy and labs/imaging but are hesitant to pay for nursing and medical services which they feel is a "noble job"
It's worse for physician branches("We have come just to show reports") compared to surgical ones.

[Dr Piyush Agrawal @docpiyush1995]

💯 take.

[Kuldeep Gadkari @DocGadkari]

This❤️❤️

[Nishith MD @drnishurs]

Yes ideal situation is patients paying 5-10x for a doc consultation / procedure. And minimise the conflicts of interests of docs by regulating other prices …

Hard to achieve because people in general is reluctant to give money to service + current distortions is too deep …

[Amit Thadhani @amitsurg]

@jindalyogesh28 That is nice to hear. What got me ticked off was that it is happening even at Punjab border right outside Mohali and CM still not doing anything to stop it but his hoardings calling himself brave are everywhere.

[Amit Thadhani @amitsurg]

Traveling from HP to Chandigarh, greeted by endless miles of burning parali right from HP-Punjab border to the outskirts of Chandigarh.
All the best, Delhi. “brave Punjab CM” is out to screw you again.

[Abhinav Agarwal @AbhinavAgarwal]

Look what arrived today!
Looking forward to reading in print of @ArunKrishnan_ 's retelling of key moments of the Mahabharat from the perspective of the key players, Mahakshana!

[Rahul Shivshankar @RShivshankar]

Cabinet Expansion or Cabinet of Exceptions?
FROM TODAY, J&K CM OMAR ABDULLAH CABINET WILL HAVE NO REPRESENTATION FROM JAMMU.
Four new ministers have been inducted, all from the Kashmir Valley. Meanwhile, Jammu-based minister Satish Sharma has been dropped.
Voters of Jammu being punished for overwhelmingly voting for BJP?
Doesn't the latest expansion deepen the regional imbalance?

[IANS @ians_india]

Delhi: Sanjeev Mehra, President of the Khan Market Traders Association, reacting to the INDIA bloc’s proposed rally at Ramlila Maidan on November 1, says, “Our letters are having no impact on the Congress party or Rahul Gandhi, and I do not understand what their objective is. We had appealed to them not to hold protests during the festive season, as this causes significant losses to traders. It seems they are determined to keep the economy, which they once called ‘dead’, in that condition. If we cannot earn during the peak business season, our workers and their families will suffer. Then they will achieve their objective of claiming that unemployment has increased. My question is directed at every political party: are we traders the only ones who must keep suffering? We are always the ones bearing the brunt. Our appeal has been rejected. Yesterday, they posted on Twitter that we should approach the Prime Minister. If the Prime Minister is not listening to you despite all your efforts, why would he listen to traders? This is becoming a pattern. After demanding the resignation of the Chief Election Commissioner, they have now turned their attention to Gyanesh Kumar. Next, they will demand Amit Shah’s resignation, and after that, the Prime Minister’s.”