Dr Nishit Gupta

Director ,Nishit Clinical Laboratory Paschim Vihar Pvt Ltd

[TheLiverDoc™ @theliverdoc]

STAY WITH ME.

A few years ago, a patient was referred to me because he was diagnosed with complicated cirrhosis. He had an infection which led to a condition called hepatic encephalopathy (brain failure due to high ammonia levels). The treatment largely involved ammonia reducing therapies. One drug was central to this - Rifaximin - a non-absorbable antibiotic that reduced ammonia in the body. I prescribed him Rifaximin for 6 weeks and advised him follow-up.

He came back to me, not after six weeks, but in 4 weeks, this time, in liver coma (worst stage of brain failure - due to very high ammonia). He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance and his wife borrowed the money from neighbors and friends to clear hospital dues.

Upon questioning, I found that he was not taking the Rifaximin drug I had prescribed. He was only on the other two drugs (one, a syrup called lactulose for improving ammonia clearance in gut). I was furious, because the patient spent a whole week unecessarily in the ICU and wasted so much money that he never had - just because he was "not compliant" to my orders. I decided it was time for me to school him a bit.

But I was wrong. He was compliant. He had purchased Rifaximin and was on it. For 15 days. Thereafter, he could not afford it. He was an autorickshaw driver who shuttled school children every morning and evening. He could hardly make ends meet. He had two children of his own. The Rifaximin brand I prescribed him was 42 rupees per tablet. He had to consume two a day - which would mean 2520 rupees a month. He just did not have that money - so he skipped it - to not compromise on other important matters - childrens education and food.

He was confused and scared about opting for a cheaper version of Rifaximin because one, he was unsure about the quality of Rifaximin that was not prescribed by me and two, he was "scared" that I would scold him for buying a cheaper Rifaximin and if that got him into trouble.

I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.

It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient.

This narrative, that generic drugs 'are never good' and that only big pharmaceutical marketed drugs are what works has been deeply ingrained into doctors and patients alike - I do not know by whom and since when. Looking back, these strong emotions were based on either opinions, testimonials or second- and third-hand information. Not evidence.

Like I said. Stay with me. This is life changing and will disrupt the drug market in India. Here are the results of The Citizens Generic vs. Brand Drugs Quality Project.
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[ananthvikas @ananthvikas]

@AaronGoodman33 Here's another algorithm that simplifies #flowcytometry approach to t cell lymphomas by @PrashantTembha1 . I've found this quite easy to replicate. Reference https://t.co/hL0JtjnXPR

[Dr Pragya Shukla @drpragya_shukla]

This is what I have been shouting hoarse against at all public platforms. Humble request to celebrities and media houses , please don’t make people believe that if they cannot go to MSKCC ( with all due respect to the institute) or other foreign cancer hospital, you cannot be treated and cured of cancer. The cancer care facilities in India are at par with international standards.

[Haematologica @Haematologica]

The crazy case of a #T-cell ALL that switched to acute myeloid leukemia shortly after #CART-cellTherapy targeting #CD7. #Myeloid switch could be a new escape mechanism of leukemia under the pressure of targeting CD7.
https://t.co/99fQeqnofR

[Dr Nishit Gupta @nishitlab]

@AaronGoodman33 Just great

[Dr Nishit Gupta @nishitlab]

@AnuragVerma_SP @DrKumarVishwas Yes he is right

[Dr Nishit Gupta @nishitlab]

#ima #dma #APP #DMA @DalmiyaDr

[Dr Nishit Gupta @nishitlab]

@DRJSSURI @Indian__doctor Yes, “I”F”. They are “The Pathologists”!!!

[Dr Nishit Gupta @nishitlab]

@darkandcrude @Prasshmehta Yes

[Prashant Mehta @Prasshmehta]

-For Lymph node biopsies reported as ‘reactive’ it is useful to run ‘flow cytometry’
- Nodal TFH lymphoma , AITL and some unusual situations can be picked up
- Anti TRBC-1 antibody can help determine T -cell clonality
- Tissue in RPMI medium/or use FNA to make cell suspension

[Dr Nishit Gupta @nishitlab]

@RailMinIndia @PIB_India Congratulations
You should definitely work on the street hawkers and road taxis and stall creating a huge jam just outside of all the railway stations specially New Delhi and old delhi railway station and giving panic and difficulty in boarding u boarding the trains

[Dr Nishit Gupta @nishitlab]

Everyone is invited for your suggestions and review ! Don’t miss it tomorrow 12:00 pm at your screens

[Dr Nishit Gupta @nishitlab]

Congratulations India 🇮🇳 we are now on Moon 🌝🔭 and feels so proud to celebrate my birthday today 🎂🎁.
Cheers! Cheers! Cheers!

[Dr Nishit Gupta @nishitlab]

Center for
Haematopathology Excellence

[Dr Nishit Gupta @nishitlab]

https://t.co/vVl3TuwIf4

[Children of Peace @ChildrenofPeace]

#Israel has carried out its first tests of an autonomous aircraft that can carry passengers & heavy cargo - an air taxi. The revolutionary aircraft which is part of the Israel National Drone Initiative is expected to serve as future public transportation (Pic Credit: Mark Nomdar)

[Dr Nishit Gupta @nishitlab]

Biosphere with self ecosystem #terrarium #biosphere #forests

[Dr Nishit Gupta @nishitlab]

Also known as jugaad with compulsion of working with limited resources https://t.co/VWchcqapOP

[Dr Nishit Gupta @nishitlab]

@dtptraffic @RailMinIndia @RailwaySeva @RailwayNorthern @NWRailways @DelhiGovDigital Thank you sir 🙏 for cooperation

[Dr. ROHIT JAIN @funkyaarjay]

@TOIBusiness @VikasReports @gurgaonpolice @BJP4Haryana @DGPHaryana @News18Haryana @INCHaryana @AAPHaryana @DC_Gurugram @CgstGurugram @GST_Council