LyrArc Article Gist
Laura Marshall-Andrews is a GP, a General Practitioner doctor, in Brighton, England, with a different approach to patients and health care. She takes into account the whole patient, the patient's mental condition, putting back some of the things that reduce isolation, increasing feelings of self-worth, bringing more community and nature interactions of a positive nature that can affect the patient's health. In some situations having a doctor who listens and is willing to take the time to talk to and know the patient, and being aware of the patient's whole condition as opposed to fragmented areas based on fields of medicine can make a huge difference. Don't look for a diagnosis, treat the whole person,  says Laura Marshall Andrews in her new book- What Seems To Be The Problem? She believes social prescribing takes a whole load off the National Health Service in Britain. This includes art, photography classes, dance classes, singing classes. A study by the University of Westminster shows the GP visits go down by 30% and emergency A&E visits by 25% with social activity prescribing. Yoga, meditation, gardening, nature walks, are also part of the same activities that can help people improve how they feel and think and bring the sense of peace in their lives that brings better health with it. In the loneliness and isolation, community dislocations and pressures of life in today's cities, all these activities are immensely important to the idea of whole health of the whole person. Dr Andrews says that if you keep a community happy and creative, then you are not going to need a lot of expensive hospital treatments." "Cum Scientia Caritas" the motto of the Royal College of General Practitioners means Science with Caring. ...

LyrArc Article Gist
During the first days of vaccination drive in India the uptake is lower than expected, below 48% in many states of India. Healthcare workers are coming forward in smaller numbers. The glitches in the app that was used to transmit information is one reason, the other being that not enough information was disclosed about the two vaccines.  On the first day Jan. 16 India vaccinated 200,000 healthcare workers. The target was 300,000. The uptake is lowest in states such as Tamilnadu and Punjab.  One of the reasons for the low uptake is also that India has a lower number of cases, and cases are in decline in India for coronavirus. The first wave peaked on September 13 at over 90,000 and has declined ever since to 13,000 on January 19, 2021. The Indian diet includes vegetables and a large part of the country is vegetarian. Indian diet also includes herbs such as turmeric, ginger and cinnamon, and many others that help build immunity. The lack of cars for large numbers of the population means a lot more exercize walking long distances is essential in daily living. Another factor is that the mandate for masks is strictly followed everywhere. Also helpful is that after independence in 1947 the pharmaceutical industry was built up to serve the large population with prices regulated carefully by the government, enabling steady supply of medicine during the pandemic. ...

LyrArc Article Gist
The India- U.S. trade deal after the negotiations and the visit of the Indian prime minister to the U.S. is expected to take additional time. The U.S. wanted to see a 20% duty on mobile phones and ethernet switches to be reduced, greater access to the Indian market for medical devices such as stents and knee implants, and greater access for dairy, agricultural products. Making these products affordable in India is a goal of the government preventing it from making concessions. India wants preferential access to the U.S. market as a developing country restored under the Generalized System of Preferences.  A comprehensive trade deal would have to include issues of intellectual property, e-commerce, and the sensitive issue of H1B visas. Commerce minister Piyush Goyal led negotiations for India and Foreign Secretary Vijay Gokhale said the two sides "narrowed" down their differences. India's Jio from Reliance Group has hugely reduced the price of mobile phones and mobile data making it accessible with 4G across the country at prices that are the lowest in the world. The introduction of a universal health care program requires bringing down the price of medical products to improve access to modern medicine. This means less room for American products that would increase the price and reduce access in a vast developing country. India is also playing catchup in these technologies so that there is less room for unrestricted entry in the Indian market.  Efforts were made to increase trade and investment in India with the help of Mr. Bloomberg during the visit of the prime minister, and the Bill Gates Foundation continued its commitment to public welfare gains in India in the fields of sanitation, hygiene and healthcare.  ...

LyrArc Article Gist
So we need lobbyists and food producers and cola producers out of the schools. Here is an alarming fact- the current standards that govern whats served at all public and many private schools haven't been upsdated in 14 years. And the current standards don't even mention calories should be limited to 650-850 calories for lunch and 500-600 for breakfast. With the Institute of Medicine recommendations for more fruits and vegetables and healthy whole grain foods for school lunches comes cost its estimated that schools get $2.68 for the free lunches served to poor students, which cost $2.92 plus overhead and labor costs. The Obama administration is expected to add $1 billion but more is needed. Here s another place where money is needed at home that can be saved from expanding the war in South Asia-

LyrArc Article Gist
Prime minister Modi's address in Hindi to the nation on May 12 on "Atman Nirbhar Bharat" (self reliant India) as India looks ahead to a situation beyond the coronavirus. What would the economy look like as India moves forward? He says the emphasis will be on planning for the need for land, labor, liquidity, and laws to develop the Indian economy. A bold package of economic action for an investment of 20 lakh crore rupees or $280 billion was announced with details to be provided later. The basic philosophy of the next move forward was what the prime minister concentrated his speech on. Modi says there are 5 pillars for the Atman Nirbhar Bharat, or Self Reliant India. The first action not to go for incremental change- go instead for a quantum leap, be bold. This applies to both technology and investment and creating an environment where results can be achieved. Second action to make the kind of infrastructure that would set a new standard in the world. Third a "sabhi ke sapno ke aadhar," taking everyone along, be technology driven. Third action celebrate and build on India's vibrant demography, once seen as a weakness this will be turned into a strength. Fifth action be Demand driven - "demand or supply chain puri samtha ke saman karne ki jaruat che." The demand and supply chain  should be taken good care of. That also means be local and local manufacturing. Be vocal for local is the new message said Modi, because this is what worked and is saving us in the pandemic. As external supply chains failed countries in Europe and North America, it is the local supply chain for medicine, health care equipment, and food supplies, local technology for citizen id and bank accounts for direct deposit, agricultural supplies, strong and large national postal and rail networks and millions of employees spanning the country in all directions, that have proved of amazing value in this crisis. "Is local ne bhi bachaya, ham sabki jinnadari hai," - the local saved us and is everyone's responsibility.   ...

LyrArc Article Gist
PM Modi talks about the changes since 2014 and the difference in India now compared to before 2014, during his visit to Shimla, Himachal Pradesh, a place that is close to his heart. His visit is for the "Garib Kalyan Sammelan" for the many schemes launched by his government for the benefit of ordinary people. "Before 2014 there were headlines in the newspapers, debates were taking place on TV channels regarding loot corruption and scams. But time has changed, now the talk is about benefit of government schemes. The World Bank too talks about ease of doing business in India. The Government prior to 2014 regarded corruption as a necessary part of the system. That government succumbed to corruption instead of fighting it. The country then was watching money for schemes being looted instead of going to the needy." With the combination of Jan Dhan, Aadhar and Mobile Modi said money was directly reaching the beneficiary account. Previous governments had accepted that money would not reach the beneficiary and development would be looted. "We have taken the initiative to make 100% benefits reach 100% of the beneficiaries. The government has taken the pledge for reaching the saturation of beneficiaries. 100% empowerment means ending the discrimination, every poor person gets the full benefit of government schemes." "Earlier there was compulsion to suffer because of smoke from the kitchen, today there is the facility to get LPG cylinders from the Ujjwala scheme. Earlier there was the shame of open defecation, today the poor have dignity of toilets. Earlier there was helplessness to raise money for treatment and hospitalization, today the poor have the benefit of Ayushman Bharat." PM Modi talked about how the Northeast was alienated before 2014, and now it was connected by heart and by infrastructure. During the pandemic India sent medicine and vaccines to 150 countries. India stretched out its hand to help other nations. India, he said, has shown that it not only has the potential, it is also a performer. International organizations are accepting that poverty is coming down and there are more facilities for the people. ...

LyrArc Article Gist
Stephanie Nolan's reports from Africa provide the few glimpses one can get today of the situation in Africa where variants are growing as a result of lack of vaccines (vaccine inequality) and the faltering vaccination drive, shortage of medicine and food supplies. Her report from South Africa showed how healthworkers and scientists in South Africa are working hard on the frontlines. This one from Zambia looks at the vaccination centers and vaccination workers as vaccination drives falter. The African continent with 1.4 billion people received 404 million doses. Today only 7% of the population is vaccinated in Zambia and the rest of Africa. People in Zambia do not have car transport so they have to walk 3-6 kilometres to get to a vaccination center, when they turn up at a center and it is out of vaccines they stop coming. Other problems are the social media accounts that show the vaccination drives as harmful to people, or CNN and other news that talk about blood clots that when carefully understood affect a tiny fraction of people. There are other issues also. Ida Musonda, a nurse in a clinic near Lusaka says after not many people turned up that she should go to markets and churches, but says there is no fuel for the vehicle to get clinic workers there. Bernadette Kawango is shown with her children. She works at an auto parts store and lives in a low income neighborhood in the edge of Lusaka. She ignores all the social media accounts that scare people from vaccines, yet she says she worries more about cholera, TB and malaria, and also HIV, AIDS. And she does not know anybody diagnosed with coronavirus.  The result is that there is vaccine shortage resulting in a kind of vaccine indifference (why walk miles to a center if it may not have vaccines), compounded by other problems such as the other diseases that also pose a threat in Africa, and the low incomes in a shrinking economy. And with about 8% vaccinated in Africa, the problem of variants can only be tackled by consistent and not erratic supply of vaccines. ...

LyrArc Article Gist
Geriatrician Bill Thomas is trying to change attitudes and perceptions in America about aging. He sees this as a special period in life offering many opportunities to be creative, to find new meaning and joy in different activites, and to contribute to society in many ways. He is supported in these efforts by the AARP. With modern medicine baby boomers are expected to live much longer. To make these lives productive and useful society in all countries needs to change its perceptions about aging. Jimmy Carter, a former president, showed this in his attitude to aging, doing many activities he enjoyed and contributing to society in many ways. This has a lot to do with healthy habits, and healthy attitudes to life, which should be cultivated when still young, so that one becomes more resilient as one ages and looks for new things to do.

LyrArc Article Gist
Andrew Witty, a 43 year old Briton, is taking over as CEO of GlaxoSmithKline. Before this he was in charge of European operations. His first moves include strengthening Glaxo's presence in the emerging markets of Russia, India and China. He has put new managers in charge of these efforts. He sees more opportunities to sell consumer health products in India and other emerging markets where people buy most of their medicines over the counter. He also hopes to make new pricing deals with insurers and governments to persuade them about linking the price of the drugs to how effective they are in treating patients.

LyrArc Article Gist
Eyal Press brings ups the issues of moral injury when physicians work under a system of corporate takeover of medicine. She cites  the situation of Emergency Room's at hospitals where the service is outsourced to private groups working only with profits in mind. Sociologist Paul Starr in his book  The Social Transformation of American Medicine said that about 50 years ago this was not the prevailing practice in America, when physicians earned the public's trust by being "above the market and pure commercialism." The trend now is to form unions such as the one at Stanford University for medical professionals, as this provides a balance when dealing with corporate interests. A 30 year old resident at Stanford is cited, who says the prestige of the profession of medicine does not any more prevent the degradation that is being experienced by workers in other sectors of todays economy. With its excesses in one direction away from the values of the past. Physicians he sees as moving to the category  of "laborers," like other workers in such an economy, that is far removed from what existed in America 50 years ago. ...

LyrArc Article Gist
The costs of fraud in medical care from spurious Medicare claims to kickbacks for unecessary services is estimated at $125 to 175 billion. Costs of unnecessary care from overuse to unnecessary lab tests are between $250-325 billion. The amount wasted for on treatment for preventable conditions such as heart disease and diabetes. is $25-50 billion. This number is much higher when all the complications from obesity are figured in. These amounts alone add up to $500 billion. Add to it the problems and the costs of medical errors leading to bad drug reactions or other misdiagnosed procedures which cost an estimated $75-100 billion and the the total is upto $600 billion. These amounts are not going to be tackled by computerization of medical records. The whole manner and ways in which medicine is practiced today and the manner in which the public takes care of its health would have to change for an impact to be made in these numbers.

LyrArc Article Gist
Generics from Teva Pharmaceuticals hurt Wyeth as Teva starts a generic for Protonix a heartburn medicine.

LyrArc Article Gist
Britain has come together in surprising ways during coronavirus with a community of ten million volunteers helping with food and medicine and other voluntary work. It is a beacon of hope during the crisis and it is here to stay.

LyrArc Article Gist
European Medicines Agency approves the Pfizer BioNTech vaccine on December 21, 2020.

LyrArc Article Gist
This article details the manner in which pharmaceutical companies like Sanofi, Novartis and other western pharma companies are using EU patent laws to have customs offices in the Netherlands and other European transit points to detain pharma shipments by Indian companies to developing countries. Cipla and Ind-Swift shipments are mentioned. India's pharma exports of generics and other medicines is $4.9 billion in 2009 according to Global Trade Information Services. Indian pharma companies are having to divert these shipments through Singapore and other transit poits to avoid this detaining of shipments and this costs more. India plans to file a complaint with the World Trade Organization according to India's commerce secretary, which one expert says it has agood chance of winning.

LyrArc Article Gist
Jack Hough points out the problem with TIPS, Treasury Inflation Protected Securities. The CPI-U that is used to calculate the inflation for TIPS is not representative of inflation for the average household. It understates the cost of gasoline, tution increases for kids in school, and price increases for prescription medicines. Prescription drugs have a weighting of only 1.25%, college tution only 1.53%. The CPI-U index went up by about 3.9% in 2011, and at the same time the gasoline portion increased by 33%, for households spending a lot on commuting to work. Another problem is slowing inflation- with inflation slowing to 2%. Compared to TIPS the alternative of dividend payments by cash rich companies with secure market positions are a better hedge against inflation.

LyrArc Article Gist
NITI Aayog does much of the development planning for India. It's CEO Parmeswaran Iyer, says about one third of the population of 1.2 billion people has reached the middle class. The poverty level has dropped to about 16% of the population. He describes the steps taken to achieve this. First inflation control by keeping inflation below 6%- it was 5.7% in December 2022. The decline of loan rates for education, buying home and appliances to about 8%. Second the pioneering action of One Nation One Tax under GST that has saved Rs 18,000 lakh crore or Rs 12000 per household annual saving. To create small micro business in a country the size of India with a large informal economy action was taken. 120 million of 380 million beneficiaries are from the  middle class for PM Mudra Yojana who received Rs 7 trillion in collateral free loans. This is designed to provide non farm small loans of 10 lakh rupees (about $8000) to micro unit enterprises at the bottom of the development pyramid to encourage an entrepreneurial culture and micro enterprises. Non Performing assets (bad loans) or NPA were reduced from 11.1% of the banking system to 5.8% in 2022. This is critical to support future growth as banks that well capitalized can make the loans needed to support growth. In health and education  a large network of new universities and medical colleges, hospitals is being built. The Ayushman Yojana provides health screening to millions of people and aid is channeled to people for low cost generic medicines. It is the size of these efforts that is making the difference in the lives of ordinary people. For technological advancement the government has moved quickly on digitalization, and 5G implementation to be done by 2024. ...

LyrArc Article Gist
Germany's national broadcaster DW.com looks into the details of the vaccination drive in countries around the world, including Germany, and finds that there is more to the story than meets the eye in headlines about safety in vaccinations. Many headlines do not tell the whole story carefully. DW revewed reports from Italy, Austria, South Korea, Germany, Spain, the USA, Norway, Belgium and Peru, and found that in most cases health authorites have not found causal links between the vaccination and deaths.  As of March 15 it says 360 million people have been vaccinated in 120 countries, or about 9.25 million a day.  DW.com cites the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) which states: 'there is no indication that vaccination has caused these conditions, which are not listed as side effects with this vaccine. Information available so far indicates that the number of thromboembolic events in vaccinated people is no higher than that seen in the general population." As of March 10, 2021 30 cases of blood clots are recorded for 5 million people vaccinated with Astra Zeneca vaccine in the European Economic Area.  The Paul Ehrlich Institute which is in charge of vaccination in Germany has looked into 113 reported deaths in 46 years to 100 years old patients in Germany. Of these 113 deaths PEI finds that 20 died of the Covid 19 infection as it takes 14 days after the second dose for full protection, and 43 died of pre-existing conditions or other infections. For the patient population it says "they were seriously ill patients with many underlying diseases." PEI says "based on the data we have we assume they died of their underlying disease- in a coincidental time with the vaccination." A virologist at the Technical University of Munich, says that the deaths after vaccination are below the expected number of deaths without the vaccination.  ...

LyrArc Article Gist
Pearlstein quotes Dickens in "Oliver Twist," about the law being an ass, and the constitutional law exercize in the Supreme Court of the U.S. giving a sense of a failure of the so-called best and brightest in reasoning out the issues. He points out that a serious problem is that American business which is burdened with high health care costs for employees is seriously missing in this debate after years of complaining about high costs. The National Federation of Independent Businesses is actually one of the plaintiffs questioning the constitutionality of the Obama health care law. Pearlstein says business wanted an end to the fee-for-service medicine that increases consumption of medical services and pushes up cost relentlessly, and that Obama's health care law does this. This is not the case as both Democrats and Republican administrations have failed to resolve this side of the cost issue, and this is the hidden reason for the loss of credibility for both sides in this debate, leaving health care problems to be resolved in future administrations. ...

LyrArc Article Gist
Tyler Cowen, Professor of Economics at George Mason University, points out some basic truths about health care as it is practiced today in the USA, and healthcare spending as it stands today. He questions whether starting out with extra spending plans to provide coverage to all will help solve the basic problems facing American health care. Too many tests and diagnostic procedures used by doctors is not aproblem that will be solved by spending more money to cover everyone. And government taking on more spending to cover all will not address all the other major shortcomings of the American way of practicing medicine, like prescribing a battery of tests, that tend to drive up costs, to just mention one of the problems. And it will not address any of the shortcomings in the way Americans take care of their health, diet, exercize and healthy lifestyles. THese are critical to get good health outcomes for the people, and which combined with careful spending of dollars where it will provide the greatest benefit, is the only way the health care solutions can be found....

LyrArc Article Gist
According to the General Accountability Office inquiry, 28 drug products had price increases over 100% in 2000, in 2008 71 drug products had such large increases. Medicines like Adderall for attention deficit disorder, Inderal for chest pain, Sumycin for infections were in the list of 416 brand name drug products where makers or distributors raised prices at least once by 100% or more for period 2000-2008. As large pharmaceutical companies sold their marginally profitable drug products or small selling products to smaller companies, these smaller companies would immediately increase prices to recover the money they paid to the large pharmaceutical companies. 26 of the brand name products saw prices raised 10 fold. A third of the drugs with large price increases treat depression and disorders of the central nervous system.

LyrArc Article Gist
China's healthcare costs have increased in the last decade without effective cost control measures. With the decline in consumer spending in the last decade to where it is now only 35% of GDP, and ordinary Chinese setting aside a large portion of savings for costly drugs and healthcare, reducing healthcare costs is a high priority to rebalance the economy and increase consumer spending. By comparison in the U.S. it is 70%. Bussey points out the importance of this for the new leadership of Jinping-Keqiang in China. Xinhua, the Party offical news agency, expressed China's new policy, saying that "some believe China may see a nationwide price cut on medicines." Regulators have begun probes of Nestle and Danone for possible anticompetitive activity and the two companies dropped prices for baby formula.

LyrArc Article Gist
The bill to bring girls marriageable age to 21, in parity with the boys marriageable age of 21 that exists today, was introduced in the Indian parliament by Smriti Irani. This is seen as a crucial bill to amend the Prohibition of Child Marraige Act 2006. Child marraige was a sign of the weakness in Indian society and practices that were being reformed in the nineteenth century/ twentieth century beginning with Ram Mohan Roy's efforts in 1800. Roy was the first Indian to put forward ideas for modernization that were later put forward effectively by Swami Vivekananda, putting Indian religious thought back on its original foundations of the Upanishads including the Bhagavad Gita, free of the deterioration over the centuries since the Middle ages. And in doing so extend even the ideas of the French and Indian Revolutions to the idea of women's rights. The efforts of Gandhi and the framers of the Indian constitution, begun under Roy and then Vivekananda during the British period, have inspired renewed efforts under Mr. Modi to build a strong nation under a framework of these values- values of the French and American Revolutions and the values that support gender equality. In real life this means, as Mr. Modi has reminded the public, that young girls can now use these crucial years to continue their education and pursue their dreams for a better life in the same way as young boys can. It is as if Jefferson, one of the Founding Fathers in America in 1776, would have said- "We hold these truths to be self-evident, that all men and women are created equal, and they are endowed by their Creator with certain inalienable rights, and among these are life, liberty, and the pursuit of happiness." It is this pursuit of happiness, pursuit of one's own dreams to be a scientist, educator, civil servant, to be active in law or medicine, or science, the humanities, the same for boys or girls, that is now being put forward in the New India of the 21st century. In India this has happened not with the stroke of a pen through the tumult of a revolution but with deep roots through the efforts of Roy, Vivekananda, Gandhi and the framers of the Indian Constitution, and now with the tireless efforts of today's leaders. ...

LyrArc Article Gist
This WSJ report on critical analysis of coronavirus data has a very useful chart of Estimated Range of Symptomatic Cases Reported by Country. Complete coronavirus data for all symptomatic persons who have the coronavirus infection is lacking in most countries. Many people in large populations have symptoms and are positive but are not reflected in the official data collection. This is a big problem as the total number of cases are understated by a magnitude of twice to five times the numbers reported in official tally.   South Korea has done a good job of getting more of the symptomatic people with the infection in its data, as about 53% to 90% of such persons are reflected in official data. Next comes Germany at a range of 38% to 55%.  China comes third and has about 28% to about 38% of such persons reflected in its data, the U.S. currently on April 4 at about 14% to 19%, according to this chart in the WSJ. The source for this is Mathematical Modeling Center at the London School of Hygiene and Tropical Medicine. What this means is that the US. number of cases at 278,000  reported infected people with symptoms (April 4) is only 14% to 19% of the true number. Another way to say this is that the actual infected persons with symptoms is about 5 times what is reported, or over 1 million not the 278,000 reported.  As happens for China data collection agencies may never get the true number. To be comparable to the Chinese numbers, as the U.S. is a large country, the figure closer to the true numbers would be twice the 278,000 reported or over half a million symptomatic infections of coronavirus in the U.S. Why is this data important. With widespread testing as in South Korea one gets data that tells one how many people are infected (the size of the problem) and therefore the resources needed and the point of greatest impact. Also it tells one the typical transmission rate per person, and it helps hospitals in each area know what to expect and what resources are needed to prepare- not find people suddenly turn up in the E.R. in unpredictable numbers. The lack of widespread testing and better reporting in the data to get a grip on the pandemic is shown in this chart for countries hardest hit, less than 5-6% for Italy and Spain. The UK and France at 5-8%.   ...

LyrArc Article Gist
Ken Murray, a retired family medicine professor at the University of Southern California, describes how doctors address the option of prolonging life when the prospects of survival improve say from 5% to 15%. The choice is based on the human need to find closure in an atmosphere that gives comfort, a sense of peace and a sense of place with home and family, with hospitals not deisnged to and not able to perform that role. Murray gives the example of his cousin Torch, who he says was born at home by the light of a flashlight, who decides to not choose aggressive treatment, which would have prolonged his life for no more than 4 months. Instead he spent the next 8 months with family and did everything he could do with the 8 months that made for quality of life, rather than just choosing quantity in and out of hospitals. He died peacefully in his sleep. The heroics in and out of hospitals would actually have deprived the patient of the opportunity to reach a sense of closure that comes from the comfort of home, family, and arriving at a sense of peace....