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Thursday, 11 December 2014 20:24

PM Modi must rein in the loony fringe in the Parivar

Written by Kamal Shah
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Its been about six months since the Government took over. When the Government was sworn-in, I had written about how very rarely, in this day and age, does a Government get such an overwhelming majority in the Indian Parliament and why this opportunity must not be squandered.

Though the Government has done a decent job on a lot of fronts, the danger of not succeeding lies within. We see, with amazing alacrity, every now and then, some Hindutva-obsessed lunatic making a remark or doing something so crazy that the Government has to spend an inordinate amount of time defending this.

Let there be no mistake. This Government was not elected on the Hindutva platform. There was nary of mention of religion in Modi's speeches. Yes, there was the odd ridiculous speech here and ludicrous interview there. But, by and large, it would be safe to say that this election was won on the platform of development.

There is so much to be done by the Government. Some very good initiatives have been rolled out, some are on the drawing board. India can ill-afford to have the Government's focus shift away from these critical issues. Let us not forget that we may not see a Government with a majority in the near future.

Another important aspect is that there was a lot of distrust of Modi among the minorities. That did reduce recently. A large number of Muslims and Christians voted for Modi assuming that he would solve their basic problems. When the demented dudes and dudettes of the Parivar are given a free rein, and some actually encouraged, these minorities would feel let down. They will never vote for Modi again. The task at hand for the Prime Minister is not one that will be accomplished in one term. We need a strong Government for at least two terms to give any positive direction to the country. Without the support of the minorities, I am afraid, such a majority in Parliament would not be possible.

Modi is seen as a strong leader. Few doubt his intentions. If he does not act soon enough to control these loose canons and makes sure he takes the entire country with him in the march to development, he would have lost a huge opportunity to make a real difference. He would have only himself to blame for this.

... http://www.kamaldshah.com/2014/12/pm-modi-must-rein-in-loony-fringe-in.html

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Tuesday, 09 December 2014 05:43

User Review: AliveCor Heart Monitor App

Written by Greg Collette
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Heart attack is one of the most common reasons we BigD-ers shuffle off this mortal coil.  Not because the kidneys have anything to do with managing our heart chemically, but because without kidneys we fill up with fluid and raise our blood pressure, putting stress on what is usually a pretty reliable ticker (heart failure is often the cause of death for people who decide not to go on, or give up dialysis).  Constant fluid overloads over a long period gradually wear out hearts, they get tired and emotional and without regular maintenance, become unreliable, or worse.

My 19+years off and on dialysis (mostly on) makes me a paid-up member of this group.  The main way my heart plays up is Atrial Fibrillation (AF), where it beats out of rhythm.  AF can be anything from mild (I hardly notice it) to severe (where because it is doing such a lousy job of pumping blood and the oxygen it carries that I find it hard to stay upright).  When in AF, my heart beats faster (to keep up the blood flow), but no matter how hard it tries, my blood pressure is always low.  In fact, if I’m in the early stages, a fast pulse and low BP when I am clearly above my base weight are great indicators that I’ve gone into AF.

Of course there are side effects (besides being slower than a three-legged turtle).  Because the heart is doing a lousy job of moving blood around, it can pool in inconvenient places, and even cause clots.  Not good, but only disastrous if that happens in the brain (the most common cause of a stroke), or the heart (causing a heart attack).  So if I’m in AF for more than a day or two, I take Warfarin, (Coumadin, Jantoven, Marevan, Uniwarfin) an anticoagulant, to minimise clotting.  This in itself has an effect for BigD-ers: we must ensure that clinic staff know we’re on it so they can use a smaller amount of Heparin during each run, and I wait longer for bleeding to stop after the needles come out.  This also applies to any cuts and scratches I inflict upon my body parts.

So the ideal situation is to not go into AF, or to catch it early.

Stopping it before it starts

The best way to stop it before it starts is to visit a cardiologist regularly.  The cardiologist I go to is excellent.  His stated aim is to keep people alive longer than we would be without his help – an excellent objective say I.  And he’s done a sterling job so far.  I’ve had AF for more than 10 years.

In the early days he zapped my heart back into rhythm with those electric paddles we have all seen on our favourite TV show (anyone remember Dr Ben Casey? Sadly I do… but I digress).

Since those early days, he has had me taking two heart medications:

  • Metoprolol, a beta blocker (it blocks the electrical impulses that pass to the lower heart), that reduces heart rate and AF, and the force of heart muscle contractions to lower blood pressure. Since starting, I usually score a heart rate of around 55 BPM – much the same as all the athletic types in the family.  Since I choose not to share how I achieve it, most people think I am incredibly fit, which I see this as a positive side effect
  • Flecainide (Tambocor), which also blocks electrical signals in the heart that cause an irregular heartbeat, is used for serious AF (I used to take Amiodarone, but it gradually became less effective, so I was weaned off it and onto it’s big shot replacement).

These two have mostly kept AF at bay.  Once in a blue moon I forget to take a dose, and AF can make a tentative appearance.  But once these little white friends are back into my system, it fades away.

Catching it early

This was a little more difficult until recently.  Apart from feeling “out of rhythm” and confirming it by checking my pulse (easy with a fistula), my main measure was the low BP/fast heart rate/above base weight I mentioned previously.

That was until I got my hands on a miracle machine.  It came about like this.  Julie went to see our No 2 son, Liam in London month or so ago.  One of the social events he arranged was to get together with Malcolm, one of his excellent friends who stayed with us when he was a student doctor on placement at the Royal Melbourne Hospital.  The world turned, as it is wont to do, and he is now Malcolm Finlay, Consulting Cardiologist (yes way!).  He was trialling a new mini ECG/heart monitor for the iPhone, called the AliveCor Heart Monitor.

He demonstrated it and to her and obviously thought it a valuable tool.  It is a small metal and plastic plate about the size of a business card.  You place two fingers at either end, on the metal pads and hold it close to the iPhone while it is running the associated App.  It immediately picks up the signal from the plate and displays a heartbeat signal comparable to readings from Lead I of a standard ECG. (Other signals are available: a left knee-right hand combination gives me a Lead II signal and placing it on the lower left side of the chest, below my enormous pecs, mimics the signal from the Anterior Precordial Lead,) One of my AliveCor ECGs on the websiteOne of my AliveCor ECGs on the website (click to view)

The App records the signal for 30 seconds, does some analysis and saves it for later use by the user’s cardiologist.  The App also tracks medications, symptoms and lifestyle activities (like drinking coffee, or more rigorous activities).

Julie went bug-eyed thinking of me (quite understandable) and of how valuable it would be for tracking my AF (I am also a pretty enthusiastic App and tech user).  Needless to say, she called me and told me about it, and when I picked her up from the airport a week later, she took one out of her bag and handed it over.  Bliss.

I managed to wait until I got back to the car before my first go.  It’s as good as it sounds.  I joined the AliveCor user’s website, where my ECGs are stored as PDFs (see pics) and am setting up an email link with my cardiologist for the times my heart gets the wobbles, for more immediate feedback.  All the key bits, BPM, ECG numbers, symptoms, medications are also graphed for trends (quite satisfying).

One of my early morning ECGs: definitely in AF!

I had an AF episode a couple of weeks ago, and I took ECGs during the hour it lasted, and after.  Since all was well once my heart returned to rhythm, I have printed them out and tucked them away in an envelope, ready for my next visit to my cardiologist (no, not anal at all…).

So, my unbiased view of this excellent App/unit after about a month of use: just wonderful.  It is easy to use, totally portable (I have taken ECGs in the car (parked), on the train, at restaurants, even in the smallest room in the house).  It’s free (though you can buy analysis services on the website) and immediate, with a link to advice and help an email away.  Ah the peace of mind.  Feel the serenity.

Note: the AliveCor Heart Monitor is not cheap.  Last time I checked it cost between $150 and $300 depending on what specials were available.  But this is my heart I’m talking about, not a new set of shoes.  Definitely worth it (and while I’m sure it or competitors will get cheaper over time); why wait?

Five stars

Five Stars! – iTunes and Google App store


I just received news from AliveCor about new models at reduced prices:

50% thinner and 40% lighter, the 3rd generation AliveCor Heart Monitor provides the clinically-proven quality you have come to expect in an even sleeker, lower-profile design. At only $74.99 USD, we’re making it easier to bring heart health knowledge and peace of mind to even more patients with known or undiagnosed heart conditions.”

Almost down to Christmas present pricing!  Go to store.alivecor.com for more details and to order.

... https://bigdandme.wordpress.com/2014/12/09/user-review-alivecor-heart-monitor-app/

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Wednesday, 03 December 2014 20:45

When talking about the dialysis diet was called 'vulgar'

Written by Kamal Shah
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I was talking to a group of dialysis patients a few months back. I first did a general talk about how to have a good quality of life despite being on dialysis. I then had a Q&A. Typically, questions in this kind of a session invariably turn towards the diet. Diet, for most dialysis patients, is the worst problem if you don't count fluid restrictions.

I was answering some of the general questions on diet when a gentleman, probably about 60 years old started shouting. His contention was that any talk about things like diet was totally unnecessary and he even called it vulgar. I was quite taken aback. He said his wife was on dialysis and their entire life's savings have been spent on her treatment. The anger in his voice was palpable. For him, any talk that purportedly gives support to dialysis patients should only be about how patients should work together to get the government to subsidise dialysis or even make it free.

I explained to him that while I understood the financial problem of dialysis patients and their families, for the patients, diet is a big problem. Addressing the financial issues was going to take time in a country like India because a huge, concerted effort from patients, families, providers, doctors etc. would be needed and the process would be very slow. In the meantime, what was wrong in patients getting some queries answered on their diet and other simple things that could make their life better?He softened up after this.

I could totally understand his problem though. While in developed countries, patients don't need to think about how much their treatment costs, in India, treatment options are primarily dictated by ability to pay. When patients are often wondering how long they would be able to continue dialysis, talk about diet, exercise, quality of life etc. may appear vulgar!

When I talk about more frequent dialysis, I realise that a large number of patients would do it if they could afford it. When the constraints are not in your control, what really can you do?

Honestly, I was quite shaken up by the gentleman's outburst. Their life probably turned upside down after the diagnosis. All their plans probably went haywire. He needed some place to vent. He obviously couldn't vent in front of his wife. I am at least hoping that he didn't do that! A guilt trip is the last thing a dialysis patient needs!

This is why I am fully supportive of any attempt at Government sponsored healthcare. We need to eventually get into a mode where an individual gets the treatment he or she needs without having to worry about where the money for this is going to come from.

... http://www.kamaldshah.com/2014/12/when-talking-about-dialysis-diet-was.html

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India currently spends about 1% of GDP on healthcare. China spends about 3% and the US about 8.3%. That is about to change. If things go as per plan, Prime Minister Narendra Modi's government is planning to rollout Universal Healthcare for India beginning April 2015. The project will be taken up in phases and would eventually cover the entire country by March 2019.

I have always been a proponent of Universal Healthcare. The erstwhile united Andhra Pradesh state had shown the way by implementing the dramatically successful Aarogyasri scheme where people who were below the poverty line (BPL) were given access to healthcare they could only have dreamed of in the past. Currently, of course, the number of beneficiaries of the scheme far exceed the number of people who were BPL as per the records. The scheme is being misused by people who are not the intended beneficiaries. Despite this, I would say the scheme is really good because the lives of thousands of poor people are being saved every year thanks to this scheme. The loopholes must be plugged and the scheme continued.

Modi's task would, of course, be far more challenging. For starters, however, they wouldn't have to worry about unintended beneficiaries getting the benefits of the scheme. There would be no unintended beneficiaries as the scheme is not restricted to BPL people. It is for all. Some might argue that this is not wise as there was no need to subsidise healthcare for people who could afford it. While this argument holds merit in the case of the super rich, ask any middle class family with someone on a chronic condition like dialysis and you would see how medical treatment can wipe out any average family's life's savings in just a few months.

The scheme is going to cost the government about $11.4 billion annually. To put this number in perspective, India spent $47.4 billion on defence in 2013. So a fourth of that for Universal Healthcare is a good bargain, if you ask me!

The plan is being thought through well. Primary healthcare will continue to be offered by the Government especially in rural areas where infrastructure is going to be improved. Tertiary healthcare is going to be offered through the insurance model. The scheme includes some basic drugs and diagnostic tests free.

While reaching the entire country in an effective way will obviously take decades (which is not surprising since it involves a sixth of the world's population!), we must not shy away from this basic necessity of the people due to this. A beginning has to be made somewhere.

I have always maintained that access to healthcare should be a fundamental right. No citizen of the country should be allowed to suffer if a treatment is available just because he or she cannot afford it.

Dr. Martin Luther King, Jr had once said, "Of all the forms of inequality, injustice in health care is the most shocking and inhuman." Let us not allow this injustice in health care to continue for much longer in our country.

... http://www.kamaldshah.com/2014/11/modi-government-planning-universal.html

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Sunday, 23 November 2014 05:00

Finally, the HB mystery unmasked!

Written by Greg Collette
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As regular readers will know, over the last few months, I became quite unwell well, with fevers, lethargy, persistently low haemoglobin level (HB) and generally feeling crappy.  Also, gradually (so gradually I didn’t realise it was happening), my muscles and joints began to stiffen and lock up.  I was walking around like a wizened old man: bent over, no flexibility, only just able to touch my toes.

I eventually spent a couple of weeks in two different hospitals.  But it seemed that no-one could find the problem, until one young and enthusiastic doctor thought he recognised it, because it was his specialty.  He sent me for a full body MRI and which confirmed his hunch.  I had something I could barely pronounce: Polymyalgia Rheumatica (PMR).

Polymyalgia means “pain in many muscles”, which is pretty accurate.  The textbook says it causes pain and stiffness in people aged 50 and over (I’m 62 – Check!), including:

  • Muscle pain and stiffness, particularly in the neck, shoulders, hips and upper arms (Check!)
  • Stiffness that worsens after resting – for example, when getting up in the morning (or getting out of a car after a 30 minute drive – Check!)
  • Fatigue (Check!)
  • Difficulty sleeping (not me!)
  • Difficulty raising arms above shoulder height (Check!)
  • Unexplained weight loss (I lost 5 kilos (11lb) – Check!).
  • The onset is usually sudden (Check!).

The pain and stiffness came from inflammation when my white blood cells attacked my larger joints causing swelling in the shoulders and hips, and in the tissues around them.  The reason for PMR is unknown, though it may be triggered by respiratory viruses.

Apart from people over 50, women are more likely to develop it than men and interestingly, Caucasians are most susceptible especially people of Northern European (Scandinavian) origin (where my ancestors hail from!).

The good news is that it is pretty easy to treat, with my old friend from transplant days, Prednisone (/Prednisolone).  I have disliked and dreaded taking this drug since my first transplant.  It has many side effects on the bones, body and brain, but the one I dislike the most is the tissue-thin skin that bruises and tears at the lightest brush against a hard or sharp surface.

Still, after just two days of 20mg, my symptoms faded away.  It has simply eliminated the inflammation and all the nasty symptoms that came with it.  I feel ten years younger.  Toe touching is no longer a problem.

I have to take the Prednisone for at least a year, in gradually reducing doses until I find a level that just keeps the PMR at bay.  I am reducing the amount I take by 1mg a month .  (It’s a bad idea to stop or slow Prednisone suddenly: that can lead to an Addison crisis, and that’s not for me.)

One interesting reaction to being free of PMR is the rise in my HB level.  It has soared to 15+ gm/dL a dangerously high levels for people on dialysis, increasing my risk of thrombosis (blood clots).  Obviously the PMR suppressed my (or EPO’s) ability to create red blood cells.  Once removed, red blood cell production went into overdrive.

My nephrologist wanted it back down ASAP, so he has reduced my EPO and more traumatically, told staff to dump my blood at the end of three runs, rather than returning it to me.  That’s about 250mls of blood each time.   300ml of blood equates roughly to an HB level of 1 gm/dL, so the maths is right.  It just feels very wrong throwing blood-filled lines into the bin, especially after struggling to get every red cell back when my HB was so low.

Anyway, after all that time and drama, I’m back to being my sprightly self: walking, going to the gym and generally feeling exuberantly dangerous to myself and others.

... https://bigdandme.wordpress.com/2014/11/23/finally-the-hb-mystery-unmasked/

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I have often felt that I don't really want to get a transplant. I am leading a fairly normal life - working full time, exercising, traveling. Why would I want to do anything different? The only problem was the dialysis sessions I needed at night which I was managing fairly well. Well, travel was restricted but it was not a major problem and in a couple of years, we should see some portable machines come to India and that should be taken care of as well.

However, I am not sure if that is entirely accurate. Dialysis, however much you get, can never replace all the functions of the kidney. There are some functions that it does not even attempt to replace. That is left to the medicines to manage. We unfortunately know so little about the human body that it is always an uphill task to manage such intricate mechanisms within the body with a bunch of tablets.

Only a transplanted kidney can give you close to normal body functioning. Things like Mineral and Bone Disorders (MBD) are very difficult to get a handle of. I have experienced this first hand. I am struggling with severe, debilitating bone pain from the past month or so, something which has been getting worse and we were not able to do anything to arrest it. Even seasoned nephrologists agree that MBD is something that they are just not on control of yet.

The trouble with me is my primary disease - Atypical Hemolytic Uremic Syndrome (aHUS). With this disease, the chances of recurrence after a kidney transplant are more than 90%! Which pretty much rules me out from getting one unless I get access to a drug that will prevent recurrence of the HUS.

There is a drug Eculizumab that is available in many countries that has been shown to prevent recurrence of HUS in transplanted kidneys. There is one more drug (Omeros 721) in clinical trials stage. Both these drugs are not available in India yet.

I just hope they become available before my MBD gets out of hand.

... http://www.kamaldshah.com/2014/11/only-something-that-will-prevent-hus.html

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Sunday, 09 November 2014 03:48

App review: My Food Coach for all BigD-ers

Written by Greg Collette
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My Food Coach: Main Menu

A few weeks ago Ken Marshall, the Chief Executive of FoodCare Inc. in California, emailed me about a new App for renal patients called My Food Coach.  The app and its supporting website provide customised nutrition guidance for recipes, grocery items, restaurant dishes and meal plans for people with special dietary restrictions like kidney failure and diabetes.

It is hosted by the US National Kidney Foundation (NKF), and is an excellent tool to help us BigD-ers stick to our “low this, not too much of that” diets and still enjoy a range of different foods at home and out on the town.

And it’s Free on the Apple App Store and Google Play.




Medical conditions list

When I signed up, I provided basic info (age, gender, height, weight, activity level) and nominated osteopenia, dialysis with normal potassium and no diabetes.

The App then assigned me a range of dietary guidelines (maximum or minimum amounts of different food nutrients from various health associations) and each time I select a Guidelines supermarket food item, recipe or a meal it measures it against the guidelines, and tells me if it is OK (with a green tick), is reasonably healthy, bad and or forbidden.

And I can add my own recipes via the website, and get the same personalized nutrition analysis and guidelines on them.  That could be a useful check, especially when something like my phosphate or calcium starts misbehaving, to help identify the culprit.


Recipes List


Sample recipe

I can also nominate local restaurants that serve dishes that meet my dietary guidelines, so other users can enjoy them too.

The App is about to be updated with a meal planner, which helps users plan a single meal (combinations of grocery items, recipes, restaurant dishes, etc.) or the menu for a week or more.  It tells you  if the meal passes your per-meal guidelines, or if your overall day’s intake is passing your daily guidelines.  This could be useful for someone just diagnosed with kidney failure (or diabetes, osteoporosis, etc) working with a dietitian to help understand their dietary needs.

The Pro version of the App is for registered dietitians who can use it to connect with their clients’ FoodCare profile. The dietitian can view the dietary guidelines that have been automatically assigned, and then go in and customize them for any individual client.  Advanced coaching support like expanded patient notes, uploading lab results, tracking client health stats, etc. are planned for future releases.

The App is quite new, so the recipe and meal lists are fairly thin right now (November 2014), but growing.  Ken tells me that they’re also adding more social networking features so the NKF can better engage their community members (sharing and featuring recipes, recipe commenting, more social sharing, etc.).

The App and website are currently US-oriented (I struggled to put my height and weight in feet, inches and pounds without a calculator!), and some of the functions are not so relevant (Events focus on the US, News is not local and Packaged Goods are not the ones we know).  Ken assures me that they’re “hoping to launch” an Australia version in the next few months.  That would be great, especially for packaged food available in Australian supermarkets.

But these are peripheral to the main game: customised nutrition guidance.  All in all, the App is a great resource, really simple, with one main screen and lots of background management functions.  The resources are very comprehensive and I especially like the Connect with a Dietitian and that they can view their clients’ FoodCare profile and customise client dietary guidelines for any individual.  An ideal resource for anyone on a restricted diet (like us BigD-ers), especially those just starting out.

Rating:  Four Stars!

... https://bigdandme.wordpress.com/2014/11/09/app-review-my-food-coach-for-all-bigd-ers/

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Thursday, 06 November 2014 20:05

A duodenum biopsy

Written by Kamal Shah
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I have been having recurrent diarrhea for the past month or so. I am on my third antibiotic course. Everything seems to be ok for a few days and then it starts again. The day before yesterday, the gastroenterologist suggested that we do an endoscopy and a biopsy of the duodenum.

This sounded scary. Biopsy of the duodenum? Whatever did that entail?!

I have become an endoscopy veteran by now and have had more than I care to count. In fact, I stumbled upon this post where I actually compare how endoscopies have changed over the years! Just imagine! So, I wasn't in the least worried about the endoscopy. It was the other beast I was worried about. How can something called 'biopsy of the duodenum' be anything pleasant?!

Anyway, these days I have stopped thinking about all this, stopped applying my mind to my treatment and surrendered completely to the doctors. Its become a pointless exercise. So much of it is just trial and error!

So, I went ahead and got the endoscopy and the duodenum biopsy done. I was advised to do a heparin-free dialysis that night. A biopsy involved cutting off a tiny little piece of the tissue in the duodenum and examining it under the microscope. So, there was a small chance of bleeding. Heparin is the drug that is used for almost all dialysis patients to prevent the blood from clotting when it is outside the body getting purified in the artificial kidney. So, if you used heparin after a biopsy (and even a surgery), chances are that the site of injury will start bleeding.

It is normally fairly straightforward to do a heparin-free dialysis in-centre during the day. All that is needed is to flush the lines with saline every 30 minutes. At night, it can be quite a bother. Giving a saline flush every 30 minutes means someone needs to stay up the whole night. Guru, the tech who dialyzes me was, as usual, very co-operative. He stayed up the whole night and religiously flushed my bloodlines with saline every 30 minutes.

All in all, everything went off well. The biopsy report is expected in 4-5 days. Let us hope we get some clue on what the issue is.

... http://www.kamaldshah.com/2014/11/a-duodenum-biopsy.html

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Tuesday, 04 November 2014 20:06

India's patent laws - two sides of the debate

Written by Kamal Shah
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When I contacted Alexion Pharmaceuticals, the sole company in the world that manufactures Eculizumab, the only drug with which I can have a successful transplant, they said they had no plans to bring the drug to India. Their chief concern was India's weak IP protection laws.

In effect, they were worried that a local company could easily reverse engineer the drug and sell it at a fraction of the price. I was quite surprised that Indian laws would allow that. For a while, I assumed that they were referring to the illegal drug market where the drug would be copied in highly questionable conditions and sold illegally.

I was wrong. Indian patent laws allow reputed Indian manufacturers to reverse engineer drugs and sell them at a fraction of the price at which the original drug is sold by the company that actually invented the drug.

I read up a little on this recently. This issue was in the news after two significant rulings - on Novartis' Gleevec and Bayer's Nexavar, both cancer drugs. The rulings rejected the requests of these companies to prevent Indian companies from selling reverse engineered versions of the drugs at a fraction of the cost at which the originals were being sold.

There are a few things we must know. India used to provide only for process patents and not product patents. So, you could get a patent only for the way you produce a certain drug, not the drug itself. This changed in 2005, when due to India signing the WTO treaty required it to become TRIPS compliant which provided for product patents. However, some safeguards were provided which prevented MNCs from monopolising their products often to the detriment of the general public. It is often the interpretation of the safeguards that come up for litigation.

For example, there is a provision called Compulsory License where the country can allow a company to manufacture a generic version of a patented drug without the consent of the patent holder and sell it in the country by paying a certain royalty to the patent holder. Under what circumstances this can be done and what is the royalty that would be paid are all not specified clearly.

Look at all this from a big pharma company's point of view. They would believe that since they have the patent to the drug, no one must be allowed to sell it. In fact, the price at which Indian companies sell the drug is often a miniscule fraction of the manufacturer's price. Further, the cheaper version could also be exported to other countries and this could be disastrous for the patent holder! The pharma companies spend a lot of money on research and actually bringing the drug to the market. They believe that it is unfair to them to allow generic versions to be sold by someone else, at such low prices!

Fair point.

Now, look at this from a patient's point of view. There is a drug that is available in the market. The drug could save his life. But is priced so high that he cannot afford it. Or it is priced so high, his insurance / government will not pay for it. He would say this is completely unfair! He would argue that in the case of life saving drugs, commercial exploitation must not be allowed. When someone else is able to produce the drug and sell it much lower prices, this should definitely be allowed!

Again, fair point!

What is the way out?

... http://www.kamaldshah.com/2014/11/indias-patent-laws-two-sides-of-debate.html

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