saadhu.com : The Healer and The Drug Pusher
Chapter 8 : Smooth
(A sample chapter from The healer and the drug pusher)
The new drug Smooth had been launched recently by a multinational Pharmaceutical Company based in Europe. Raju was their Country Manager in Sri Lanka and the drugs were imported and marketed by the company that Raju worked for. They had been able to get the drug approved by the authorities in Sri Lanka, within a few months of the launching of the product in the United States.
Smooth had a smooth passage through drug registration procedures, because the manufacturer had a long established name and reputation. Raju was able to get a lot of publicity in the media, through his personal contacts and also because Smooth was being talked about in all western countries as the salvation of the girls suffering from acne.
Promotion of Smooth began long before the product was available in the country, when all the key medical consultants were approached. A lunch was arranged at a five-star beach hotel on the South coast, where the consultants were invited with their families. A special luxury train was arranged to take them from Colombo to the beach resort. While the doctors were attending a presentation on Smooth, made by a doctor from London, there was music and a few dance items, and a Fashion display to entertain the ladies. The children played in the pool and the sea. All the print and electronic media had been invited and Raju had already given the details they wanted published. It was near sundown when the invitees left the hotel, very much grateful for the makers of Smooth, for a memorable day and equally memorable gifts that had been given to each one of the guests, men, women and children.
As with all well planned promotional campaigns, a few doctors had been left out, inadvertently or intentionally and the following Monday when Rajus Medical Representatives called on these doctors, they had simply told them to go and meet those who had climbed on their Smooth Train. This did not worry Raju because he knew that he could always get them around after a few weeks.
Rajus office was flooded with telephone inquiries from young girls and their mothers, wanting to know when the medicine would be available in Colombo. They were prepared to pay any amount, to get hold of the drug and Raju was aware that Smooth was smuggled into the country and was available at Rs. 1,500 per tube, while the retail price would be only Rs. 700 when it came into the market. The company would enjoy the huge profits from the product for several years, till they held the Patent rights.
By then Indian manufacturers would come out with their own brands, and the monopoly would be over.
When Raju informed his head office about the smuggled Smooth, he was instructed not to worry about it. The manufacturer considered it as additional publicity.
You go ahead with your promotion. If anyone asks you about the product available in the market, just say that you have not imported any stocks to Sri Lanka yet. You are waiting for registration. You can mention that the product is already available in India and Pakistan The General Manager, Global Trade, told him from Berlin.
Can we have our stocks as soon as I get the registration certificate?
The goods are ready. Immediately you give the green light and your company opens the LC, we will ship it
I expect the approval at the next meeting of the Committee. It would take another week for them to issue the certificate. We can plan for the launch in three weeks time then Raju told him.
Thats good timing. I should be able to arrive in Colombo for the launch, in that case.
Raju had a very busy three weeks, preparing for the launch, recruiting new Medical Representatives, purchasing cars for them, arranging for their product training in Singapore, which was for one week of intensive training, drilling them on the advantages of Smooth and how it should be promoted.
Smooth was to be distributed to the chemists on the very day of the announcement of the availability of the product, and it had been very carefully worked out by the Sales Manager, to ensure that all major towns would receive goods in the morning. Most customers had already paid the money and placed their orders with his office. It had brought a smile to Rajus face, when he was informed. He thought of other pharmaceutical distributors who could only sell their products on credit terms and then at heavy discounts.
Their company had wanted to keep the price at a much higher level than the Rs. 700, that was decided by their manufacturer, because they knew people would buy it even at double the price. However their principals had not agreed.
Daddy, how safe is "Smooth"? Bhanu asked her father one evening, as he sat before the television, happy and relaxed with the successful sales figures they were getting day by day.
Why? Who says it is not safe? Raju retorted in an annoyed tone, not wanting anything to dampen his success.
Do you know about its side effects? she shot back.
There are no side effects. It has been approved by the US FDA. It is perfectly safe.
Daddy, you dont have to tell me about FDA approval. How many drugs have they approved and then withdrawn, when people started falling dead in front of their doctors?.
You are exaggerating. There had been only a few isolated cases. The newspapers exaggerated the whole thing.
Shall I get a list for you, from the internet?
So that is where you are getting all this nonsense. I know there are a lot of cranks who flood the internet with all sorts of rubbish Raju was getting angry.
Daddy, I am serious. I just found that Smooth can cause extensive damage to the liver. I am worried about Suneeta. Did she use Smooth? she asked him.
What is she talking about? asked her mother who had come in and had heard the last few words.
I was trying to tell Daddy, that Suneetas illness could have been caused by "Daddys-Miracle- Acne-Cure" Bhanu told her mother.
Is this true? Chitra turned to him.
It cant be. Smooth is perfectly safe Raju became defensive.
Smooth is not safe. It destroys liver tissue. It should never have been introduced to this country. It is better to live with acne, than die from liver failure. You are trying to murder innocent people, Bhanu said.
Bhanu, that is not the way to talk to your father. He did not know that it was dangerous her mother told Bhanu.
It is not dangerous Raju repeated, which was ignored by Bhanu.
Mummy, I am not trying to be disrespectful. You know I would never do that, but how can daddy say he did not know. It is his duty to know about all the harmful effects of any drug he is promoting, Bhanu told her mother.
What are we to tell Suneeta. How can we face her and her parents? Bhanu brought them back to the present reality, when her parents remained silent.
Isnt it true that more than twenty five percent of the cases of Fulminant hepatic failure are due to drug reactions? she asked again, after a little silence.
Did you really make sure that this thing was safe, before you marketed it? Chitra asked her husband, even though she did not have a clear idea of what her daughter was talking about.
Do you think that I would have allowed it into the market, if I had known it was dangerous? he yelled at her, and Chitra did not answer him.
They all fell silent once again, realizing the seriousness of the situation.
Daddy, the first thing to do is, contact your head office and ask them for their advice. They would have faced this situation many times, and would be having a course of action planned. Smooth was sold in many other countries, long before it came to Sri Lanka. That means many girls would have fallen ill and would have been treated Bhanu suggested.
Then I would have heard about them Raju said.
Unless all such news had been suppressed. Your principals could easily do it.
What is Suneetas condition now? Chitra asked, to bring them back to the immediate problem. How do we know that she was using Smooth?
She may need a transplant Raju said in a soft, defeated voice.
I dont think we can get a transplant here. They will have to take her to America Bhanu said. Sumanadasa uncle doesnt have that kind of money Bhanu said.
How much is it going to cost? Chitra asked.
Over one million Raju told her.
Ask your company to pay. It is their fault was Bhanus instant response.
It is easy for you to say was only what Raju could tell them.
Poor child Chitra sighed, and to think that we are in a way responsible.
I will sell all my jewellery and give it to Sumanadasa uncle. Bhanu told her parents.
They are not yours to sell Raju snapped.
No. That is why I want to sell them. I dont want to wear them ever again, when I think of how you earned the money, to buy the jewellery
You are talking as if I am a thief, a crook?
There is a word for that kind of money, "filthy lucre"
Raju watched her, unable to believe it was his daughter speaking to him like this.
Daddy, I am not trying to fight with you, all I want is to save my friends life. Why cant your company accept responsibility Bhanu said, when her father remained silent.
We didnt force her to use this product Raju tried to argue.
What else do you call it when you get the newspapers to write so much about it, when you arrange TV discussions, when you bribe the doctors to prescribe it she asked.
The newspapers published what they received on the international news services.
Or what your company fed them, and they would have been very careful not to feed any adverse reports on Smooth.
Will you please stop this fight Chitra shouted at both father and daughter, let us think what we can do to save this child. How we are to tell Sumane?
But I still think that we have to stop other girls from suffering the same fate, we have to tell the whole world, the dangers of using Smooth Bhanu would not give in.
Probably she had not followed the instructions given by the doctor. You are ever ready to blame the doctor, but very often it is the patient who is to blame Raju tried to defend his miracle cure.
Daddy, How could you say that, you have known her all these years. You used to say that she was your younger daughter. I think that is not you talking, that is your Multinational Drug Pusher who is talking through you. I know my father wouldnt say such a thing about Suneeta. she was almost in tears.
We cant save the world. Let us try to save the child we know. Later you can think of others. Anyway I also think that daddy should tell his company and the manufacturers. They have to do something Chitra told them.
I will tell them tomorrow, when I go to office Raju said in the end.
We shouldnt wait till tomorrow. You should call your boss, and ask him to call London now, they would still be working. May be they will know of some treatment, which can be started immediately. Some antidote. Every second we waste, poor Suneeta is dying. Our doctors are just treating her blindly for liver damage. If we could tell them the cause, they could start some specific course of treatment Bhanu told her father.
Chitra watched her husband, and her silence told him more than all the words that Bhanu could use. He got up from his chair and went to the telephone.
Raju, he identified himself to his Executive Director, and without any formalities continued, we have a little problem, a girl who was using Smooth has suffered liver damage.... we are not certain it is due to Smooth, but there had been reports of liver damage in girls who used Smooth.... no, not in Sri Lanka, but in Europe and U.S....it is on the Internet...but what should we do about it.... we cant just keep quiet.... shall I call London...they may be able to advice on some treatment.... but this is serious, the girl is in a very bad condition.... and she is the daughter of one of my close friends...he put the telephone down, slowly.
What does he say Bhanu asked.
He wants to discuss this in the office tomorrow Raju replied, in a helpless voice.
How can we wait till tomorrow. She may not survive till tomorrow Bhanu asked.
Dont say such things. Gods will look after her Chitra tried to calm them down. let us pray to Baba32 she said.
How can Baba help us. Only daddys company can help her now
Raju went to his room and came out in a short while, dressed to go out. He picked up the car key without a word.
Where are you going now?
Im going to the hospital.
Let us all go then Chitra stood up.
No. visiting hours will be over by the time we reach there and anyway I am going to talk to some doctors, not to see Suneeta Raju left the house.
Bhanu went into her room and Chitra sat alone, watching the television screen, which had not been switched on. Bhanus eyes were glued to her computer monitor. She was surfing the web for any information she could get on any antidotes for Smooth. She came across more references to liver damages and deaths, suspected to be from Smooth, and she went on searching for any victim who has survived. It was a long search and she was oblivious to the time she was on the Net, or the telephone bill she was running up, or the fact that their telephone line was tied up.
The next day they were all in Suneetas room, trying to look cheerful and trying very hard to keep the gravity of the situation from her. Suneeta looked cheerful, but Bhanu knew that she too was pretending, that she knew her chances of recovery were remote, but she did not want her parents and friends to worry about her.
Bhanu was angry with her fathers company, with her father, and most of all with herself, because she could not tell Suneeta or her parents about Smooth. She had promised her father that she would not say anything till he returned from office after his discussion with his Director and with their Head Office.
The less you see of doctors, the healthier you can be Bhanu heard someone out on the balcony say. She edged closer to him. It was Sumanadasas brother, Gunadasa, who worked in the Telecommunications Office.
Uncle, did you read that article in the Daily News, "Less people die when doctors are on strike"? Bhanu asked him.
Why not, and I do agree with him. Some years ago in Israel, when the doctors had been on strike for one month, the death rate had dropped by half. In Columbia, during a two month strike, the death rate had dropped by thirty five percent. He replied.
Where do you get all this from?
Oh, I read them here and there he shrugged it off.
I get my information from the Internet Bhanu explained. that is where I read that people are born healthy and would remain healthy, if their lives are not tampered with, by doctors.
You are very correct. Man has been on this earth for over a million years. They did not depend on western medicine. Health depends on prevention, through hygiene and nutrition, not on doctors. Doctors make sick people get worse.
Please stop it. You are in a hospital. What if a doctor heard you Gunadasa wife pleaded.
Who cares. What could they do to me? Refuse to treat me? Then they would be doing me a favour he laughed. The basic problem is because today our doctors know only about sickness. They dont know anything about health.
Dont blame all the doctors. There are some very good doctors his wife said.
Where? In Sri Lanka? her husband tried to sound surprised.
How about Dr. Rajasinghe?. Isnt he one of the best physicians in the country? she asked in return.
You have already forgotten how he saved our daughter from an unnecessary appendectomy
Why? When was that Bhanu butted in.
It was when she was about 12 years old. She was having fever for more than a week, not a very high temperature, but it was not going down. So we took her to the Suwa Setha hospital. A lady doctor examined her, and said that she was suffering from acute appendicitis and said that she should be admitted immediately for surgery.
She advised to get her urine tested and arrange for admission.
I did not believe this woman. So what I did was take the urine report to Dr. Rajasinghe Gunadasa added.
What did he say Bhanu asked.
He advised us to take the girl home and give her some coriander water.
That is all? Bhanu asked
That was all. He said that it was a mild urine infection and that we should not worry. Later I found out that this lady doctors father was the surgeon at the hospital
That is why I say that Dr. Rajasinghe is the best physician in the country today. There are people who say that just visiting him will cure them of their illness, and he never prescribes strong drugs or make people spend unnecessarily on this scan and that scan and that test
I would like to meet this doctor Bhanu said.
He is not in Colombo now. He has gone back to his home town, Homagama. Why dont you see him at his clinic, next time you have any problem? was her advice.
But I never go to a doctor. I have no faith in them.
In this one you will have faith, once you see him.
There are always exceptions.
There had been money hungry physicians even in the past, even over two thousand years ago, who learnt a little medicine and practiced it because they were greedy for wealth Gunadasa said.
Please tell us about such people Bhanu pleaded.
These physicians would occasionally cure a patient, not by their skill, but because the patient was lucky or was not destined to die at that time. This would make the physician think that he can cure anyone and will make the best of it.
So how could they build up a practice?
They would go around talking about their own skills, about patients they had cured, and specially when they would hear of a wealthy person falling ill, they will make sure that the patient heard about him and would come to him.
So doctors have not changed for the last 2000 years Bhanu said, encouraged in her crusade when she learnt that there were others who shared her views.
Sumanadasa had to find the money to take her to the United States. He had been told that it was the best place to go to, for a transplantation of the liver.
It is the seventh leading cause of death in the States. They have developed all the advanced techniques he was told by a doctor.
It is going to cost a lot, air tickets would cost more than the treatment, probably.
Your problem would be to find a transplantable liver. It is getting difficult to find any cadavaric livers the doctor continued.
Then what are we to do?
I have heard of a new Bio Artificial Liver developed in the States. Initially it was meant only for temporary support. Let me find out if they have developed it any further so that it could give permanent support he told Sumanadasa.
You mean, my daughter would have to be linked to some kind of machine Sumanadasa was getting angry.
No. It is nothing like that. Anyway, let me get some more information.
Have you made an appeal for assistance from the Presidents fund the doctor asked him.
I dont have any connections with politicians Sumanadasa told him.
What has politicians to do with it? the doctor couldnt understand.
Do you think that without the right connections to a Minister or some other VIP, we could get any money from the Presidents fund?
Thats what it is meant for. To help people in their time of need.
No. To help THEIR people, in times of need.
But I have read and heard about so many cases where money from the Presidents Fund was given for overseas medical treatment.
I have also heard that.
So why dont you give it a try. Make an appeal?
I dont think it would help. Most of the Presidents fund goes to their own party supporters or those with right connections. I have heard of cases where children are given funds to study in America with the Presidents funds.
That was those days, and I think it was just one instance, where a very bright boy was given a scholarship.
No. It was well planned. First a built up in the papers of how clever and bright the boy was and all that, then how opportunities were so limited in our country for such a boy to advance his knowledge, and then suddenly you see the funds available.
But wasnt it a reasonable thing to do? the doctor asked.
Have you heard of this boy genius since then. What has he achieved in America? Has he come back to this country, where is he now? Sumanadasa said.
Just because one president did a thing like that, dont judge all Presidents in the same way.
I dont know.
Any way you have nothing to lose. You prepare a letter, I will help you to make all the medical reports ready the doctor persuaded trim and I am sure Raju will help you.
When Sumanadasa mentioned the subject to Raju, he agreed to prepare the letter and the documents and to forward the appeal to the Presidents Office.
You dont worry about anything. I will attend to everything Raju assured Sumanadasa.
Rajus mind went back to when he had first met Sumanadasa. He tried to
think back how many years ago, it had been.