Antibiotics: Myths Versus Facts

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DOES ANTIBIOTIC OVERUSE EXPLAIN “IDIOSYNCRATIC ILLNESSES”?

    The World Health Organization (WHO) has been engaged in a vigorous awareness campaign during the last few weeks to promote precautionary measures against “antibiotic overuse”. According to the WHO, the various idiosyncratic complaints flooding the world (especially Asia) today are a result of excessive reliance on antibiotics to cure every ailment. Some experts beg to differ. According to them, that might have been a problem when antibiotics were first invented & marketed en masse. But in today’s day, practically everyone – from the laborer to the doctor – in the Developing World is well aware of the importance of being careful to stick to the recommended methods of antibiotic usage.

    Take the common cold: In the Developed World, a patient stocks up on cough syrup & chicken soup, & in 3 or 4 days, all things being equal, he or she is almost completely healed. But things are more complicated in the Developing World, where a combination of dirty air, contaminated water, adulterated food & undernourishment together, mean that catching even the simplest of viruses automatically indicates the requirement of a course of antibiotics.

    As an illustration of this state-of-affairs, here are 3 examples from a day in the life of a Pakistani citizen (all narratives are true, but names have been deleted to protect the privacy rights of the people in question):

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The Shopkeeper’s Tooth

    An educated shop assistant needed to get a tooth extracted. He was absolutely healthy & the dentist attended to the matter smoothly. The dentist prescribed Brufen (Abbott’s Ibuprofen) for the pain & instructed the shop assistant to steer clear of any hard or dirty edible; the shop assistant complied. However, a day or so later, he developed a fever; the dentist insisted on the by-the-book approach & told him to keep taking Brufen & be patient. The fever rose & he began to get weaker. Eventually, the shop assistant was advised by another doctor to take a course of antibiotics; only after he started taking the new prescription, did he start feeling well again.

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The Doctor’s Kid

    A doctor’s child caught a cold. The doctor was a strong believer in avoiding the ill-effects of antibiotic overuse. The child was quite small (& undernourished, much like the majority of middle-class Pakistani children), & developed a high fever. The doctor did his utmost to treat the child’s condition with Calpol (GSK’s paracetamol for infants & children) & fluids, but in the end, a strong antibiotic had to be prescribed because the infection had progressed while the doctor was trying to steer clear of antibiotics.

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A Drink Of Water

    The water in Rawalpindi stinks. This isn’t a metaphor for “dirty water”, it actually stinks – especially in summer. All the boiling in the world can’t drive away the strong bitter taste & the horrible stench of hydrogen sulphide. The situation is so bad in the city, that the common man can’t decide whether suffering from thirst is a bigger punishment or actually drinking the water is. To make things worse, the only option is Nestle’s bottled water; but not only does it cost a pretty penny, the supply can be spotty sometimes (much like the supply of every other basic necessity in Pakistan). While people have eventually broken their natural human instincts to recoil in disgust at what passes for potable water, they still need to keep under antibiotic cover before they die of drinking the water!

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The WHO is technically correct to assert the importance of using antibiotics with care; but, what is the definition of “care” in a country blanketed in PM2.5, chemical pollution, biological experimentation & harmful radiation?

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BIG PHARMA’S BIG REVENUES

    Logic dictates that waiting for governmental research & development organizations to come up with an efficient solution to the problem of idiosyncratic illnesses is an exercise in futility. As the recent Paris Climate Agreement has proved to the entire world, it is impossible to sign an agreement without the cooperation of all sovereign nations & it is unsustainable to implement the agreement without the full cooperation of the private sector. Given below are the top 10 pharmaceutical companies (in alphabetical order) operating in Pakistan, along with some relevant financial details:

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1. Abbott Laboratories

    Founded by Dr. Wallace Calvin Abbott 127 years ago in Illinois, US, as the Abbott Alkaloidal Company, Abbott serves the global market for branded generic drugs, medical devices, diagnostic assays & nutritional products. According to 2014 statistics, it made a revenue of US$20.247 billion, operating income of US$2.599 billion, net income of US$2.284 billion, total assets of US$15.261 billion & total equity of US$41.275 billion. As of 2015, it employs 73,000 worldwide.

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2. Boston Scientific Corporation (Pakistani Distributors: Ferozsons Laboratories)

    Founded 36 years ago in Massachusetts, US, Boston Scientific is a worldwide developer, manufacturer & marketer of medical devices, whose products are used in a range of interventional medical specialties, including interventional radiology, interventional cardiology, peripheral interventions, neuromodulation, neurovascular intervention, electrophysiology, cardiac surgery, vascular surgery, endoscopy, oncology, urology & gynaecology. According to 2014 statistics, it made a revenue of US$7.38 billion, operating income of US$299 million, net income of US$267 million, total assets of US$16.83 billion & total equity of US$16.83 billion. As of 2011, it employs 24,000 worldwide.

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3. Getz

    Founded 20 years ago in Karachi, Pakistan, Getz produces Uniferon (Interferon), Ribazole (Ribavarin) & Asacol (Mesalazine); financial information is unavailable, but the company is obviously firmly solvent, judging by the fact that it has the financial strength to employ 3,000 workers.

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4. GlaxoSmithKline

    GSK came into being 15 years ago as a result of a merger between Glaxo Wellcome (formed from Glaxo’s 1995 acquisition of Burroughs Wellcome) & SmithKline Beecham (from the 1989 merger of the Beecham Group & the SmithKline Beckman Corporation). It is a leading manufacturer of pharmaceuticals, vaccines, oral healthcare products, nutritional products & over-the-counter medicines. According to 2014 statistics, it made a revenue of US$34.9 billion, operating income of US$5.4 billion & net income of US$4.2 billion. As of 2015, it employs 96,575 worldwide.

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5. Johnson & Johnson

    Founded by brothers Robert Wood Johnson, James Wood Johnson & Edward Mead Johnson 129 years ago in New Jersey, US, J&J is a highly reputable brand in the medical equipment & pharmaceutical sectors. According to 2014 statistics, it made a revenue of US$74.331 billion, operating income of US$20.563 billion, net income of US$16.323 billion, total assets of US$131.119 billion & total equity of US$69.752 billion. As of 2014, it employs 126,500 worldwide.

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6. Merck

    Founded by Friedrich Jacob Merck 347 years ago in Darmstadt, Germany, Merck is an established producer of liquid crystals, life science & performance chemicals, over-the-counter medicines, small molecules & biopharmaceuticals. On account of the private policy encouraged by the Merck family, financial details are sparse, but according to 2014 statistics, it made a revenue of US$12.271 billion, & as of 2015, employed 39,842 worldwide.

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7. Novartis

    Novartis was born of a merger between the pharmaceutical & agrochemical divisions of Ciba-Geigy & Sandoz 19 years ago. It produces a wide range of products in the categories of pharmaceuticals, generic drugs, over-the-counter drugs, vaccines, diagnostics, contact lenses & animal health. According to 2014 statistics, it made a revenue of US$53.63 billion, operating income of US$11.08 billion, net income of US$10.21 billion, total assets of US$125.38 billion & total equity of US$70.76 billion. As of 2014, it employs 120,000 worldwide.

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8. Pfizer

    Founded by Charles Pfizer & his cousin Charles F. Erhart 166 years ago in New York, US, as Charles Pfizer & Company, Pfizer produces a range of at least 50 separate drugs that cover practically every disease known to man. According to 2014 statistics, it made a revenue of US$49.605 billion, operating income of US$12.240 billion, net income of US$9.135 billion, total assets of US$169.274 billion & total equity of US$71.622 billion. As of 2013, it employs 78,000 worldwide.

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9. Sanofi

    Founded 42 years ago as a subsidiary of Elf Aquitaine (a French oil company subsequently acquired by Total), when Elf Aquitaine took control of the Labaz group, a pharmaceutical company, Sanofi is an industry leader in prescription & over-the-counter drugs for thrombosis, cardiovascular disease, diabetes, central nervous system disorders, oncology, internal medicine & vaccines. According to the latest statistics, it made a revenue of US$36.61 billion, operating income of US$6.66 billion, profit of US$4.76 billion, total assets of US$104.16 billion & total equity of US$61.68 billion. As of 2013, it employs 112,128 worldwide.

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10. Searle

    G.D. Searle, LLC is a wholly owned trademark of Pfizer. It is currently used mainly as a distribution trademark for various pharmaceuticals that were developed by G. D. Searle & Company (often referred to as Searle). Prior to its 1985 merger with Monsanto, Searle was a company focusing on life sciences, specifically pharmaceuticals, agriculture & animal health.

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KHYBER PAKHTUNKHWA PROVINCE’S NEW HEALTH INSURANCE PROGRAM

    December brought an interesting New Year’s gift for the people of Khyber Pakhtunkhwa (KP) Province: German Government-owned development bank KfW announced that it would provide a stipend of PKR25,000 (approximately US$240) per annum to every poor person in the province to pay his annual medical bills. Most experts didn’t know what to discuss first: the purity of intention or the inadequacy of effort. At the rate of around PKR2,000 per month, this stipend would barely pay for the medicines needed to treat a case of the sniffles!

    Nobody expects the German Government to know how hard & expensive it is for the average Pakistani to keep body & soul together. Add the responsibility of looking after a family, & the result is usually the loss of either the body or the soul. Making sure that the right resources in the right quantities go to the right parties is the mission of the WHO. It is hoped that it takes the proper level of interest in this experimental project before suffering, misunderstandings & bills start accumulating for the already-overburdened Pakistani citizenry.

 

 

Food Security = National Security

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HENRY KISSINGER WAS RIGHT

    “Control the food & you control the people.”

    Deprived of air, a human being will die in minutes; deprived of water, in days; of food, in weeks. But air & water are so abundant, that dying of a lack of these items is a relatively rare occurrence. The real horrors unfold in the food sector.

    But the purpose of this analysis is not to revise for the millionth time the horrifying statistics pertaining to how a Developing World child under five dies of hunger every ten seconds. This discussion focuses on the (relatively ignored) other half of the picture: How is it possible that global hunger is progressing unhindered since decades, but the agriculture & food production companies continue to make handsome annual revenues?

    Economics 101 dictates that if a product does not have a large customer pool, its price will plummet until marketing it will not be commercially viable. That would indicate that agriculture & food production companies would be the private sector parties most invested in eradicating hunger. But there is another principle taught in Economics: goods that are essential to sustaining life, known as inelastic goods, must be carefully regulated by the national & international authorities so that private sector actors do not take unfair advantage of their importance & raise prices prohibitively high.

    Now let’s assume that the various national & international authorities have been doing their jobs; the principle upon which they would regulate the private sector would be based on the minimum food necessary to sustain the life & health of the population. This figure varies from nation to nation. For instance, everyone knows that the average American consumes a far higher quantity & quality of food per day than the average Pakistani. Therefore, the statistics of what constitutes a healthy diet would vary from region to region. However, the discrepancy between Eastern & Western standards is gradually narrowing. There was an article in a financial magazine a few years back, which was devoted to discussing the causes of the steady increase in world food prices; the author posited that the trigger behind the current situation was the increasing standard of living in large Developing World nations like China. The author regretted the fact that the Chinese are getting richer & consequently demanding higher & higher standard food for themselves & their children; according to him/her, this was creating an extremely high demand for American standard food & was consequently driving food prices up. In effect, the idea was that before Asia started considering it a right to have access to the same quality food as Europe & the US, the agricultural & food companies made a huge profit by selling lower standard food at exorbitant prices in the Developing World in order to keep the price of good quality food in the Developed World within reasonable limits.

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THE NEW FOOD SECURITY CHALLENGE

    The fact that the standards of the Developing World are slowly improving is cause for great joy & celebration. But just like in other areas of life, you triumph over one obstacle, you know it is time to start identifying the next one. Business is a highly competitive arena. Canadian businessman Kevin O’Leary summed up the sentiment of the financial world very well when he said the following words,”Business is war. I go out there, I want to kill the competitors. I want to make their lives miserable. I want to steal their market share. I want them to fear me and I want everyone on my team thinking we’re going to win.”

    The problem is that some executives take his words too literally. Financial analysts who specialize in the food sector have noted the rise of a new challenge: The interference in the desire for food. Will the authorities mind what the private sector does with a given shipment of edibles if the parties for whom it is legally intended can’t eat it? The current answer is: no, they won’t. This is a disconcerting conclusion, especially if it has any link to a strange situation that has started spreading across the Developing World nations of Asia during the last decade or so. People are losing the desire to eat. As any competent doctor with a respectable practice can verify (if he doesn’t fear for his life or the life of his loved ones), people literally aren’t being allowed to eat in peace. Every time they sit down to a meal, something happens that they either can’t eat or they can’t retain food.

    Some of the complaints that interfere with the peaceful ingestion & digestion of food (considering that they come about mostly at meal times & affect people who have been medically tested countless times & been declared absolutely healthy) that are currently sweeping across Pakistan are as follows:

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Pressure To The Head, Neck & Shoulders – Followed By Bruising

    One increasingly common complaint in Pakistan, is that the victim is sitting calmly & busy with some activity (it is irrelevant whether it is work, recreation or relaxation) when he/she suddenly gets the sensation of heavy pressure being repeatedly felt on various parts of the body, particularly the head, neck & shoulders – as if somebody is physically attacking & hitting him/her! But there is nobody there. Victims can actually see the bruises forming on the assaulted areas! Ghosts? Ridiculous. Insanity? The victims are all intelligent & 100% sane in all respects.

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Idiosyncratic Gum Swelling & Random Toothache

    In today’s day, there is hardly anybody who doesn’t know the rules of maintaining dental health: Brush, floss & make sure to eat items that contain the necessary nutrients. However, an increasing number of patients are visiting dental clinics all over Pakistan because their gums start swelling (& shrinking) of their own accord, their teeth start (& stop) paining without any trigger, even though they have no oral infection & their teeth aren’t sensitive. The dentist can’t account for the problem & – if he wants to increase his/her income – suggests dispensing with teeth altogether & donning dentures.

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Intense Muscle Spasms

    The muscular system is the root of our ability not only to move, but even to carry out bodily functions. This covers every activity the human body is capable of, be it autonomic functions such as blinking, breathing, swallowing, digestion, urination, defecation, etc.; or voluntary functions such as chewing, talking, laughing, moving, etc. Excessive stimulation as well as excessive debilitation of various muscle groups can cause serious health complaints & can even prove fatal. Examples of chemical triggers are curare & black widow spider venom. Exposure to different frequencies of sound has been proven several times to play an effective role in interference in muscular function (partly based on the principles of resonant frequency).

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Sudden, Persistent Choking Sensation

    Choking is either a signal that some foreign item is entering the trachea (which closes to prevent such an outcome) or anaphylactic shock (generally as a result of food allergies); these problems are addressed by coughing or medical attention. What is the name of a phenomenon where the victim is not eating, drinking or talking & doesn’t have any allergies, but suddenly starts feeling a choking sensation – which all the coughing, anaphylaxis treatments & Heimlich maneuvers in the world don’t seem to relieve.

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Jaw Muscle Spasms

    People with head injuries or epilepsy are susceptible to seizures, during which they can unconsciously clench their teeth & often bite their tongues. What is the explanation for a sudden jaw spasm that results in the otherwise perfectly healthy victim biting either the tongue or the inside of the cheek while wide awake, absolutely alert & completely calm?

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Respiratory Muscle Spasms

    A common complaint since some years is the feeling as though the respiratory muscles in the chest & abdomen have somehow slowed down. Sometimes, this phenomenon is accompanied with a sort of “jolt” in the chest or abdomen. Blood pressure? Normal or low. Health in general? All right. So, what could trigger this strange sensation?

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External Pressure On The Nose

    As children, we have all played games where we pinched our noses closed & made funny voices. What can cause the nose to visibly get pushed partly closed on its own, not allowing the victim to breathe comfortably?

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Sudden Nausea

    Everybody is well acquainted with the natural instinct to salivate & feel hungry (even if one has just eaten) on catching the aroma of a favorite dish. What can account for feeling nauseated at the sight or smell of any & all foods & drinks, no matter how hungry one is & how much one wanted to eat or drink that very item just a second earlier? Aversive conditioning? Only possible after months of professionally-supervised practice & with only a select inventory. Anorexia? Only possible with a victim who is obsessed with personal appearance.

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Intestinal Muscle Spasms

    While the role of the stomach is given the greatest attention, the digestion of nutrients & separation/evacuation of waste products is handled (to a great extent) by the intestines. The intestines are basically muscles; therefore, if they are exposed to vibrations, they can start intermittently “malfunctioning”, thereby causing problems in absorption or evacuation (either expelling nutrients & fluids or retaining waste products). However, no matter how many doctor visits the patient makes or how many drugs he/she takes, the problem will persist as long as the exposure to unhealthy frequencies continues.

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WHO PROFITS?

    As the recent fiascos with companies like Valeant & VW have amply proven, rogue executives with over-ambitious financial plans can have a very detrimental effect on the hard-won reliability of a brand name. The lesson learnt is that rotten employees always come back to haunt the companies that hire them. As indicated earlier, the two sectors that stand to gain the most from artificially controlling the global consumption of different varieties of food, are the agricultural companies & the food producers. Given below, is a Top Ten List in both sectors:

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Agriculture (Courtesy www.insidermonkey.com)

BASF

    BASF stands for Baden Aniline & Soda Factory. They are one of the top producers of chemical products for different industries. For agriculture they produce most pesticides & herbicides. They also create products like ammonia, sulphuric acid, dyes, soda & plastics. They also have more than 100,000 people under employment.

AVEBE

    AVEBE is a cooperative with more than 2,500 members included. They mainly produce starch products out of potato starch. These starch products have a lot of applications like food, construction, adhesives & paper. They have factories in the Netherlands, Germany & Sweden.

Archer Daniels Midland

    One of the largest food-processing companies, Archer Daniels Midland specializes in grains & oilseeds. They are based in  Chicago & have more than 600 production facilities worldwide. Most of their products are ingredients used for the food & beverage industry.

Alico Incorporated

    Alico Incorporated is another American agriculture business included in this list. They mainly ship citrus & cattle. The total farmland they have is on an average 100,000 acres. They also extended their services to the protection of natural resources.

Alberta Wheat Pool

    Alberta started as a cooperative in 1923. It was comprised of wheat farmers from different parts of Canada. Since then it has been on a number of mergers since the 2000s. They’ve had around a total of 3 mergers since 2001. The last merger made them a farmer-owned cooperative no longer. The current corporation goes under the name Vittera.

Agrium

    Headquartered in Canada, Agrium is one of the largest distributors of agricultural products & services in the Americas & Australia. They ship a lot of specialized fertilizer to North America. They also have a variety of fertilizers to choose from, some of which have been scrutinized because of bad chemical effects.

AgriSA

    AgriSA stands for Agri South Africa. It is an association made up of commercial agricultural producers & businesses. They represent around 70,000 farmers in the region & have a number of divisions each managing a sector of their agricultural business.

Agria Corporation

    Agria Corporation is a global Corporation handling different facets of the sector. The main products they produce & ship are seeds & grains. They also sell farm materials & other farm products. They even have a branch that handles wool & livestock trading.

Adler Seeds

    Named after the original founder Howard Adler, the company would later merge with Kelly Farms & be named Adler Seeds. As their company name denotes, they mainly handle the production & distribution of seeds worldwide. They are currently headquartered in Indiana.

Adecoagro

    The leading agriculture & industrial company in South America, their products range from different food products to bio-electricity. A few of their goods include rice, milk & sugar.

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Food (Courtesy www.marketwatch.com)

Associated British Foods PLC

    Associated British Foods is a U.K. food manufacturer that has built out a global presence largely through acquisitions. Associated British Foods operates sugar factories, sells food ingredients to wholesale & industry customers, & manufactures consumer products such as Mazola Corn Oil & Twinings Tea. According to Oxfam, the company received low marks for its practices in water use, having failed to conduct impact assessments, while also failing to adopt strong practices in managing its water supply chain.

The Coca-Cola Co.

    Coca-Cola is among the most valuable brands in the world. In total, Coca-Cola & its bottlers sold 28.2 billion cases worth of drinks, of which 47% were “trademark Coca-Cola”. In total, sales for The Coca-Cola Co. were nearly $47 billion in its latest fiscal year. Overall, The Coca-Cola Co. scores well for some practices, including addressing inequality for women working in production & supporting female empowerment for workers in its supply chain. The company is also well-rated for its land-management practices.

Groupe Danone S.A.

    France’s Groupe Danone has a truly global presence. Its largest market, by sales, is Russia, followed by France, the U.S., China, & Indonesia. According to the company, Danone is the world’s largest seller of fresh dairy products, which accounted for 11.8 billion euros in revenue, or over half of the company’s total sales in 2013. Danone is also among the world’s largest sellers of early life nutrition products & bottled waters. Danone received high scores for its policies in a number of major issues, including transparency & managing water resources. However, the company also received low scores in other policies, including its handling of land & farming issues. Danone received the lowest score of any company from Oxfam for its policies regarding women’s issues in agricultural production.

General Mills, Inc.

    General Mills owns some of America’s best-known brands, including Betty Crocker, Green Giant & Pillsbury. No company received a lower rating from Oxfam for its overall approach to major policy issues. General Mills had the lowest scores in awareness & policies regarding climate change. Recently, however, General Mills announced new initiatives designed to reduce greenhouse gas emissions in its supply chain. As part of the announcement, General Mills also pledged to implement specific emissions targets, to review supplier practices, & to name its largest suppliers of palm oil & sugar to improve transparency.

Kellogg Co.

    Among the top food companies, Kellogg is the smallest by revenue. Still, as of 2013, the company had nearly $15 billion in sales, a similar amount in total assets, & more than 30,000 employees. Kellogg also owns a large number of very well-known brands, including Kellogg’s Cereal, Keebler, & Pringles, which it acquired in 2012 for $2.7 billion. According to Kellogg, it is the world’s leading cereal company & the second-largest maker of cookies. In all, Kellogg makes 1,600 different foods, which it sells in more than 180 different countries. Kellogg received a lower overall rating from Oxfam for its practices than all but two of the other ten companies. However, in a recent release, Oxfam praised Kellogg for its pledge to cut greenhouse emissions in its supply chain.

Mars, Inc.

    Mars is the only one of the world’s ten largest food companies that is privately owned. Mars owns several well-known chocolate brands, such as M&Ms, Milky Way, Snickers & Twix. Mars also owns a range of food brands such as Uncle Ben’s Rice, as well as chewing gum & candy-maker Wrigley. Among the Big Ten global food companies, Mars received the lowest policy ratings for water & land issues. In both cases, Oxfam penalized the company for its lack of knowledge of its environmental impact, as well as for its supplier policies.

Mondelez International, Inc.

    In 2012, Kraft Foods split into two separate companies, Kraft Foods Group & Mondelez. While Kraft Foods Group took North American grocery brands, Mondelez took its snacks & candies brands, which include Cadbury, Nabisco, Oreo & Trident, among many others. The company had more than $35 billion in revenue & more than $72 billion in assets as of last year. It also employed 100,000 workers worldwide. According to Oxfam, Mondelez received low marks for its transparency, as well as for its handling of issues related to climate change & workers.

Nestlé S.A.

    By many measures, Nestlé is the largest of the ten food companies, with more than 92 billion Swiss francs in revenue last year — net profit & total asset figures that dwarf other food companies — & roughly 333,000 employees. Nestlé is also the top-rated company by Oxfam for its approach to major policy issues. It received the highest scores for addressing transparency, water use, & climate change of any major food company. In its 2013 report, Oxfam highlighted Nestlé’s efforts in addressing labor abuses the company discovered in its cocoa supply chain in the Ivory Coast.

PepsiCo Inc.

    In addition to owning famous soda brands such as Pepsi, Mountain Dew, & Gatorade, PepsiCo also controls food brands such as Tostitos, Doritos, & Quaker. PepsiCo also employed nearly a quarter of a million people worldwide at the end of 2013. Pepsi was among the world’s biggest advertisers. Advertising Age estimates that PepsiCo’s worldwide media spending totalled $2.5 billion in 2012. According to three groups that measure brand value — Interbrand, BrandZ, & CoreBrand — Pepsi is one of the world’s most valuable brands in any industry. While PepsiCo received a lower score on policy issues than three other companies reviewed by Oxfam, it has developed a reputation for company responsibility in at least one area. CEO Indra Nooyi has pushed for healthier products in her time at the helm of the company.

Unilever Group

    Unilever products are hardly limited to food & drinks. The U.K.- & Netherlands-based group also makes personal care & home care products. Still, its foods & refreshments businesses accounted for almost 23 billion euros of the company’s nearly 50 billion euros in revenue last year. Brands owned by Unilever include Lipton Tea, Hellmann’s Mayonnaise, & Ben & Jerry’s Ice Cream, to name only a few. Unilever generally scores fairly well for its efforts in addressing policy issues. Oxfam rated it above all other companies for its worker & farming policies. Only Nestlé received a higher overall rating for its handling of the issues highlighted by Oxfam.