“But that’s no fair” my kids said in unison. It was one of those days when they were bickering about something and I took their electronic privileges away. I said “Life is not fair, little baby penguins get eaten by killer whales”. My daughter said “What does that mean anyway?” So I proceeded to tell them about predator and prey. It is true that life is not fair. But in the wild it is Nature’s way of ensuring the survival of the fittest. Even in our day to day lives, if you are not better than someone else, you don’t make the team or you don’t get the promotion. Now I agree that in some instances, people who actually deserve to make the team or get a raise don’t. But for the most part, survival of the fittest holds. You know the joke where they say you don’t have to run very fast to get away from a bear, you just have to be faster than the other guy. Years ago, I was in an organization like the ROTC. We were all competing to go to paratrooping camp. Unfortunately, there were 4 slots and I was the fifth. Guess what, I could not go to the camp. I felt bad, but that was how it all went. I tell our kids to develop a thick skin and not to be oversensitive. I also tell them that when someone criticizes you or gives you negative feedback, look at who it is. Is it someone that cares about them like a parent or a teacher or a mentor? In that case, take the criticism seriously. But if it is someone that does not care about them, a stranger or a student in school forget it and move on. Life is too short to dwell over little things. Also in your professional life, your job etc, there are going to be bad reviews, or layoffs. It may be personal or it may be business related. You have to suck it up and move on. The first time I got laid off from a job was at the end of January 1995. At about the same time, my father passed away. I was reeling from one shock and got a second one. But my employers did not feel sorry for me. In fact my supervisor called to convey his condolences, but then said “can you please help me with something before you leave, I am swamped.” I went in to work, helped my supervisor, did my exit interview and caught a plane in the evening to be with my family. Do you think my employer was unfair?

Children get trophies for participation. They don’t keep score in games. Every team makes the playoffs. Are we sheltering our kids to become gutless, spineless adults who expect someone else to fight for them? I always wonder if we are preparing our younger generation for the real world where there is fierce competition, there are no points for second place and life is not fair.

Hi everyone, before I provide additional information, I would like to mention that I have worked in the pharmaceutical industry for 18 years and I have seen the drug development process from up close. So my view may be biased. I will try to be neutral and present the facts. Also it should be noted that my thoughts on this subject do not represent the views of my company. I started writing books and this blog to express my thoughts. The first amendment gives me the right to freedom of speech. I want to be true to you, my readers, true to the topic at hand and finally true to myself. In doing so I am going to choose thought provoking topics that may not sit well with everyone. I am not going to beat around the bush or walk on eggshells on such topics.I am going to choose examples to get my point across. This is not fiction, but real facts about people and issues.

Okay, now that the disclaimer and disclosure is out of the way, let us delve into this issue. Back in mid-September, Turing Pharmaceuticals and it’s CEO came under a lot of fire for raising the price of their drug Daraprim by 5,455% i.e. from $13.50/tablet to $750/tablet. The company cited R&D costs as one of the main reasons for the price increase.

According to many estimates, the cost of bringing a new drug to market is $2.6 billion and it takes 10-15 years. When the drug is discovered, the company applies for patent protection and patents last for 20 years. But given that the company spends so much time and money, it essentially has about 5 years to recoup their cost. Consider the fact that the company is working on more than one drug at a time. It has to go through several stages of development. Actually, I have covered this in my book Taming Ebola. You can find it at http://www.amazon.com/Taming-Ebola-Aniruddha-Railkar-ebook/dp/B00PM1HJMY/ref=sr_1_1?ie=UTF8&qid=1445350572&sr=8-1&keywords=Taming+ebola. So I will not cover it here. But one out of 10 new drug candidates are successful. Sometimes drug candidates fail in later stages and the company cannot recoup their costs at all. For existing drugs that are off patent, cheaper generic versions can be obtained, but even developing a generic drug can take 2-3 years and $10-50 million. So generic drug manufacturers also have to recoup their costs. Unlike an innovator, there may be many generic drug manufacturers for one drug, therefore their margins are very thin.

Drug pricing is also determined by supply and demand, the effectiveness of the drug and other factors as well. For example there are certain diseases that affect a very small number of the population. Obviously, the per unit cost of such drugs is high. Some drugs can cure the disease, while some can slow the progression. For some diseases, there is no cure, but the patients still have to be treated. Another factor is reimbursement by insurance companies. In the US, the private insurance companies as well as government programs cover many drugs and so the out of pocket costs for the patient are less. But in Europe, many drugs are covered by government programs and it is fairly common for them to exclude some drugs off their formulary. But that means some life saving drugs will not be available to everyone. Companies do negotiate prices to make it more attractive for governments to put the drugs on the formulary. This trend is catching up in the US. Pharmacy Benefits Management (PBM) companies like Express Scripts and CVS are negotiating discounts for their members. Recently, Gilead Sciences got approval for a dug that completely cures Hepatitis C. The cost: $84,000/year. The previous treatment was a combination of two drugs: interferon and Ribavarin. The cost: $1,500/year. The cure rate: 50%. CVS made a deal with Gilead. But Express Scripts refused. Instead they made a deal with Gilead’s competitor Abbvie. Lawmakers in the US have challenged the prices and written letters to Gilead management. So far no success. I realize that people who cannot afford medicines or do not have good insurance coverage, should not have to choose between putting food on the table and buying medicines. But I feel we need to look at more than the economics. Given a choice between 100% cure and high cost versus 50% cure and low cost, is that worth a chance? What about costs of hospitalization or an organ transplant? Can you put a price on the amount of time with loved ones and improved quality of life?

Hi everyone. As I said, I will try to post something about health, wealth and wisdom. I also hope to publish on a regular basis (once a day, once a week or once a month) but not sure. Please provide suggestions on the frequency of my posts.

Today’s post is about health. For those in the US, I am sure you heard about a former basketball player, Lamar Odom being hospitalized and is now in critical condition. I hope he makes a recovery. But one of the culprits in Mr. Odom’s medical problems was reportedly a dietary supplement which is like an “herbal Viagra”. I am sure Pfizer is not too happy about that comparison. However, this does put the whole issue of dietary supplements under the spotlight. According to an article on Yahoo (https://www.yahoo.com/health/dietary-supplements-send-23000-to-the-hospital-115936324.html) approximately 150 million Americans take dietary supplements. It is a $14.8 billion, yes billion with a “b”, industry. In the US, dietary supplements are not regulated by the Food and Drug Administration. Every year, 23,000 people are hospitalized due to dietary supplements. But the cause for concern is that 21.6% of those cases are children. Obviously, the supplements were not stored properly and were within reach of children. Some of the most popular dietary supplements? You guessed it- weight loss and sexual enhancement. Out of the 23,000 cases, weight loss supplements resulted in 3,339 cases in women and about a third of that in men. On the other hand 567 cases in males were related to sexual enhancement products and 368 cases were attributed to body building products. Corresponding numbers in women were virtually non-existent.

If you are taking or considering taking dietary supplements, please consult your doctor first. If your doctor is okay with it, don’t exceed the recommended dosage hoping for faster results. If possible, do a search on the ingredients, especially the one that is the “active” ingredient. See if any of those ingredients will interact with existing medications that you may be taking. If possible, buy supplements from manufacturers that have been certified by some organization (I am not trying to endorse a particular manufacturer, but I am sure you have seen the commercials).Finally, most importantly, please keep any and all supplements out of reach of young children.

Hi all, Yesterday I asked you what topics you would like me to address, a good friend suggested writing about stepping out of ones comfort zone. So here goes, Last night I was watching Dancing With The Stars (DWTS), In this show, a male or female professional ballroom dancer is paired up with a female or male actor respectively. This year the youngest star. Bindi Irwin, the daughter of the late Crocodile Hunter. Steve Irwin. is 15, The oldest star is celebrity chef Paula Deen. who is 68, Former contestants have been astronaut Buzz Aldrin, Apple co-founder Steve Wozniack, Also wounded Iraqi war veteran, Noah Galloway. who lost one arm and one leg. Jose Renee “JR” Martinez. who suffered severe burns while serving in Iraq and double amputee Olympic snowboarding champion, Amy Purdy, JR won his season of DWTS, Noah Galloway wanted people to know that he is more than a guy without an arm and a leg; and Amy Purdy thinks that the only disability is the one in your mind, All these dancers have one thing in common, They stepped outside their comfort zone and did something completely different from what they were used to doing. On a trip to Cancun a couple of years ago, I stepped out of my comfort zone. I don’t know how to swim, But I wore a life jacket and jumped into a sink hole 30 feet deep, I was not sure if I could find the courage to do so. I did have a life jacket, but when I jumped, it almost came off, Anyway, after I jumped, I felt free, terrified, but free. So my friends, step out of your comfort zone and do something different that makes you uncomfortable.