The Pharma Conundrum? Is the world getting any healthier?

What are the world's largest selling drugs? 

Total Prescription Drug Market - 750 Billion USD 

Top Ten Drugs = ~ 75 Billion 

Humira - Rheumatoid Arthritis 
Seretide - Asthma 
Crestor - Cholesterol 
Enbrel - Plaque Psoriasis / Rhematoid Arthritis 
Lantus - Diabetes 
Nexium - Acid Reflux 
Abilify - Bipolar / Schizophrenia 
Remicade - Autoimmune Diseases / Rheumatoid Arthritis 
Cymbalta - Depression 
Mabthera - Transplant Rejections / Leukemia 

Ponder over the list, I want to give you some time to look at the list, check the nature of the market, the top selling drugs ~ Looks like a pattern to me... Do you see it? 

There is some profound things to be understood here and medicine does not stop with so called Allopathic formulations...

So yoga the cure for all?

If somebody thinks Yoga is just exercise it is just wrong or that is all that they understand of Yoga as an exercise of contortionists. The yoga that is popular is just the Hatha Yoga, what about the others that also includes medicine.

Modern medicine is diagnostic in nature and is never holistic, and definitely it has brought in many benefits and improved our understanding of how our body works, but it is more addressing the local causative agents,, but there are alternates.

Similar to having a pain reliever to a pain killer, reliever may not give you a immediate cure but takes a while, but suppressing pain in the case of the killer, is just straining the body and numbing it not to know the physical symptoms.

Newer studies have clearly shown that many aspects of pain management or specific response to stimuli (Caused by bacterial, viral infections) are better managed by mind over body.

http://cbc.ucsd.edu/ramabio.html

A very interesting take on the functioning of the brain.... Read Ramachandran's book, you would have a new insight about how brains can do wonders to cure your ills, whether it is by a foreign body like a Virus or a bacterium or just malfunctioning part.

What about Indian medicine? Is allopathy better than other forms of medicine?

This from Huffington post, just to let you know about the side effects.... many a times we see that they side effects include "Death"

Americans may assume that the fine print in a drug's packaging represents the collective scientific knowledge about that medication, allowing doctors and patients to make informed health care decisions. In fact, negotiations between pharmaceutical companies and the FDA over warning labels are common during the drug approval process, with drugmakers endeavouring to cherry-pick what's included in order to present their products in the best possible light.

http://www.huffingtonpost.com/2013/12/18/nuvaring-blood-clots_n_4461429.html

There are eight apex research institutions in India on Ayurveda

http://www.nia.nic.in/

They have the prescriptions and the databases 
http://ccras.nic.in/

They are the ones researching in Panchkarma, as it is popular in Kerala.

Innovation! Is it stifled in India? Does Mergers and Acquisitions by foreign corporates help?

Fact one, Innovation need seed money and much more and an environment that nurtures such a culture. Does dollars from abroad help in it.. It is definitely an yes.

It is also a fact that I can sell products to the world, that same product may have no applicability to the Indian context. How would you sell for example e-prescription services to Indian doctors when we as a nation have not much called as medical records? or pharmacies that are fully networked?

Innovation does not develop in vacuum, it needs the funds, the resources human as well as the industry and the market to take them to fruition. It is like saying every patent would make money, most do not, similarly there are a thousand ideas that may not see its chrysalis moment just because of timing issues. Typical cases, e-learning on bandwidth that leaks than gushes. The idea is cool , but never would see the light of the day.

Greed is good, why would I innovate? There are different types of innovation, the one that is done at the grass roots level or in rural India (Which the Urban elite would never see), but these are path breaking innovations, which helps us with keeping our tables full.

We have a tendency to think that innovation is lasers, electronics, large data centres and compute power. Innovation is a beautiful concept that comes out of crazy places, the Mitticool refrigerator is as much an innovation as the big analytics algorithm that flipkart uses.

http://www.rtbi.in/

The research cell does wonderful work bringing innovation to rural areas. The problem many a times is that of the media, innovation is mostly iterative and grows in steps and very few are the bang that we see out of the blue.

To build an environment where innovators survive is important for a country like India to thrive, a country of more than a billion and a few big ticket purchases from foreign shores for these innovators, what does this lead to... Money is a great leveler, people need it and the more they see their brethren making the moolah, you will have a deluge of people who wants to emulate the model, well if it triggers a problem of plenty would we complain?

A good take from across the world about how different countries fared with foreign M&A

Trade is done with the major reason of making a profit, if we leave out the few that have more social function, the reason to trade is to make a profit.

As a country , India needs to be clear as to what is the outcome of allowing for M&A, wherein Indian corporates venture out and buy up other organizations or vice-versa.

Reading through some of the research material it looks like we as a country need to ensure that our objectives and goals are clear, for example..

Are the policies favourable for Indian corporates to buy up foreign firms with the intent to have the economies of scale that would accrue back to the parent company.. A case of Renuka Sugars buying Brazilian sugar mills to cover for a longer crushing season and to cater to the growing sugar and ethanol market in India and Brazil.

We can also talk of Hindalco take over of Novelis , or Airtel ventures into Africa, Tata with JLR or Corus. We can take these examples to see how they have fared. Tata JLR is reaping profits for them when the Indian market is dull for Tata Motors whereas Corus forced a 1.6 billion write off for Tata Steel.? Tata is a great example of two different cases of M&As.

The below are some content from the Internet that would give you a lot of insights....

An interesting study in the UK says that productivity gains due to foreign take overs are positive. This is a bit dated study but check the fact that UK being one of the OECD sees the differential, think of the differential that it can bring about in a country like India.

http://www.jstor.org/discover/10.2307/3569775?uid=3739728&uid=2129&uid=2&uid=70&uid=4&uid=3739256&sid=21104129456771

The study below talks on the positive effects of a takeover on the stock prices of the company being taken over with the impact being significant in developing markets

http://www.ifc.org/wps/wcm/connect/e63a830048a7e593a277e76060ad5911/impact%2Bof%2BUS%2Btakeovers%2Bin%2Bforeign%2Bmarkets-their%2Bdifferential%2Beffects%2Bon%2Bemerging%2Band%2Bdeveloped%2Bmarkets_Natasha%2BBurns.pdf?MOD=AJPERES&CACHEID=e63a830048a7e593a277e76060ad5911

Another positive take on the legal profession as Internal legal firms peddle their wares in India and the move to positively impact

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2344272

The below is a study on the positive impact of M&A on the book value of Indian corporates.

http://www.igidr.ac.in/money/mfc-13/MERGERS%20AND%20ACQUISITIONS%20IN%20INDIA.pdf

This is an interesting take on why mergers do happen and talks about mergers and take overs from a country like OECD and India and US and Europe. The advantages, the reasons thereof and welfare options available.

http://www.econstor.eu/bitstream/10419/72323/1/386330220.pdf

Is a Merger Good or Acquisition Good?

Differentiate between Mergers and Acquisition. 

When Google paid for Motorola, the reason was not the large manufacturing capability but the patents. That is a full acquisition. 

Mergers are more done between equals, a thing that comes to mind is Compaq and HP. Well Compaq was killed eventually but was more considered a merger at that time. Similarly can we call Chrysler being a subsidiary of Fiat? or is it more like a merger? 

Many a times the purchase is to kick start a fledgling business or buying the innovation. So the objectives of a purchase has to be seen in light of why? And many a times these are purchases are made to shore investor confidence and reasons are given as to what is expected. 

I am not sure if any study showed that innovation is killed, but to keep you updated, it is obvious fact that the larger the organization, it stifles innovation. The same reason most organizations have a separate R&D divisions which do not follow the over all business guidelines of the operating business. 

Take examples of Yahoo, Google or IBM or Tata, the R&D divisions work independently and they have objectives that are far different from that of the parent organization. But innovation is what makes margins better or extends the life of a product or service. 

Agreed to the fact that M&A are always not rosy as said or but then what percentage of M&A have a direct impact on the economy? I am running through some numbers, await a more detailed post soon...

So is there research material to back the dribble i have here?

The below PWC report is on the reasons as to why many a M&A is triggered by the need to get the innovation of the taken over organization. If this is the main driver, most of the M&A is done to extend the R&D capabilities and have a positive impact on innovation in the "Taken Over" entity

http://www.pwc.com/en_US/us/advisory/business-strategy-consulting/assets/acquiring-innovation.pdf

The below dutch study clearly states that innovation is positive and M&A are more and more driven by the requirement to be innovative. The three factors discussed are innovation efficiency, innovation outputs and Innovation inputs.

The study has found that M&A have positive impacts as resources available are increased by manifold and has an overall positive effect. But this study is specific to the Dutch industry and may have it skewed in the Indian context

http://final.dime-eu.org/files/Cefis_Sabidussi_B1.pdf

The below is called Doblin's ten types of innovation, a very interesting look at what are the type of innovation that returns the maximum. This Doblin study has the numbers and statistics to prove each of the innovations and why M&A happen in organizations that want to take advantage of the innovation they are buying or merging with.

http://www.doblin.com/tentypes

The below paper from Denmark talks on the negative effects on innovation on the acquired organization. Again the sample is small and can be skewed

http://druid8.sit.aau.dk/acc_papers/5dlrukqlsousbght4rfvefufu5qc.pdf

The sections available publicly talk on the positive effects on innovation from organizations that are merged or acquired.

http://books.google.com/books?id=KH8zpajEYssC&lpg=PA65&ots=BQ7y1BneKb&dq=Effects%20Of%20Acquisitions%20on%20R%26D%20Inputs%20and%20Outputs&pg=PA68#v=onepage&q=Effects%20Of%20Acquisitions%20on%20R&D%20Inputs%20and%20Outputs&f=false

Check this empirical study , it shows that actually M&A can spur more innovation in the acquired company. The reason is that the extra muscle as well as the fact that new knowledge is shared from the parent can be tonic for innovation.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=10&ved=0CGoQFjAJ&url=https%3A%2F%2Farchive.ama.org%2Farchive%2FResourceLibrary%2FJournalofMarketing%2Fdocuments%2Fjmkg.69.1.114.pdf&ei=RqIMVNKfPIyeyAST6IKgDg&usg=AFQjCNFzjLVC1Pii-js7FQdBlAbRUgl_TQ&sig2=FWRTXacaL5OF-Dl9Jv-bcg&bvm=bv.74649129,d.aWw

However, looking at the overall picture, it is quite clear that dismissing it as killing innovation or saying all of these are positive is detrimental to our understanding of the problem, There are too many factors in play, after all every purchase with all the good intent do not go well.

The assumption here can be then, that if the M&A went through well, there is a good chance that the combined entity did well to spur innovation, which may not be the case for the failed ones.

Is constitution an immutable document? Should it remain so?

Change it if it makes sense, but then in democracy it is not easy, You need not just majority to pass a constitutional amendment, you need more than 2/3rd majority. There is a reason to the number, such that you just need to win a larger majority to make a change. 

If these changes were made by the law makers we elected, very well and good. What is wrong with that? Yes, we were forced into emergency, though I never had any real experience of that time, from stories it looked like dark days in India, but then there were changes made to ensure that such an emergency kind of situation is not repeated? Has the system been flexible enough to take into consideration such an eventuality. 

We are still a democratic institution, does it not say something about its ability to survive a scare?

One thing is for sure, the Indian constitution is too large for me to take an exam on it and pass. :-)

A good part is the constitution of a body to look into the constitution. This was done exactly to address the weakness and there are public hearings too.

http://lawmin.nic.in/ncrwc/finalreport.htm

If the rigidity of the US constitution is its strengths, its flexibility is its strength when it comes to India. The problem with the US constitution is that it is taken as a "document" that cannot be modified or too sacrosanct that the founding fathers evolved it.

An US view of the Indian constitution. Good read, the so called problem is its strength, many a times is it not..

http://www.usnews.com/opinion/blogs/world-report/2013/11/15/what-india-can-teach-america-about-democracy

As argues a few cases do happen like this, that is discussed earlier.

http://indiacode.nic.in/coiweb/amend/amend24.htm

And check out all the amendments

http://en.wikipedia.org/wiki/List_of_amendments_of_the_Constitution_of_India

Two views on the strengths/ Weakness

http://www.pbs.org/wnet/wideangle/previous_seasons/shows/india/debate4.html

Power of the constitution to constitute a constitution body to review the constitution.!!!

All the people who commented on the constitution. If you did not participate , it is not because a window was not given....

http://lawmin.nic.in/ncrwc/finalreport/v2b3-8.htm

So what does the report talk about

Why is the report a crap, when the inputs of so many have been taken into consideration?

We would take a western view as valid, where in work by so many of our eminent people is considered trash?

We need to change our viewpoint as to a cause and effect Western look at things to a more Indian view?

And do we think a person like Soli Sorabjee is incompetent? The author of this report

http://en.wikipedia.org/wiki/Soli_Sorabjee

The panel members are

1. Justice Shri B.P. Jeevan Reddy, Chairman, Law Commission of India

1. Justice Shri R.S. Sarkaria, former Judge, Supreme Court of India

1. Justice Shri Kottapalli Punnayya, former Judge, Andhra Pradesh High Court

1. Shri P.A.Sangma, former Speaker, Lok Sabha; and Member of Parliament

1. Shri Soli J. Sorabjee, Attorney General for India

1. Shri K. Parasaran, Senior Advocate and former Attorney General for India

1. Dr.Subhash C. Kashyap, former Secretary General, Lok Sabha

1. Shri C.R. Irani, Chief Editor and Managing Director, The Statesman

1. Dr. Abid Hussain, former Ambassador of India in the USA

1. Smt. Sumitra G. Kulkarni, former Member of Parliament, (Rajya Sabha)

The same Nehru said this

"The Constitution is after all some kind of legal body given to the ways of Government and the life of the people. A Constitution if it is out of touch with the people’s life, aims and aspirations, becomes rather empty: if it falls behind those aims, it drags the people down. It should be something ahead to keep people’s eyes and minds made up to a certain high mark…. Remember this that while we want this Constitution to be as solid and as permanent a structure as we can make it, … there should be a certain flexibility. If you make anything rigid and permanent, you stop a nation’s growth, the growth of a living, vital, organic people.”

This is a statement which makes lot of sense or you make the constitution into something like a "Bible" that is not changed irrespective of the idiosyncrasies that are proven beyond doubt.

“.. ..… we have in India a strange habit of making gods of various things, adding them to our innumerable pantheon, and having given them our theoretical worship, doing exactly the reverse. If we want to kill a thing in this country, we deify it. That is the habit of this country largely. So if you wish to kill this Constitution, make it sacred and sacrosanct – certainly. If you want it to be a dead thing, not a growing thing, a static, unwieldy, unchanging thing, then by all means do so, realizing that that is the best way of stabbing it in the front and in the back… A Constitution which is unchanging and static, it does not matter how good it is, but as a Constitution it is past its use. It is in its old age already and gradually approaching its death. A Constitution to be living must be growing; must be adaptable; must be flexible; must be changeable… Therefore, it is a desirable and a good thing for people to realize that this very fine Constitution that we have fashioned after years of labour, is good in so far as it goes, but as society changes as conditions change, we amend it in the proper way. It is not like the unalterable law of the Medes and Persians that it cannot be changed, although the world around may change.”

This is a visionary statement, Nehru might have had all the problems, he was after all human, but he was definitely a leader, many a times it is easier in hind sight to talk on the weaknesses or something , but in the context of time.. It is the best you had to live at that time.

Well what is fundamental today may not be fundamental tomorrow?

There is flexibility in everything, what is fundamental in 17th century is not applicable today or what is applicable today is not fundamental then. 

For example: 

Gay marriage - You would be killed for it, now it may become fundamental right - A clause saying "The state shall not differentiate in spite of the person's orientation" 

Women equality: No one said it was wrong to disenfranchise women, for example Switzerland women vote count only in 1971!! 

Tomorrow the law will also state 

Right to have access to the Internet as a fundamental right. 
Right to live in a "Smart City" 

Think of all the problem in the US constitution on Gun Control, an document that cannot be changed!!! or easy to be changed!! 

If the law makers "YOU" elected passed a constitutional amendment or did not pass on a key change well is it mistake of the document? 

Right to property is not a fundamental right, but it is still there as a constitutional right. Think of all the problems Government had, when it had to lay the roads, the industries or any such initiative. This is what might have prompted the change. 

You also need fantastic roads and services but would fight tooth and nail to have inalienable property rights? 

I am not saying everything is perfect, it is a every changing landscape that would need continued correction, just appreciate for what it can do.. by changing you can correct a wrong, by not correcting it, you are making a great disservice to society.

So who did have a say in it?

Looking into the list of organizations that had a say in the review 

Salim Ali Centre for Ornithology and Natural History (SACON), Coimbatore 

From this, we are clear , the BIRDS were given a chance to voice its views...

Is begging a constitutional right?

Does not ban, but it is the states responsibility to ensure that they can make a decent living. As always "nobody" defines decent.

I am not sure why any thing needs to be written in stone, accept to the fact that humans are fallible and need to correct, whether it is fundamental rights or any such document.

We can always argue , if Indian states wants self determination (I am not saying Kashmir) would the constitution allow for it? If it does not, and keeps the Union sacrosanct are we not denying a fundamental right of a set of people to have their own country and run their own systems?

On the same lines, I can say, Women who are 50 percent should get 50 percent of every job, service or participation in Government. Everybody will agree to this, take it to the next level, reservations for every possible 3200 odd castes and tribes identified.

It is always a balancing act and this can only be achieved with a flexible constitution that changes according to the needs of the time.

And the problem of digital divide is a serious problem, just like providing economic equality through equal opportunities, it is very important for the state to ensure that we provide connectivity to the rural and underprivileged sections to the Internet , it is a great leveler, it is as important to bridge the digital divide as any other problems confronting the world today.

http://www.weforum.org/news/global-information-technology-report-highlights-lack-progress-bridging-new-digital-divide?news=page

Should Kashmir be independent?

Personally I care very little about the constitution, it is just a guidance, if majority do not want it, just get rid of it and rewrite something afresh. 

There is nothing that is permanent, we change, think of all the lines we have drawn across the world and call them countries. Is it representative. The British drew random lines across Africa and every African country today is in turmoil between different people. 

If to secede is immutable, seceding from Britain to create India and Pakistan too was not right, so was the constitution of Pakistan against secession of Bangladesh. 

We are not here to debate why a constitution is violated, my point it will always be and it does not matter, it is after all a piece of put together by some jurists. :-)

Change it with time

Count me as Plus one, It does not matter, to me the constitution is a piece of paper that was passed by the right people "At that time" 

It is amendable, should be amendable and should change with time. It has provisions to do it and that is to be welcomed. 

My point, is majority of people (Can be 2/3 or 100 percent) but then this is amendable too right should chose to vote away or keep the country together or add something to the fundamental right. 

Trivializing what may not be considered a primary fundamental right today, will become so in the future, humans evolve, change and their needs will make it such that, just like "Right to education", Right to live under a concrete roof , As our politicians harped, Bijili, Sadak Paani, or Garibi Hatao, it is the milieu of the population or the political class at that point of time. 

All I am saying do not make a rigid document and say everything has to be the way the document says so. If that was the case, we can still use Arthashastra or Manu's document as our constitution, they are just a few thousand years old. 

It is simple, keep it flexible, change as required and it includes secession, transgenders, third genders, the various classes, and any thing living in this world. 

Think of the world when the Moon gets colonized or Mars gets colonized, Right to move to any planet becomes a fundamental right. But the present world does not even allow you to travel between countries without a VISA.

Smart Cities in India - An utopian Dream?

Simple to say that it is possible, it is nothing to do with Government doing it, it is a business opportunity.

In a country where there are thousands of entrepreneurs, it is a huge opportunity to show case and make your money. The need to build a 100 would help in building the next 1000 not only in India but abroad.

Strategic Opportunity Analysis of the Global Smart City Market by a Frost and Sullivan, talks about this opportunity. Just like how Parachute is a global brand when it comes to cocounut oil, you would have the L&T and Gammon to grow into smart city builders of the future. After all they have their investors to answer, is it not? See the section on smart city providers, as of now a lot of work by IBM/Accenture on smart cities is done in India, it is time to see a few Indian names there and this is an opportunity to prove a point.

http://www-01.ibm.com/common/ssi/cgi-bin/ssialias?infotype=SA&subtype=WH&htmlfid=UVW12372USEN#loaded

SO what makes a smart city?

Five of the following eight parameters make it a smart city 
Smart Education 
Smart Energy 
Smart Building 
Smart Healthcare 
Smart infrastructure 
Smart Technology 
Smart Citizen 

It is not in isolation that they would work, they would work as an Integrated one self. Are the technologies available to do such ? Yes, it is already in use and available. Is it possible to build and progress into a smart city in ten years. YES. It is not outlandish or an utopian dream. 

Pick up a small city, for example Ponneri north of Chennai is selected to become one of the smart cities, A population of 24000 today. A good way to test your skills and improve upon the services. Once the city is developed to become smarter, it is a matter of time that the model can be replicated across India. The tools, the software would be in place. As they say the cookie cutter approach works once you have the first cookie baked and tested to be good.

What makes for a smart city?

As the word says "Smart" that is what it is, ICT as a means of providing an integrated platform is what a smart city would do best. 

Integration is the key element to smartness, and this integration is possible through ICT. What it means is that we would leverage less resources to achieve the same level of quality of life or better. 

You can envisage where you can get all your Government work done through the web, you can plan your trip to use the least amount of time or least of the resources. How best the city as a being manages its traffic. How efficiently you educate your students and also provide them with transport and also the necessary tools to leverage the technologies that makes the city smart. 

As rightly said, there is no upper limit to the smartness, Stockholm invested first in Smart Mobility, a simple green corridor that is built if you travel at 40 kmph between traffic stops is a level of smartness. Using ICT at school to deliver curriculum is smartness. 

IT is doing what you are already doing in a more efficient way. eGovernance is an area where the Government has a big way to let you know that they are building smart city communities, these can be , simple way to apply for your Birth Certificate, paying your bills online to be able to see how much you consumed and what is your Carbon footprint. The major problem is non availability of data to make informed decisions, and this is exactly what the smart cities would do. 

Instead of an Ad-hoc decision you have the tools and data to take informed decision, the biggest difference between a smart and not smart city.

Would it be another boondoggle by the Government?

Saying Government always squanders money or the results are pathetically bad across the board is a wrong generalization. 

A lot of smartness is being built into how we work and what we do on a daily basis. Many think that what has e-governance has to do with Smart City. A smart city is one which reduces resources required to provide the same level or higher level of services. 

What is that makes a city smart, we can have parameters to say, that the passenger kilometer spent on pubilc transport as a measure, the time spent to get things done at a Government office. If you do not need to move out of your office/home to get a lot of things that you do today, it is smartness, why by investing on a server (Can be money.. I am using it here as a metaphor) if i reduce the number of motor-cyle or car kilometres, this is a level of smartness. 

Think of health care delivery, or as you said the power that you consume, if i design smart cities to leverage the heat or cold of the local climate to power my systems or to cool my systems, I am making a smart decision. 

As for building 100 smart cities in 10 years, many cities will transition to become smart cities, so having a vision to build smart cities is nothing wrong. May be in years following you might not differentiate between a smart city and not a smart city. 

India has one major advantage, we have the people and resources to write code to run these "Internet of things". IoT is often an integral part of smart cities, and a seed money of 7000 crores is good enough, and that is the kind of money that would push the IBM, Siemens of the world to see and present a case as to how to build such cities. 

Economics of building such cities will triumph and we will see that many an entrepreneur will see it as an opportunity. What these cities may do, is for it to trigger other cities to provide the same set of opportunities and services as the new smart cities. And people would demand such services, it is like a chain reaction, and instead of looking at it as a 7000 crores down the drain, take it as an impetus to start the reaction.