Dr. No…! Or Dr. Knows!

Whenever there is a discussion taking place about medical field, most of the reactions are, “These guys always cheat!” It is like a popular phrase in not so rich a country like India, “All business people are profit mongering thieves!” This sentence is contradictory. Business is an activity of making one’s living or making money by producing or buying and selling products (goods and services). The definition clearly states that it is an activity for making money. It is also said that doing a job is noble thing to do but we forget that when we do a job, we do it for someone who is doing business!

This discussion came about during a chitchat at home where five of the family members were doctors. Subject for discussion was basically how much is the right fee for medical advice, surgery, tests etc. Tests performed are standard procedures where almost identical methods are used for evaluation. The only difference could be a little more automation and sophistication of equipment. So, fees here should be uniform. But ultimately charges are market driven. Consultation and surgery fees will differ as these are dependent on individual skills and expertise.

A doctor friend of mine bought a modern computerized x ray machine. I asked him why did he buy this expensive machine. His reply was very different and interesting. He is my age. He said, “Pramod what is your opinion about my buying this machine.” I said, “Fantastic! Now you will be able to judge patient’s problems better!” His establishment is in the older part of our city where rates for services are generally inexpensive. He told me, “You are one of the very few who has appreciated my going with latest technology, most said what is use if you are not going charge fancy rates.” His further comment was most interesting. He said, “Pramod, consider this as my Mercedes! I would rather move around in a Wagon R as roads in this area are small and congested. I enjoy using this modern equipment, as it helps me improve my diagnosis.”

Among all the pathy’s, we have to accept a fact that only in Allopathy, a lot of research is taking place. All this research is sponsored by pharma companies, who else will do it? It is the business of pharma companies to find new drugs which help improve treatment and rate of cure. Fifty years back, when cancer was detected, death was imminent. There was no chance of cure. This was happening because the equipment of those days, knowledge of doctors, quality of drugs created a situation where it was always too late! But now all these things have improved so much that detection is early, equipment and drugs are better and so is knowledge of doctors. This has resulted in improving cure rate tremendously. When research is done a lot of money is invested. The companies try to get ROI as early as possible (it makes business sense) but when they get competition the prices of new drugs or equipment start tapering off fast. The pharma companies are not thieves; they are investing a lot of money for betterment of themselves and also of the mankind. It is duty of pharma companies to be profitable on behalf of the share holders as they are not a charity organization.

I am not saying that all the pharma companies are saints and there are bound to be black sheep. But this is true in all fields and in all pathy’s. It’s human nature to cheat but this % is generally similar everywhere. Also, like in every field there are checks and balances. There are organizations and associations which track malpractice. I will give you an example. Years back one of the giant pharma company’s sales guy met a doctor in Harvard Medical School. He suggested to the doctor, that if the doctor prescribed certain drugs to patients, they would pay US $ 5000/ month. The doctor promptly reported this offer to his management. There was a court case and the pharma company was fined US $ 940/ million! This still does not mean that such things are not happening but these are not as rampant as they are said to happen.

There is another theory. The threshold values of BP, Diabetes, Cholesterol are changed frequently to suit the pharma companies. This is done with the help of famous doctors. During last fifty years computerization has helped medical field as it has helped all other fields too! These threshold values are not absolute values. Medical fraternity decides this based on the study of large number of patients over a large period of time. Finally, they average it out. What computerization has done is that collecting data and processing it has become extremely accurate and fast. Previously it was taking maybe 30 to 40 years to analyze changes due to manual methods, now this is done every 10 to 15 years! Hence, we notice these changes introduced, as the changes are more frequent! Another reason for this is that in the modern world of internet, news and information spreads really fast!

The fees charged by doctors, medicines prescribed by them, methods followed by them are based on their knowledge and experience; obviously the fees are market driven too! We hear the stories about doctor A squeezes the patients but doctor B does not. The fees charged by these professionals are absolutely market driven. Do you know what fees are charged by Supreme court lawyers? Sometimes these are in lacs per day. I know of one patent attorney who charges about 20 k per hour! Heart Surgeons charge in lacs for bypass surgeries.

Now a new trend has started in medical field about which we all need to be careful. Dental technicians now start their own clinics and charge 1/5 th of the fees charged by the dentists. Many of their patients end up, going to real dentist after wasting money and sometimes with incorrect treatment.  Dieticians suggest diets to people sometimes without knowing medical history of patients. When I said this during a discussion, one of my friends was angry. He said, “Doctors have no clue about diets!” I asked him, “What clue do dieticians have about medical side of the person?” There are certain orthopedic technicians who start their own practice. Physiotherapists have started their own practice. One person has ten bed facility to give traction. I know of someone who has taken 40 plus traction sessions of one hour each, from this person, without medical advice. Traction is suggested by Orthopedic Surgeons based on certain criteria. Many patients take treatment from Physiotherapists without even taking advice from Orthopedic Surgeons. Patients go by treatments suggested by non doctors!

I am not saying that everything is hunky dory in the medical field. Major errors do happen even in case of celebrities. Hema Malini’s mother was operated upon right leg while she had problem on her left leg. That too in a hospital in New York. Mistakes and goof ups are part and parcel of this field. If you want to know first-hand, how things do go wrong, read a book by Dr. Atul Gavande, “Checklist Manifesto”! Atul is well-known Indian born surgeon who lives in America. Dentists have told me patients come to them after being treated by other doctors where they have undergone root canal treatment. On re checking they have found that the cheats had never performed root canal!

I will round up with a very interesting story told to me by my Daughter Dr. Priya. She is a pediatric dentist. An eight-month old baby was brought to her. The parents said that the baby had a gold tooth, yes Gold Tooth! 3 to 4 other dentists had already seen the baby and had declared that this gold tooth must be removed and can be done only under general anesthesia.  Parents naturally did not want treatment under anesthesia. Priya checked the baby and used a small tool to check the “gold tooth”. She just gave a small jerk and out came the gold tooth! Well it was an ear piece which the baby’s mother had lost, stuck in the baby’s mouth. Time taken ten seconds, anesthesia not needed, fees 0.00 rupees!

Friends, select your doctor in such a way that you get a great treatment if needed. And Yes! Don’t be scared, there are goof ups as in any field but % of cheats is also similar to any other field!

Money Matters!

Money, Money, Money is lovely song by Abba from 70’s. Money is an important thing in life but it is not everything.

Historically when life started, there was no trade as there was no ownership concept. With individual ownership concept, starting 10000 years back, barter system started. Which later got converted to money and later into currency system. With industrial revolution, wealth generation started galloping and with that the greed! Before this period, only rich people were  the royalty and their kin! This of course continues, I need not say who the modern royalty is. Latest revolution in computers and related businesses have crossed imagination in wealth generation, beyond everybody’s expectations. But the main thing is the “you and me” gang started doing well, moneywise!

How do people make money? Some are brilliant wealth creators, they develop products, processes and concepts which the whole world appreciates and buys. Some inherit money but people like you and me, make money in a very conventional way. Typical people of our generation got themselves good education, took a job, tried to get office accommodation, later bought own home. With other family responsibilities, small amount of money remained in balance which was promptly invested in Bank Deposits. This was the process of living life, straight as an arrow and most important, safety first!

But is the conventional way of living safe life and being satisfied with it, relevant in today’s times. Probably safe deposits route was perfect for socialistic thinking of 70’s and 80’s of last century, we got used to it and continued. One person in Mumbai was given Shares of Wipro in 70’s worth Rs.10000/. The person was moneyed even in those days. He promptly forgot about the shares. When he died around 2010, his family found these shares which were simply stowed away. Their value had become Rs. 280/ million! Wow, Wow and Wow! In today’s financial jargon it is called long term investment! The money was invested in the so-called Market! In modern economies an individual is now being forced to be in the “Market”. For bank fixed deposit now, interest rates are negligible hence the shift. But there is greed. People got lured from FD in banks to very high returns from time immemorial. When banks could not give good returns, how someone else will be able to give high  returns on money. No one raised such issues, at least initially.

In came Charles Ponzi in 1920 in USA. He started one such scheme and lots of  people got sucked and ruined in his schemes. A Ponzi scheme is a fraudulent investment operation where the operator, an individual or organization, pays returns to its investors from new capital paid to the operators by new investors, rather than from profit earned by the operator on previous investments. As explained, excellent marketing techniques helped first group of people to be lured to such schemes. They were given exorbitant returns from the money invested by next batch of people. This cycle continued for some period and then unexpectedly for the investors, but expected by knowledgeable people, these schemes collapsed. With the schemes collapse, the people collapsed. The way Cadbury chocolate has become generic name for chocolate made by any other company, all such fraudulent schemes came to be known as Ponzi schemes.

Latest to join the bandwagon is the currency in news, I won’t call it popular, Bitcoin. Bitcoin is a cryptocurrency, a digital asset designed to work as a medium of exchange that uses cryptography to control its creation and management, rather than relying on central authorities. The presumed pseudonymous Satoshi Nakamoto integrated many existing ideas from the cypherpunk community when creating bitcoin. Over the course of bitcoin’s history, it has undergone rapid growth to become a significant currency both on and offline – from the mid 2010 onward, some businesses on a global scale began accepting bitcoins in addition to standard currencies.

To give you some feel, in 2010 Bitcoin was trading at 1 bitcoin = US $ 0.003. In November 2017 at its peak it was trading at 1 bitcoin = US $ 17,900/. Today, January 2018 it is trading at 1 bitcoin = US $ 11,171/, this is the  reduction in one month. Ponzi Scheme? I don’t know. Bitcoin is trying to replace global currency in the form electronic currency. But for such type of Electronic currency to succeed, all nations in this world will have to agree. Ten developed nations in the world including US, UK, Denmark, Sweden, Australia have formally accepted Bitcoin as a currency. This may get accepted over a period of time as money. All sovereign countries formally have to be accept Bitcoin. Without this acceptance I visualize a tricky scenario e.g. today you can get one Pizza in US for one bitcoin. How much will you pay for the same Pizza in UK and in Australia? Is this rate going to be based on comparative rates of current currencies? Presently, I find it difficult to understand how this will be achieved. Will I dabble in Bitcoins today? Definitely not. The currency which can get 38% devalued in such a small duration, and has yet to get approval from most of the countries in the world, is a strict no, no for me. I am sure Bitcoin or something similar may become a global currency in future but I feel that is still some time away.

What will today’s generation tell their children about money management? Take your education and learn some special skills of your own! Well, I am sure you know the market conditions, if not study them and create your wealth. Don’t waste your money on homes and cars, when you can always rent whatever you want. But try to stay away from Bitcoins of this world. It is today’s Ponzi scheme!

To you my friends one quick suggestion. Under financial advisor, put some money in market schemes which are Trigger based. Your funds are normally invested in debt funds; but when the equity market is on the Bull run, the money  will get transferred to Equity, make decent money and when Bear run starts money will be shifted back to Debt funds! Any takers from my generation?