The Mr Jekyll in Dr Hyde
Preface: Years ago Robert Louis Stevenson wrote a classic masterpiece Strange Case of Dr. Jekyll and Mr. Hyde on the dual personality of human beings. His contention was that every person has a good and a bad guy within, and, which predominates when determines individual behaviour. My contention is slightly different, and that is, that this is not always a subconscious involuntary psychological transition. I believe each person essentially chooses good or bad as a personality cult, conscientiously and in full cognizance. What he chooses may have a rational or irrational basis, but nevertheless his belief in his righteousness is complete and firm. Just as “Strange Case of Dr. Jekyll and Mr. Hyde” was received with much skepticism and awe, the logic and rhetoric of these Mr. Hydes in Dr. Jekylls is equally hard to accept or digest, but just once, may be for a moment, be tempted to pause and think “Is there some truth in this, is this justifiable, or is this possible?” Did I hear a “Why not?”
My father was a doctor. Many years ago, when I was preparing to join medical school, someone asked me why I wanted to become a doctor. I said “Because my father is a doctor” and he replied almost in derision “Ah! That’s why!” Then I began to ponder. Was it really because my father was a doctor, because I wanted to carry on the “family tradition”, because that’s what was expected of me. I reasoned and realized that indeed I wanted to carry on in my fathers footsteps, but not because I considered it the logical, traditional and expected thing to do. It was because I had observed his work and the job satisfaction he derived out of it. It was because of the way he was revered and worshiped by his patients. It was because of the way his patients showered him with blessings and praise, and offerings of things they had laboured over, or they had produced, or they considered dear enough. There was never any hint of expectation on his part, or desire on his patient’s part to be free of gratitude for whatever my father might have done for them. Such was the power of their trust and faith, and his sense of duty and compassion. I got into medical school on the basis of my merit in the qualifying examination. I carried through the medical school with the National Scholarship of merit and finally passed out, a Dr. Jekyll made.
The quest to become a doctor has not diminished, albeit it has grown manifold. Why, is a part of my subsequent composition. With this growing quest has come the proposition and reality of diminishing number of seats in medical schools. The reasons are all too obvious, and besides, that is not the subject of this manuscript. What resulted was the mushrooming of a host of private medical schools, where seats could be had sans the hard work and merit, through the backdoor may be, all for a price, and there were hordes of parents willing to shell out any amount so that their wards could ‘carry on the tradition’ or ‘follow in the footsteps’. Consequently, one heard of sums running into lakhs paid for admissions. Is it illogical to assume that these sums have to be recovered? No one, not even someone who is not a businessman, can perceive making dead investments of such magnitude. Money has to be recovered, and that is where it all begins, where Mr. Hyde takes birth.
If I am a doctor, I have to prescribe medicines. It is my professional right, it is my trade tool, and it is what I am supposed to do. No one questions a lawyer why he is citing law books to defend his client, guilty or otherwise. It’s what he is supposed to do. Do I or anybody else question a teacher why he uses a blackboard or chalk or paper or pen? No one is going to question me why I am writing this article, because I feel an urge to put pen to paper. As Dr. Jekyll, it is my duty to write what I consider to the best of my knowledge and my experience the best medicines for the patient’s ailment. It is my onus and duty, my obligation and responsibility to try and cure the patient with drugs at my command. It is also binding on me that I shall “do no harm”.
There are umpteen number of drug companies manufacturing drugs. Assuming that all multinational companies manufacture high quality drugs, there is still a plethora of similar drugs in the market. Give me one reason why I should prescribe one reputed company’s drug over another, all criterion being equal. Because they send me regular multicolored brochures? Because their representatives regularly call upon me and encroach on my time to remind me of products which I remember anyway? Or because they leave my table loaded with free samples I don’t need, and have a hard time giving them way because my patients don’t need them either? Mr. Hyde has a very plausible and acceptable reason. Because that particular company gives him gifts, or may be takes him to conferences to brush up his professional knowledge and skill. You will find any number who will cry foul at this, but look around, search and tell me of one profession where this is not rampant in some form or the other.
There are well nigh close to 20,000 companies, big and small that manufacture drugs. They are all licensed by the Drug Controller of India, as producing ethical and quality drugs as per the Pharmacopeias. The fact is that actual manufacturers of the generic salt of the drugs are very few, 1333 to be precise, as this requires a large facility for manufacturing from the raw material, and a quality control assessment laboratory to boot. The generic drug manufacturers then sell their products to other smaller manufacturers who merely capsule or bottle them, and sell it under their brand name. In other words most of these drug companies with small turnovers are really packaging units marketing drugs bulk produced by others. Then how come they are able to sell their products cheaper than the generic manufacturers themselves? For one, there is the question of overheads, be it advertising, research and development costs etc., etc., for the bulk producers. Second they prefer to keep their margin of profits higher. The smaller units prefer lower profit margins, but high turnovers. The second factor is what call the milkman phenomenon. Let me explain. The doodhwala rarely, if ever, brings you pure unadulterated milk. (If he does, it is at an exorbitant price compared to the market rate.) To keep his prices low, he adds water to milk. (Sometimes he adds milk to water, if he craves for even bigger profits.) This increases his bulk quantity and also allows him to lower the cost. The more the water, larger is the volume for distribution and much lower the price, but a far greater turnover and hence far greater profits. Translate this scenario to the pharmaceutical companies and you have a pretty good idea of how the marketing goes
These smaller units have no hesitancy in offering ‘cuts’ to the prescribers and when you envisage that for every Dr. Jekyll there are more than an equal number of Mr. Hyde you really have a panoramic picture. To rob Mr. Hyde of his ‘legitimate cut’, for he is the one raking in the profits for the company, comes the hue and cry to force the doctors to prescribe only generic drugs. Fair enough, but when a generic prescription goes out in the market, who dispenses the company brand? The chemist, and remember he is a trader, a businessman. Mr. Hyde may be discreet sometime, but the chemist will ALWAYS give the brand with the maximum profit margin. Trusting him to do otherwise is like trusting Shylock, of Shakespeare’s Merchant of Venice, to dispense with his pound of flesh. So which will it be- Scylla or Charybdis, the devil or the deep sea? Take your pick.
Is there then a rationalization to Mr. Hyde’s indulgence? Is this really a Hobson’s choice? Probably not, as two wrongs do not make a right, as the Mahatma would have said, but how many can really resist this temptation. Was it rationalization that prompted Omar Khayyam to write “O Thou who didst with pitfall and with gin, Beset the road I was to wander in, How canst thou with predestination round enmesh me, and impute my fall to sin”. How can you blame Mr. Hyde when every other person is a member of Mr. Fagin’s Academy from Dickens’ ‘Oliver Twist’? Was it not the Lord Jesus who said “Let him who has not sinned cast the first stone”? So go ahead, you do it.
Recently Dr. Naresh Trehan was forced to quit Escorts Hospital. What a hue and cry! ‘There never shook the earth so hard as when some mighty Caesar fell’, and why not. Here was a man who singularly built up an institution. People flocked to the place in hordes by his name. If you think there was a factor other than the Trehan phenomenon there, you have another think coming. Yet he was rather unceremoniously shunted out. True he was building his own facility elsewhere and his allegiance was no longer total, but still, it’s not the done thing. What am I hinting at? There are scores of Dr. Trehans in Government institutions, languishing in dismal set ups, and yet churning out quality stuff. They receive peanuts for their efforts. Some who have the stomach and the guts, opt out, and take the high road to better working environment, fabulous earning and an exalted status. Some carry on, but what cause withholds them from going out and emulating these brethren and get the best of both the worlds, so to say ? You really think they are Dr Jekyll turning over to Mr. Hyde? Those who stay behind are not the less courageous, the “they also serve who only stand and wait” a la John Milton kind. Some of them have very strong motivations and reasons for doing so. They are my father’s modern day prototypes, but that would be a different story, maybe on a different day, so why bother about them. In the words of Alfred E. Neumann, “What me worry?”
Let’s saunter back to the original plot, R. L. Stevensons’ ‘Strange case of Dr Jekyll and Mr. Hyde’. On Dr Jekyll’s death, his lawyer friend Gabriel Utterson finds a letter of confession from Dr. Jekyll which reveals what occurred when he realized that every man has two aspects within him good and evil which constantly wage war upon him. Acting on the theory that it was possible to polarize and separate these two aspects, he created a potion that could change a man into an embodiment of his evil side, thereby also making pure his good side. After using the potion on himself, Jekyll became physically smaller as his evil nature became predominant; this persona was called Edward Hyde. The potion did not work as planned, in that the shape-changing was successful, but the identity of Jekyll remained unchanged while adding an alternate character who was purely evil. After a few trial runs as Hyde, Jekyll soon began to undergo the change regularly in order to indulge in all forbidden pleasures that he would never commit otherwise. However, the Hyde aspect himself began to grow strong beyond Jekyll’s ability to control it with a counter-agent. This is precisely what I feel the media is doing by hounding the medical fraternity for all the wrongs committed and uncommitted. It is pushing all of them into a corner, rendering the antidote potion feeble and ineffective. Eventually, it will occur that every Dr Jekyll wakes up in bed one day to discover that he has turned into Hyde overnight.
I am not a psychiatrist. I am not fully conversant with this split personality, dual personality and bipolar disorders. What I have written is my perception of a malady afflicting a part of the society, nay, the whole of the society. We can not dissociate this section from the rest, you cannot view them in isolation, you cannot pin the scarlet letter on their lapels alone. You run the risk of breaking the thin line of divide between the righteous and the rationalizing, between the perceptive and the practical, between the wise and the worldly,betwen the good the bad and the ugly, between Dr Jekyll and Mr. Hyde.
My father was a doctor. Many years ago, when I was preparing to join medical school, someone asked me why I wanted to become a doctor. I said “Because my father is a doctor” and he replied almost in derision “Ah! That’s why!” Then I began to ponder. Was it really because my father was a doctor, because I wanted to carry on the “family tradition”, because that’s what was expected of me. I reasoned and realized that indeed I wanted to carry on in my fathers footsteps, but not because I considered it the logical, traditional and expected thing to do. It was because I had observed his work and the job satisfaction he derived out of it. It was because of the way he was revered and worshiped by his patients. It was because of the way his patients showered him with blessings and praise, and offerings of things they had laboured over, or they had produced, or they considered dear enough. There was never any hint of expectation on his part, or desire on his patient’s part to be free of gratitude for whatever my father might have done for them. Such was the power of their trust and faith, and his sense of duty and compassion. I got into medical school on the basis of my merit in the qualifying examination. I carried through the medical school with the National Scholarship of merit and finally passed out, a Dr. Jekyll made.
The quest to become a doctor has not diminished, albeit it has grown manifold. Why, is a part of my subsequent composition. With this growing quest has come the proposition and reality of diminishing number of seats in medical schools. The reasons are all too obvious, and besides, that is not the subject of this manuscript. What resulted was the mushrooming of a host of private medical schools, where seats could be had sans the hard work and merit, through the backdoor may be, all for a price, and there were hordes of parents willing to shell out any amount so that their wards could ‘carry on the tradition’ or ‘follow in the footsteps’. Consequently, one heard of sums running into lakhs paid for admissions. Is it illogical to assume that these sums have to be recovered? No one, not even someone who is not a businessman, can perceive making dead investments of such magnitude. Money has to be recovered, and that is where it all begins, where Mr. Hyde takes birth.
If I am a doctor, I have to prescribe medicines. It is my professional right, it is my trade tool, and it is what I am supposed to do. No one questions a lawyer why he is citing law books to defend his client, guilty or otherwise. It’s what he is supposed to do. Do I or anybody else question a teacher why he uses a blackboard or chalk or paper or pen? No one is going to question me why I am writing this article, because I feel an urge to put pen to paper. As Dr. Jekyll, it is my duty to write what I consider to the best of my knowledge and my experience the best medicines for the patient’s ailment. It is my onus and duty, my obligation and responsibility to try and cure the patient with drugs at my command. It is also binding on me that I shall “do no harm”.
There are umpteen number of drug companies manufacturing drugs. Assuming that all multinational companies manufacture high quality drugs, there is still a plethora of similar drugs in the market. Give me one reason why I should prescribe one reputed company’s drug over another, all criterion being equal. Because they send me regular multicolored brochures? Because their representatives regularly call upon me and encroach on my time to remind me of products which I remember anyway? Or because they leave my table loaded with free samples I don’t need, and have a hard time giving them way because my patients don’t need them either? Mr. Hyde has a very plausible and acceptable reason. Because that particular company gives him gifts, or may be takes him to conferences to brush up his professional knowledge and skill. You will find any number who will cry foul at this, but look around, search and tell me of one profession where this is not rampant in some form or the other.
There are well nigh close to 20,000 companies, big and small that manufacture drugs. They are all licensed by the Drug Controller of India, as producing ethical and quality drugs as per the Pharmacopeias. The fact is that actual manufacturers of the generic salt of the drugs are very few, 1333 to be precise, as this requires a large facility for manufacturing from the raw material, and a quality control assessment laboratory to boot. The generic drug manufacturers then sell their products to other smaller manufacturers who merely capsule or bottle them, and sell it under their brand name. In other words most of these drug companies with small turnovers are really packaging units marketing drugs bulk produced by others. Then how come they are able to sell their products cheaper than the generic manufacturers themselves? For one, there is the question of overheads, be it advertising, research and development costs etc., etc., for the bulk producers. Second they prefer to keep their margin of profits higher. The smaller units prefer lower profit margins, but high turnovers. The second factor is what call the milkman phenomenon. Let me explain. The doodhwala rarely, if ever, brings you pure unadulterated milk. (If he does, it is at an exorbitant price compared to the market rate.) To keep his prices low, he adds water to milk. (Sometimes he adds milk to water, if he craves for even bigger profits.) This increases his bulk quantity and also allows him to lower the cost. The more the water, larger is the volume for distribution and much lower the price, but a far greater turnover and hence far greater profits. Translate this scenario to the pharmaceutical companies and you have a pretty good idea of how the marketing goes
These smaller units have no hesitancy in offering ‘cuts’ to the prescribers and when you envisage that for every Dr. Jekyll there are more than an equal number of Mr. Hyde you really have a panoramic picture. To rob Mr. Hyde of his ‘legitimate cut’, for he is the one raking in the profits for the company, comes the hue and cry to force the doctors to prescribe only generic drugs. Fair enough, but when a generic prescription goes out in the market, who dispenses the company brand? The chemist, and remember he is a trader, a businessman. Mr. Hyde may be discreet sometime, but the chemist will ALWAYS give the brand with the maximum profit margin. Trusting him to do otherwise is like trusting Shylock, of Shakespeare’s Merchant of Venice, to dispense with his pound of flesh. So which will it be- Scylla or Charybdis, the devil or the deep sea? Take your pick.
Is there then a rationalization to Mr. Hyde’s indulgence? Is this really a Hobson’s choice? Probably not, as two wrongs do not make a right, as the Mahatma would have said, but how many can really resist this temptation. Was it rationalization that prompted Omar Khayyam to write “O Thou who didst with pitfall and with gin, Beset the road I was to wander in, How canst thou with predestination round enmesh me, and impute my fall to sin”. How can you blame Mr. Hyde when every other person is a member of Mr. Fagin’s Academy from Dickens’ ‘Oliver Twist’? Was it not the Lord Jesus who said “Let him who has not sinned cast the first stone”? So go ahead, you do it.
Recently Dr. Naresh Trehan was forced to quit Escorts Hospital. What a hue and cry! ‘There never shook the earth so hard as when some mighty Caesar fell’, and why not. Here was a man who singularly built up an institution. People flocked to the place in hordes by his name. If you think there was a factor other than the Trehan phenomenon there, you have another think coming. Yet he was rather unceremoniously shunted out. True he was building his own facility elsewhere and his allegiance was no longer total, but still, it’s not the done thing. What am I hinting at? There are scores of Dr. Trehans in Government institutions, languishing in dismal set ups, and yet churning out quality stuff. They receive peanuts for their efforts. Some who have the stomach and the guts, opt out, and take the high road to better working environment, fabulous earning and an exalted status. Some carry on, but what cause withholds them from going out and emulating these brethren and get the best of both the worlds, so to say ? You really think they are Dr Jekyll turning over to Mr. Hyde? Those who stay behind are not the less courageous, the “they also serve who only stand and wait” a la John Milton kind. Some of them have very strong motivations and reasons for doing so. They are my father’s modern day prototypes, but that would be a different story, maybe on a different day, so why bother about them. In the words of Alfred E. Neumann, “What me worry?”
Let’s saunter back to the original plot, R. L. Stevensons’ ‘Strange case of Dr Jekyll and Mr. Hyde’. On Dr Jekyll’s death, his lawyer friend Gabriel Utterson finds a letter of confession from Dr. Jekyll which reveals what occurred when he realized that every man has two aspects within him good and evil which constantly wage war upon him. Acting on the theory that it was possible to polarize and separate these two aspects, he created a potion that could change a man into an embodiment of his evil side, thereby also making pure his good side. After using the potion on himself, Jekyll became physically smaller as his evil nature became predominant; this persona was called Edward Hyde. The potion did not work as planned, in that the shape-changing was successful, but the identity of Jekyll remained unchanged while adding an alternate character who was purely evil. After a few trial runs as Hyde, Jekyll soon began to undergo the change regularly in order to indulge in all forbidden pleasures that he would never commit otherwise. However, the Hyde aspect himself began to grow strong beyond Jekyll’s ability to control it with a counter-agent. This is precisely what I feel the media is doing by hounding the medical fraternity for all the wrongs committed and uncommitted. It is pushing all of them into a corner, rendering the antidote potion feeble and ineffective. Eventually, it will occur that every Dr Jekyll wakes up in bed one day to discover that he has turned into Hyde overnight.
I am not a psychiatrist. I am not fully conversant with this split personality, dual personality and bipolar disorders. What I have written is my perception of a malady afflicting a part of the society, nay, the whole of the society. We can not dissociate this section from the rest, you cannot view them in isolation, you cannot pin the scarlet letter on their lapels alone. You run the risk of breaking the thin line of divide between the righteous and the rationalizing, between the perceptive and the practical, between the wise and the worldly,betwen the good the bad and the ugly, between Dr Jekyll and Mr. Hyde.
Comments
Post a Comment