“An informative look at a promising method for saving children’s lives in underdeveloped regions of the world. “
– Kirkus Reviews
Chapter 2. An Unlikely Intervention
As the monsoon season kicked off in June 2010, Bimla left for India with a sufficient supply of the PanTheryx powder. Having grown up near the city of Meerut, 100 miles south of Dehradun, Bimla was familiar with the region and its harsh summer climate. Dehradun, a city of more than half a million people, is located in the Doon Valley, east of the sacred Ganges and near the foothills of the Himalayas. Beginning in late June, the daytime temperature regularly rises above 100 degrees Fahrenheit. With incessant rainfall exceeding 30 inches per month during the monsoon season, it is known as the “Rainy City of India.”
The streets of Dehradun teem with traffic of every kind: cars, trucks, bicycles, animals, scooters, and the ubiquitous rickshaws. Pollution drapes the city like a damp blanket. Its government hospital—which provides subsidized health care to the most impoverished families—treats as many as 2,000 patients a day during the monsoon season. Patients largely live in slums that lack refrigeration or clean water. The escalating heat and humidity lead to more contaminated water and bacteria-infested food, which in turn lead to a steady onslaught of acute diarrhea cases.
Bimla described the spectacle she encountered upon entering the hospital as “just plain chaos”: throngs of parents and sickly children in lines unfurling in every direction, a stench saturating the cramped waiting rooms. Families from the slums rode public transportation or walked for hours to reach the hospital, which meant the loss of a day’s wages. By the time children arrived, most were seriously dehydrated, having endured diarrhea and vomiting for days. More than a quarter of the available beds in the pediatric ward were occupied by these children, some of whom would not survive.
Shortly after her arrival in Dehradun, Bimla met with Dr. Joshi and his associates in the hospital cafeteria. She remembers being a nervous wreck, despite her own experience as a nurse, as she sat down with the medical staff. Dr. Joshi opened the meeting by asking for specific details about the formulation of the product. Bimla cringed internally. Although the provisional patent application had been filed, the exact formulation remained confidential, and for good reason, considering India’s notorious disregard for intellectual property laws.
India’s drug market, generating annual sales of $12 billion, is one of the country’s largest economic sectors—and one of its most corrupt. With over 90,000 different brand names, 90 percent of which are generics, Indian companies sell more than 30 times the number of medical brands sold in the United States or Europe. As if the bewildering array of drugs is not confusing enough, an estimated 20 percent of the drugs sold in India are fakes. One study in New Delhi found that 12 percent of drugs sold in the capital’s pharmacies were fake or counterfeit. The report noted: “Some drugs collected for the study from traders were found to contain no active ingredients whatsoever, while other spurious drugs contained chalk or talcum powder mixed with a pain reliever to trick and defraud the patients.” Even if fake drugs are identified and the manufacturers are prosecuted, the legal system moves so slowly that the products might continue to be sold for years after charges are brought.
Aware that counterfeiting successful foreign products was all too common in India, Bimla refused to divulge any details about the product or allow the mixture outside of her oversight. All she could do was reassure the Indian doctors that the mixture was absolutely safe. “This was Bimla’s gift,” Tim later told me, retracing this defining moment for PanTheryx, “her remarkable ability to convince doctors, government agents, and others to do things they realistically should have absolutely no reason to do.”
In addition to Bimla’s natural persuasiveness, Dr. Tom Starzl’s extraordinary reputation in India helped lend the project credibility. The Starzl name carried weight with the doctors of Doon. Eventually, without knowing the product’s specific formulation, Dr. Joshi agreed to begin the trial.
Over the next several days, 57 children with serious diarrhea participated in the trial. Twenty-eight were treated with the normal standard of care: oral rehydration supplements and, at a physician’s determination, antibiotics. Twenty-nine were given the same standard of care plus the PanTheryx product. At the beginning of each 24-hour period, patients were evaluated for stool frequency, stool consistency, and overall well-being. The results of this admittedly small study were staggering. Twenty-four hours in, children given the PanTheryx product had essentially recovered, while those given only the standard of care had shown virtually no improvement.
Tim, nervously awaiting news back in Boulder, was jolted awake by a phone call in the middle of the night on the second day of the trial. In Dehradun, it was the afternoon following the start of the trial, and Bimla was clearly distressed. Half-awake, Tim struggled to make sense of what she was saying.
As it turned out, Dr. Joshi had refused to record the results for the children who were the most seriously ill when they entered the clinic on the grounds that he simply could not believe the improvement. He feared the data was so anomalous that it might jeopardize his credibility as a physician. In more than 20 years practicing medicine in India, Dr. Joshi had never seen a therapeutic intervention that halted an episode of severe pediatric diarrhea other than antibiotics, which typically required five or six days to work, if they worked at all.
Tim suggested that Bimla ask Dr. Joshi to simply record the results as they appeared and defer any analysis until the program had progressed. Dr. Joshi agreed. With each passing day, everyone in the clinic became increasingly persuaded not only that the product was effective, but also that it was capable of halting even the most severe cases of diarrhea in hours instead of days. As Dr. Joshi witnessed more and more children experience similarly “miraculous results,” his attitude evolved from incredulity to curiosity to undisguised fascination.
As parents began returning home with smiling, healthy children, their neighbors began to line up at the hospital with their own children, pleading for access to the same treatment. As she prepared to return to Boulder, Bimla carefully recovered and concealed in her luggage every remaining packet of PanTheryx material.
Weeks after Bimla had returned to Boulder, Dr. Joshi would call asking Bimla if she could send him more packets of the product, lamenting that mothers were standing outside his clinic wanting to know where they could find “the lady from America.” Armed with the knowledge that, based on a rudimentary trial at one clinic in India, their invention was effective, safe, and embraced by the patient population it was designed to serve, the Sstarzls refocused their attention on an equally daunting challenge: how to finance and grow their nascent enterprise.