Why prescription drugs are so expensive in the US?

About a month back I had the opportunity to attend a seminar on the above topic. To be frank I was surprised to hear some of the facts and hence decided to share my notes from the seminar and also talk a little bit about “My Thoughts” on the current scenario in US healthcare.

Diving right away into the topic of expensive prescriptions, I am sure anyone who has been exposed to US healthcare system would certainly have raised this question at least once apart from the other issues that plague the US healthcare system. Personally, I feel that there is nothing like a cheap prescription drug in US healthcare system. Always a prescription drug is expensive than its generic counterpart. I just like most others was always confused about this logic until I attended this seminar. My aim in this blog is to make sure that you also understand the rationale and logistics that go into the pricing of prescription drugs as opposed to generic drugs.

What factors affect a drug’s cost?

Before I jump into the specifics of the factor’s that affect a drug’s cost below are some of the generic reasons why medication costs in US, in general, is on the rise.

1. Almost 70% of one’s medication expenses occur in our senior years. With the rise in senior’s population, from the baby boom days, there is an increased use of medications by the senior citizens community.

2. Unfortunately, many commonly used drugs are newer and are expensive than the older ones. We will talk more about it in detail.

Below are the primary influencing factor’s that affect a drug’s cost.

1. Research & Development cost (R&D)

2. Drug Approval process

3. Marketing & Advertising cost

4. Administration cost

Research & Development – I am sure that most of us think that all the pharmaceutical companies spend hell a lot of money on R&D as they do not have much government help and that the R&D cost constitutes a great portion of their expense. In reality, much of the drug discovery research happens in academic laboratories like those of medical schools and teaching hospitals which are funded by NIH grants and tax payers like you and me. All that the pharmaceutical companies do is, have an eye on the drug discovery work that is going on in these institutions and find out which one could be the next “BIG” drug that could essentially mean a multi-million dollar, if not billion doallrs, business for them. When the research in these institutions reach a point from where these drug companies can take over and patent it they simply pay the academic institution a flat rate which is usually a fraction of what their estimated profit would be eventually and start the dug approval and manufacturing process. So next time when any pharmaceutical company claims that they had spent hell a lot of money in R&D you could be 99% sure that it is a lie and just ask them from which institution did they actually purchase the formula for the drug. In fact it is believed that drug companies assign only about 20% of their annual budget towards R&D.

That’s one down.

Drug Approval– This is probably the second biggest contributor for the drug’s expensive pricing. Drug Approval process can be further divided into

            a. Clinical Trials

            b. FDA Drug Approval

            c. Drug Patent

Clinical Trials – Since we are talking about drugs that could potentially save human lives it obviously makes sense to have them go thru different level of testing before releasing it to general public. Hence, it is not a surprise that FDA mandates 1 non-human trial 4 phases of human trials to test a drug’s safety and effectiveness before certifying them as “FDA Approved”. I understand that ensuring the safety of the drug should be FDA’s primary concern and I have no qualms about these trials. The different levels of trials are as below.

Non-Human Testing (pre-clinical)

Preclinical studies first done in vitro (test-tube) and in vivo

(animal) experiments.

Human Testing (Clinical)

Phase 0 – exploratory microdosing

Phase I, II, III – Human trials ranging in size

Phase IV – Post Marketing Trials

Just to further emphasize how difficult it is pass thru these trials below are some statistics.

·         1 in 1000 candidates make it through preclinical trials

·         Of that, 1 in 5000 candidates make it to clinical trials

·         Very expensive and time consuming process and

·         The entire process can take from 6 to 12 years

As mentioned above the clinical trial process is very much time consuming, expensive and can be very elaborative which I agree should be given the fact that human life is at stake here.

FDA Drug Approval – Once the trials are completed the data is submitted to FDA which then begins the actual drug approval process. This is kind of cat and mouse game where drug companies claim that FDA is slow in approving their drugs while FDA claims that they do not have enough staff to actually expedite the process. FYI, it seems that the drug approval process usually took about 1 – 2 years. Drug companies not being able to release their drugs to the market and reap the profits until they are approved raised their concerns in the congress, with the help of lobbyists, resulting in a law being passed in 1992 called as “Prescription Drug User Fee Act” (http://www.fda.gov/ForIndustry/UserFees/PrescriptionDrugUserFee/default.htm). It allowed drug companies to pay FDA to staff personnel to work exclusively on the approval process of their drugs and there by expedite the approval process and be able to market the same earlier. How does this sound? Legal bribing or Bribe Panel!!! Well, that’s the way it is.

As a result of these rushed FDA approvals, in other words greed from pharmaceutical companies to see the dollars roll in earlier, more and more drug recalls have happened in the past decade. Example – Vioxx, Baycol & Rezulin. Also it has been figured out that some of these medications really do not show much of a long-term benefit in terms improving quality of life or reducing the mortality rates. So why still encourage “Legal Bribing”? Correct? Raise your voice.

Drug Patent – Getting a drug patented essentially gives the pharmaceutical company exclusive rights to manufacture and market the drug. This basically boils down to the fact that when a company has a patent on a drug they pretty much make a hell a lot of money. This is the reason why drug companies try to maximize their profits when they have patent rights. As a common man, you might raise the question “If I have a patent on a drug then don’t I have exclusive rights to manufacture and market that drug forever?”. The answer is “No”. In other words, how patents on drugs works is as follows…

When a company is issued a patent on a drug they hold the exclusive rights for a period of 20 years and not for ever. At the end of 20 years, anybody can start to manufacture and market the drug as long as it matches exactly in dosage, safety, strength, how it is taken, quality, performance, and intended use as the original one. Also, the clock starts ticking on the patent from the moment the drug company approaches the FDA and starts the clinical trials. So now you get why the drug companies want to rush thru clinical trials and FDA approval process ASAP. Obviously, the earlier they are able to market the drug the more profit they get out of it during exclusive patent period.

That’s two down.

Marketing expenses– Contrary to the statement by drug companies that R&D is the major driving factor for the high cost of prescription medications the truth is that marketing and distribution cost forms about 35% of a drug company’s annual budget and is the #1 contributor to rising prescription drug prices. That is about 2 times R&D budget. Marketing Cost can be further sub-divided into

Direct-to-Consumer (DTC) Marketing - Today if you are watching TV or listening to radio you can be sure to see or hear a minimum of 2 drug ads every hour. This was not the scenario before 1997 when there were hardly any drug ads. In 1997 FDA relaxed the conditions for drug ads that basically resulted in a huge spike on marketing costs by the drug companies. Pharma companies also indicate that as a result of DTC marketing their sales have also spiked. They also claim that DTC marketing is the best way to get the patient involved in the diagnosis process as a result of which the doctor-patient rapport building is encouraged.

So what kind of drugs primarily go for DTC marketing?

Mainly the kind of drugs that try to imitate the mainstream patented drugs by slightly changing the formula and claiming that they do wonders. These are called as isomer entities of mainstream drugs. But keep in mind that these are just copy cat drugs made by altering the formula of a mainstream drug slightly but still claim as a prescription drug and end up being expensive. Most of such drugs are not really that effective. In reality, there might be a better effective and similar kind of drugs in the market that are far less cheaper than these isomers but they need to be pushed to the consumers and hence incur a lot of marketing cost.

Sales pitches and Free samples – It is very common for drug companies to do sales pitches and provide free samples and coupons to doctors and hospitals. These could be in the form of pens, food, trips, concert tickets or even just free samples of the drug and asking the doctor to provide the same to the patients and thereby get them used to the drug which they would eventually have to buy.

Consultation fees for educational events – These are the kind of seminars that drug companies conduct and provide the doctors with fees for attending and speaking in these seminars. Bear in mind that doctors need not necessarily do these things for the drug companies but the expectation back from the drug company is that the doctor would prescribe the company’s drugs to his/her patients.

That’s three down.

Administration expenses – This basically constitutes the salaries, bonuses, accounting and legal fees that the drug company ends up paying it employees and legal firms. Do you know that year after year drug companies have been paying millions of dollars to its executives in the form of bonuses and claim that as part of their expenses and top it by charging us more and more for the drugs so that the executives get hefty paychecks. So now you see that it is not just the financial institutions and banks that hand over hefty paychecks and bonuses to their employees but so do the drug companies. The only difference is that the drug companies do it in a smart way by taking more money from us thereby eliminating any risk from their side.

You might be wondering what constitutes “Legal Fees”. As I had said earlier patents are valid for only 20 years and after that the company loses its exclusive patent rights on a drug. But at the end of 20 years when another drug company starts manufacturing a generic version of the original drug the patented company can file law suits claiming that the new drug is not an exact match of theirs and be able to retain its exclusive market rights. Lot of drug companies use this way to make more profits out of patented drugs and they spend quiet a lot of dollars in the form of legal fees so as to ensure that they are able to reap more profits during this exclusive extended patent period.

That’s four down from the factors that directly affect the drug costs.

Pharmaceutical Industry mixing with Politics

Now let us look into how Pharmaceutical industry and US politics are inter-related and as to why politicians do not react much to raising healthcare costs, in general.

As a common man, I was surprised to learn that annually drug companies budget around $60 million for political advertising and in DC at any given time there would be around 300 paid lobbyists trying to influence the congress to make sure that US drug companies make as much profit as possible. Some examples of how the industry has mixed with politics is as follows,

·         Lobbyists persuaded congress to pass a law stating that medications need to be bought in the US for one to claim Medicare part D coverage benefit.

·         Politicians even went to the extent of claiming that canadian prescription drugs are “Unsafe”.

·         FDA, NIH and CMS have significant number of board members with financial ties to the pharma industry

With so much of politics mixing with the industry I believe it is obvious why US politicians are turning a blind eye to the rising drug prices.

Finally, here are “My Thoughts” on the system as of today. Just because drug companies spend hell a lot of money in advertising and salaries it does not justify the high pricing of the drugs. In essence, we are paying them so that they can spend more and put that burden back on us without actually passing down the profits to consumers like you and me. With all the talks going about health care reform and the different players involved in it, take it from me today that “Nothing is going to change”. There might be so many debates and talk shows surrounding this topic but I am pretty sure that “Nothing is going to change”. I sincerely hope that I would be proved wrong on this but unfortunately I am not optimistic about that. One example of that is the recent exclusion of “Public Option” from the healthcare bill that is to be presented in the senate.

End of the day, people, it is all up to us to be careful to protect our interests. We can do so by getting ourselves involved in our healthcare. How we can do so?

·        Always ask your doctor for the prescription drug information and also ask if there is a generic alternative that works as well as the prescription one.

·         Do not trust the DTC ads. Most of them are usually not as effective as the original drugs. Effective drugs will automatically be sold and do not need to pushed to consumers.

·         Get yourself involved in your community and check the financial ties of your local representative to the pharmaceutical industry.

Let me know what are “Your Thoughts” about rising drug prices.

10 facts I recently came to know

1. Hippopotamuses – incredibly dangerous creatures – have a very unique ability: instead of sweating, they exude a pink liquid which is a natural sun block. This, and their ability to spend an indefinite amount of time in the water helps to keep them safe from the blistering sun.

2. Kangaroos can’t fart. They convert the small quantity of methane they produce into an energy source which their body reuses. Scientists hope that they will be able to transfer the bacteria that causes this in kangaroos to cows, to reduce methane emissions to save the world from the latest fashionable catastrophe: global warming.

3. During the Cold War, the US military developed a rifle that fired nuclear war heads. It was called the Davy Crocket and production of this smallest nuclear weapon began in 1956, with a total of 2,100 being made. The weapon was deployed with U.S. Army forces from 1961 to 1971.

4. Have you ever noticed that when you have a bowl of nuts, the bigger ones make their way to the top? This event actually has a scientific name: the Brazil Nut Effect. The term refers to the phenomenon in which the largest particles end up on the surface when a granular material containing a mixture of objects of different sizes is shaken.

5. Rhode Island is the smallest state with the longest name. The official name, used on all state documents, is “Rhode Island and Providence Plantations.”

6. In 1859 a solar storm hit the earth (the largest in recorded history). It was caused by massive sunspots and solar flares. It was so intense that auroras were seen around the earth (even in the caribbean) and the ones over the Rocky Mountains were so bright that gold miners thought it was morning. It knocked out the telegraph systems of Europe and North America. If you wish to look it up for more information, it is called the “Solar storm of 1859″ or “Carrington Event”.

7. When correcting a person’s grammar on the Internet, invariably you make a grammatical error of your own. This is called Muphry’s Law (intentionally misspelt). Just remember that next time the grammar nazi in you decides to show its ugly head.

8. It is possible to get drunk in prison thanks to a special thing called “prison wine” or “pruno”. It is an alcoholic liquid variously made from apples, oranges, fruit cocktail, ketchup, sugar, and possibly other ingredients, including bread. Pruno originated in (and remains largely confined to) prisons, where it can be produced cheaply, easily, and discreetly. The taste is described as vomit flavored wine cooler.

9. The PhD is not the highest degree a person can receive. There is also a Doctor of Sciences (DSc/ScD) and Doctor of Letters (DLitt/LittD) which is normally awarded in Britain, Ireland, and the commonwealth nations though it is occasionally awarded in the United States. It is normally awarded for a substantial and sustained contribution to the art to which it applies – for example science and literature. Mark Twain was awarded a Doctor of Letters by Oxford University. Just to add to the confusion, there is also a PhB which is a bachelor of philosophy which is equal to a Masters degree despite its name.

10. Have you noticed that some people seem to have very appropriate (and entirely coincidental) names? Names such Usain Bolt (Jamaican sprinter), Lord Brain (brain surgeon). This is called an “aptronym” as in “aptly named”. Some people believe that the name can influence life decisions leading a person to work in a field relating to their name. This is called "Nominative Determinism".

7 * 13 = 28

Came across this awesome video in another site and thought it is worth sharing with others.

8 myths of the Healthcare bill proposed by President Obama's administration

With all the yadayadayada talks and the finger pointing going on about the proposed health care reforms, I received an email from the White House (I had subscribed to their mailing list), as part of their efforts to spread the message, explaining some important details about the proposed bill. Included in the mail were some of the "myths" (as claimed by the White House) and I thought as a responsible individual I would also play my part in spreading the message.

Please be aware that I am not in a position to support or talk against the proposed health care reforms but one thing that I am sure of is that

1. No one should be denied coverage just because they fall seriously ill
2. No one should go broke just because they fell sick and could not afford health care bills
3. No one should be uninsured and feel insecure all the time.

I am in for any reform that would guarantee these basics for all individuals irrespective of their status, race, gender or religion.

8 Common "myths" about the proposed Health Care reform

1. Reform will increase "rationing": It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.
2. We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.
3. Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.
4. Vets' health care will be affected: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.
5. Reform will add burden on small business: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.
6. Your Medicare benefits will reduce: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.
7. You cannot keep your current insurance or doctor: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.
8. Government will have access to your bank account: It is an absurd myth that government will be in charge of your bank accounts.  Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose.  Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

Please keep in mind that by spreading the message I am not necessarily agreeing that these are indeed myths. The main reason being that I still have not gone thru the details of the bill for me to take one side or the other. But from what I have been following on CNN, I believe CNN has done a good job of researching on our behalves about these myths and confirmed that most of these are indeed myths and handiwork of republicans in spreading the wrong message. So I am kind of tilting to agree that these are indeed myths and not the truth, but still not 100% on that side of the court.

Go ahead and let me know what you think about the proposed health care reforms.

Life is Cheap, but Groceries cost a fortune!!!

This sticker has been on my fridge for almost 3 years now. Every time I see it, it sounded funny but correct. But it never struck me as a seed for a blog article here. Now that I am more into blogging, last night when I saw the sticker, it immediately struck me that I should blog about it and so here I am.

What do you think about this quote? Do you think it is true or not? Let me put forward my theory here. For me it sounds more true for an ordinary citizen than a VIP. As an ordinary citizen, are not we all working hard and trying to earn as much as we can just to feed ourselves and our families. Of course to be able to feed includes buying groceries. But when we die whatever fortune we earned until then is of no use as we have spent most of them in buying groceries and nothing comes with us.

Take the case of a VIP. A VIP like any national leader spends money on his/her groceries too but consider the amount that the government would be spending to safeguard his/her life by employing security guards, providing high-security modern cars and anything else that might give the ultimate protection for the leader. If we sum up the total costs of providing security to the national leader, I am sure it would be way above the cost of groceries to feed the national leader and his family.

With all the talk of American healthcare reforms going on, isn’t it true that in today’s scenario an ordinary citizen with any life threatening disease like Mesothelioma or any other type of cancer would eventually have to die probably due to the fact that his/her health insurance company refused to provide coverage any more or even refused to pay prescription cost which is obviously sky-rocketing by the day for all major illnesses. (I plan to write a blog very soon on the sky-rocketing costs of prescription drugs). When the individual dies for the reason that the insurance company refused coverage, would you not call it as the insurance company categorizing the individual’s life as cheap and of no value to be saved without realizing how important every minute of his/her life would mean for his/her family. So in this case eventually the individual’s life is cheap compared to all the groceries that he/she might have purchased in his/her lifetime.

Consider the same situation for a national leader. Do you think the insurance company, in this case the federal govt., would dare to refuse coverage for the leader just like any other ordinary citizen. I think you know the answer to this.

So I believe, in a way, yes Life of an ordinary citizen is cheap but Groceries cost a fortune for them. For VIPS’s Life is more expensive than the Groceries.

What are your thoughts on this? Let them roll by here.3

Please say "Please"

Well, this is an interesting incident that happened when I was doing my master's in UK. Personally, for me it is probably the smallest incident that has had a lasting effect, in my life, at least until this moment.

The year was 2003 and it was a cold February/March day (not sure exactly which month). While I was doing my master's I was also doing part-time work with a catering company. The job was to work in 4-6 hr shifts mostly during weekends and sometimes on weekdays. As a student you know how tough life can be and how you try to save every penny that you can and when you can. So most of the time I used to walk from the hostel to my work place (about 30 mins) instead of spending ~3 pounds for the bus fare. (Hey, Of course 3 pounds was big money when I was a student...!!!)

Anyway, on this particular day I was on a 6 hr shift, I believe from 12 noon - 6pm. My roommate had asked me to get some milk on my way back which I gladly agreed to do. So on this cold winter day after finishing a 6 hr shift, I started walking back towards the hostel totally tired and just wanting to hit the bed and relax.

I had almost forgotten to buy milk until I was near my place and saw the grocery shop. So I went inside picked up couple of milk cans and went to the cashier.

She billed them and asked me "Do you want me to put them in plastic bags". I said "Yeah".

She gave me a wierd look, that I can still remember, without actually putting the milk cans into the plastic bags. I had no inkling of what was going thru her head neither did I have the energy to think. After a few seconds, she said "Say please". Then it struck me that I missed the magic word. So I corrected myself and said "Yes, Please".

By now she had put the milk cans into plastic bags and gave them to me. I took them but noticed that she actually did not let go the bags. Again, I had no inkling as to what she was trying to convey now. Before I could ask her for that she said "Say thank you". It was like "You missed it again". So I then said "Thank You" and was on my way out of the store walking towards the hostel.

As I was walking, I was thinking about what just happened and was wondering if I was wrong or was the cashier expecting me to request for what she should be giving (plastic bags) to me and also expect me to acknowledge for doing so. It looked to me like such a small incident and why did she ask me to explicitly say "Please" and "Thank You". Anyway, given my state of mind I did not heed much attention to this and just went about doing my tasks for rest of the day. But the incident was for sure sitting somewhere at the back of my head.

As days went by, every time I have to request anything from anybody or acknowledge anybody for anything this incident would immediately glow in my head like a flash light and I make sure to say "Please" or "Thank You". What I noticed every time when I said these magic words was the smile that the other person would have on his/her face no matter how small or big was my request. Slowly, I made it a practice to use these magic words as much as I could.

The point I wanted to make here is, having been brought up in a middle class indian culture what in UK or even in most other parts of the world would have been considered as a basic courtesy looked to me like something that the cashier was asking for too much until I slowly realized the importance of these magic words.

Back in India, generally not many would use these magic words but would just assume that people would do things for them. First time when I used these magic words with my wife she was also surprised and said “Why do you say ‘Please’ and 'Thank You’ to your wife”. Probably she assumed that it is the duty of the wife to serve the husband and the wife should not be expecting a request or acknowledgement for the same.

I could throw a different light on to this behavior by stating that probably because India was ruled by other countries for a long time and people generally tend to have the master-slave mindset. But I do not want to get into that angle and leave it to the reader's discretion.

Furthermore, now that I have moved to the US I see quiet a few indians using these magic words more often than not. I am pretty sure most of them if not all of them had the kind of experience that I had in UK. This is good. But I still do not see most of the other asian community people not using these magic words that often. Hopefully, things will change for good.

To summarize, by human psychology everybody feels happy to be requested to do something than be ordered. On the same lines, would appreciate a kind acknowledgement for the work done rather than just say "OK". So please use "Please" and "Thank You" as much as you can and you will be surprised to see that people will be happy to help you more than ever.

Its been longgg time...

Yep, its been longgg time since I blogged here, almost 6 months, other than announcing the arrival of my daughter, Teerthaa in June. Anyway before I start blogging about "My Thoughts" again here let me write about what I have been up to during this time period when I was not blogging much here. I will write more of "My Thoughts" from the next blog onwards.

I know I took this blogging experience as my New Year's Resolution for this year and just as I had mentioned in one of my initial blogs, usually people tend to lose the spirit of resolution after a month or two. I do not blame you to place me under that category going by the dates. The last blog I wrote about "My Thoughts" was on Feb 18, 2009 which is just about 6 weeks from the start of the new year.

But reality is that a series of events, as listed below, led to me not being able to concentrate on blogging here.

1. First jolt of pregnancy (February, 2009)

My wife and I were expecting the birth of our first daughter in June 2009. Exactly one week after Feb 18, 2009 we experienced our first major jolt of the pregnancy in the form of gall bladder pain for my wife. It was a terrible experience for both of us. Being the first pregnancy for my wife both of us would hit the panic button when ever anything that is not normal happens to her. This being a severe pain in her abdominal area we obviously hit the panic button and got scared if it was pre-term labor pain.

After emergency calls to the hospital, few tests and overnight stay at the hospital, it was diagnosed to be gall bladder pain and that it is common amongst pregnant women, in particular. Doctor's advised that there is nothing to be worried about and more importantly that the baby was doing good. As I had mentioned earlier this was an eye-opener of an experience for us as my wife's pregnancy was proceeding fine until that day. It took us few weeks to come out of that jolt as we had to be extra cautious with my wife's diet so as to ensure that the pain does not recur.

2. House shift (March, 2009)

With the arrival of a baby comes the need for additional space. So when we confirmed my wife's pregnancy, we knew that we are counting our days in a 1 bedroom apt and we have to move to a 2 bedroom apt pretty soon. We decided to move around end of March, 2009 time frame and so we did. As you can see that about a month after the gall bladder experience we had to shift houses.

During that one month we were busy looking around for a 2 bedroom apt and always praying that the gall bladder experience would not recur. At the end of our apt search we settled for a 2 bedroom apt in the same complex that we were then residing in. Then started our search for an economical mover. You might ask what is there to move when you are shifting within the same complex. Hallo...!!! still it is a shift from one house to another and things have to be shifted. With my wife being pregnant I had to take care of everything and make sure that she does not do much but just rest.

3. Settling in the new house (March-April, 2009)

After shifting to the new house it took us almost 3 weeks to fully settle, the reason being,
• It was around this time that I also finished a project at work and started on a new one. Excellent timing...!!!
• As stated earlier, with my wife's pregnancy I had to take care of everything and the only time I could find to do that was primarily during weekends and may be in the evening on some week days

4. Arrival of my in-laws (May, 2009)

As it is customary in Indian culture to have the pregnant women be taken care of by her parents, at least for the first pregnancy, so did we invite my wife's parents to come over to US and help us out as we were getting closer to the D-day of our daughter's birth. They arrived in the last week of April, 2009 just about a week after we fully settled in the new house. I understand that your question would be as to how come that stopped me from writing blogs. Very valid question. The answer is "No that did not stop me from writing blogs here". But that combined with the following events contributed to me not being able to focus on blogging.

5. Shopping for baby items (May - June, 2009)

By now it is less than 2 months for the arrival of our daughter so we were pretty busy in listing down the items that we have to buy for the baby. We used to make a list, scrap it make a new list go thru it once again and then adding/removing items, discuss it, re-discuss it almost every other day, all with the intention to buy only the best for our little one. The confusion was primarily due to the number of options that we had for every product that we wanted to buy. There are so many options to choose from and every item has its own set of good and bad reviews. We used to pull our hair at times being unable to decide as to which one to buy and which one to ignore. It used to be a group discussion every day between my in-laws, wife and myself.

Finally we prepared our list of baby items to buy and then we realized that we cannot get all that we wanted under one roof but would have to visit different shops in different cities. And so almost every weekend, right after lunch, we used to pack-off for shopping. It was a memorable experience.

6. Teerthaa's arrival (June - August 2009)

On June1, 2009 our daughter Teerthaa was born giving us immense pleasure to be able to see, feel and hear what we have been only discussing about over the past 9 months. Since it was a C-section delivery for my wife, it took couple of weeks for her to recover to an extent where she was not dependent on me. During this time frame Teerthaa was also getting used to life outside her mom's womb. This means getting up every 2 hours and we being sleep deprived for most of the time.

During the first 2 weeks it was very stressful as from a person used to minimum 7-8 hrs of sleep during night time you are suddenly being forced to wake up every 2 hrs, be it day or night, and you really do not get sound sleep. Being sleep deprived for a prolonged period is stressful for any individual. It is not that after 2 weeks the baby will sleep well but it is just that you get used to being sleep deprived... :) It took almost 10 weeks before Teerthaa started to sleep a minimum of 6 hrs at a stretch during night time thereby letting us also to sleep that long.

7. Parenting

Entering parenthood has been a tremendous experience. First of all, the joy of seeing your little angel sleeping, smiling, kicking arms and legs is something that cannot be explained in words but has to be experienced. Though I have written about being sleep deprived but all those sleepless nights becomes endless joy when you see your little one smile back at you. As part of parenting, every parent wants to do something different for their off-springs and so did we. We decided to create our family website wherein we could post her photos, write (blog) about Teerthaa's progress as she crossed every milestone in her growth chart and about our parenting experience. This is our way of maintaining an online diary, sort of, that we could probably sit together with Teerthaa, in the future, and feel nostalgic about parenting her.

Well, you could ask why not a general blog page. Agreed, but we wanted to create our own space in the internet and so we decided to buy our family domain name and maintain our website rather than just have a blog page under a blogging website.

Even though I could not concentrate on writing here, I made sure that I write in our family website about Teerthaa and our parenting experience as that is more important to me as a parent. Priority changes when your little one arrives... :)

8. Work pressure

To top all the above events, the work pressure on my new project was at its peak around the time when Teerthaa was born. It was around March - April, 2009 that I started on a new project at work and never expected it to be sooo hectic as it turned out to be. Even though the work pressure was manageable initially, it peaked around the end of May, 2009 and stayed that way till end of July, 2009. Think about being sleep deprived and still had to work around 12 hours a day for over 2 months at a stretch. Obviously, I was drained out. The project was successfully delivered in August 2nd week and then I decided to take a week off just to relax at home and spend time with Teerthaa.

So here I am writing this blog in the 4th week of August, pretty much the first time when I really have some time to relax and concentrate on writing blogs other than in our family website.

Now that I have listed out what has been keeping me busy away from here, I hope to be able to write more here at least until I start on with my next project which I hope will take another 2 - 3 weeks.