This is common practice in much of developed world. Long ago, they used to have re-usable glass syringes that could be sterilized. Unfortunately, people switched to disposable syringes. The unit costs are...high in the US, unreasonable in developing countries.
It's not just this hospital, it's widespread ([1] report 38%)
That article also makes it seem like patients in Pakistan are receiving what seems to me like a wildly high number of injections:
> An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar
> Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea.
> Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections.
> We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals
On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average.
If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
> > Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month,
This seems like an excessive number of doctor visits, too. I can’t imagine a household where someone is going to the doctor almost every week. 45 doctor visits a year and they’re getting injections (of what?) most of the time?
I, as someone broadly healthy and who has barely used healthcare services, asked to see my health records recently.
I was shocked to see 500+ 'interactions' between me and the healthcare provider! However it turns out the majority of those interactions are very minor things - ie. "Patient received text message reminder about appointment". "Patient was sent letter with test results" etc.
When you count interactions like that, you can get a big number fast.
Antibiotic overprescribing was a problem in the past, but in my experience providers around me are very resistant to giving antibiotics at all.
My doctor’s office even has a big sign in the waiting room saying they don’t prescribe antibiotics for common infections.
The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.
> The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.
I don’t know how widespread it is, but some people will beg for antibiotics when they definitely have a viral infection.
My friend who always used a naturopath would go on endlessly trying to diagnose herself with viral or bacterial to decide whether she should ask for antibiotics, but I definitely got the point.
I suppose many patients simply don’t know the difference.
My dad in India gets prescribed antibiotics whenever he's sick. Despite my constant explanations, he insists that this is how it should be, because when you're sick your immunity is lowered.
On the other hand, the last time I got prescribed antibiotics was probably almost 10 years ago when I ended up in the hospital from an abscess.
Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).
> Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).
FYI phenylephrine is effectively a placebo and the FDA has proposed ending its use in OTC drugs. (There've been HN threads on the subject, with many comments.)
Is that true or just a rumor? All the family medicine people I know would not do that. Only in a case where it is 50/50 bacterial or viral like an ear infection in a young kid.
IME, most people (in the US) don't bother going to a doctor for a cold unless it lasts a long time or is especially bad, because you'll probably get better on your own and going to the doctor is expensive.
I was working in a church office when I came down with a runny nose and other cold symptoms.
My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.
Now, that seemed fair from a labor perspective, but it is extremely unfair to someone like me. Because I do not own a vehicle, and seeing a doctor would involve boarding one or more buses and snorking the entire way there and back. Risking infection for everyone around me was exactly what I sought to avoid by staying home.
So what else could I do, but come into work and carry on? It is this sort of unreasonable requirement that fuels “presenteeism”.
I had a horrible tooth infection that anyone with a nose could tell was a bacterial infection yet I was massively gaslit and denied antibiotics until I went to the hospital at 11pm after a week of horrendous pain
Doctors very rarely do any kind of test in my experience (I would have thought oozing stinking green stuff would have been easy to test...)
Later
I am somewhat against antibiotics as I have a fragile/already destroyed gut. But there are times when I don't know what other solution there is after exhausting home remedies, other medication and waiting it out
A friend passed away few months ago in London from kidney infection.
UK seems very to be very cautious of over diagnosis, while my experience in Eastern Europe was opposite - my infant received 3 different kinds of steroids (potentially what stunned his growth).
IMO there is a huge amount of denial of treatment to save costs. The gaslighting over symptoms, the refusal to refer you to specialist, the refusal to order tests etc is all part of it. And they never ever say it's about costs - just a tight lipped, "I know what's best" attitude
Probably patient demand for *something*. The problem of antibiotics for viral infection is well known but the problem with needing to do something is far more widespread. I wouldn't be surprised if a lot of saline is getting injected.
It's also not perfect. Sure you can throw instruments into an autoclave or even boiling water but they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areas.
> they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areas
It's actually very easy. Sterilization takes place in a stainless steel container that has "windows" on it's sides. When the sterilization cycle ends, these "windows" are closed just as the container is taken out of the autoclave. The container will remain sterile inside until opened.
Also, simply opening the container to take one syringe from it doesn't make it dangerously contaminated. As demonstrated by the article, the biggest danger comes from other people's blood (HIV, HCV, HBV), not ordinary bacteria we have on our skin.
The point is that if the analogy of a $0.04 syringe is supposed to be as expensive as a cup of coffee, it's still not expensive even if you do it often. Maybe they have too many injections. Either way we have a bunch of kids with a disease that can kill because someone thought something as expensive as a cup of coffee was too expensive.
Median household income in US is $83k so 0.04/125 * 83k is about $26, much more than cup of coffee. If you're sticking like 15 kids a day with the same needle, that's like $400 a day saved.
That could have been said without the massive racism.
It's less about the money and more about the logistics of transporting and stocking these goods in a country that doesn't have decent basic infrastructure.
You can't characterize a country where:
- dozens of people just got HIV from syringe reuse
- that ranks 168th out of 193 countries in HDI
- ranked 136th out of 182 countries in corruption
as backwards, underdeveloped, or corrupt. /s
Equipment that can be sterilized has been forced out of the market by these disposable things. It is far easier to push disposable product on medical providers and encourage rent-seeking and subscriptions to such things.
It’s exactly the same way with contact lenses. When I was in college in the ’90s, I could get a pair of permanent contact lenses. They would cost a few hundred bucks, but they would last me several years if the prescription didn’t change. They were the same as glasses. You would clean them everyday and disinfect them, and they would serve quite well permanently.
But the contact lens industry decided that wasn’t good enough, and decided that they could sell subscription services for contact lenses that you would need to discard every night.
And those daily wear contact lenses, the disposable kind, basically forced out of the market the permanent ones and now the optometrist regards me as a Martian when I request permanent lenses instead.
You completely ignored human error aspect. Before the blood donation centers used one time use equipment, donors were getting infected with something nasty every now and then. You can sure as hell expect people to commonly forget to properly sanitize those syringes.
Sterilization is* the most strictly controlled process in any hospital. Nobody can just "forget" to sterilize or pick up a used syringe thinking it's sterile.
* Or at least it should be. It seems that Pakistan is different.
There is also the reality that a sealed package is more of a guarantee of sterility than something that should be autoclaved. Even in the US there have been cases of nasties being passed by inadequate cleaning.
And we had a big scandal locally. Were they doing a shoddy job of colonoscopies? Probably. But genetics left no doubt that they were using one needle per jab, but one syringe per patient. And drawing up from multi-use vials. Stick the hep C patient, in pulling back a bit ends up in the syringe. Discard needle, syringe is still infected. New needle, old syringe, draw from the vial again, vial is now infected.
You can still get rigid gas-permeable lenses that last basically forever, I wear them every day. You have to take them out at night and clean them, but you only buy them once (unless you damage or lose them, or your prescription changes).
I share your hate of rent-seeking and subscription culture, but tbf disposable contact lenses are legitimately a nicer product to use. I've done it both ways.
We sterilize plenty of other common tools like scalpels so that doesn't seem like a valid reason. Obviously the disposable design is not even an adequate solution to the risk of cross contamination. I would imagine if it were a real concern you could easily add something like a color changing strip that would indicate whether the needle has been autoclaved since its last use without rendering it useless.
They can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.
If you can't trust them to follow the very easy directions of "throw away the single use syringe", how likely is it that they are going to follow the much more complicated process of properly sanitizing the glass syringe?
1. They're talking about the current situation, but you're bringing up history.
2. Given the lessons from the past, why would you still want to do something this dangerous?
Women are not allowed to go to school in those countries, and are not allowed to receive an education.
Sharia law, what could go wrong with these sets of rules, right? /s
This is the type of system where the design fails and effects of it are purely self inflicted by that society. It's pretty obvious that a population without education is easier to control, and that's the sole reason women still have no rights in those countries. It's just stupid when you need them to take care of your population's health then, huh?
There's obviously terrible procedures happening at this clinic, involving contamination, but that one video doesn't seem like the culprit. Notice he removes the needle, then injects medicine into a cannula tube, not flesh. He then re-attaches the needle, draws the second dose, and injects again. That was the problem. The narrator says he then used a brand new syringe for every child, but that initial procedure contaminated the vial. Cannula tubes are primed with saline, that's kind of a long gap for blood to travel to contaminate the vial. Yes he did it wrong, but I get why he thought it would be ok.
And what will Pakistan do with such an IMF loan? The Generals would siphon off most of it to buy their palatial Dubai houses and London condos. Until Pakistan cleans up its act, giving it more loans it throwing good money after bad.
> The Generals would siphon off most of it to buy their palatial Dubai houses and London condos.
Next door to other world leaders doing the same? Is that truly our motivation for not transferring the money? Some generals might illicitly buy houses?
> Until Pakistan cleans up its act
I'm sure "The Generals" are going to help there.
> giving it more loans it throwing good money after bad.
Abandoning them entirely as hostages is not acceptable.
I had sort of hoped our Democracy would afford for a more effective approach. If you find those generals so onerous why don't you go fly over there and assassinate them?
> When we showed Buzdar our undercover footage, he insisted it had been filmed before his tenure or that it had been staged. When asked what he would say to local parents watching this footage, he said: "I can say to them with certainty, with confidence, that you should get your treatment done at THQ Taunsa."
Not gonna fix this with education if they won't admit to having a problem in the first place.
Doctors and nurses are far from the only medical professionals who might be sticking you with a needle.
In the US your phlebotomist probably has a high school degree and a certification which required a few classes over one semester at a community college and passing an exam.
I doubt Pakistan has higher requirements than most US states do.
If they aren't educated, throw the whole thing away and start over. if they are educated, and decided to share HIV needles with children, throw the whole thing away, but put them all in prison.
Pakistanis are in a habit of executing circumspect people with needles after the US helped assassinate Bin Laden through a needle / vaccination campaign. They are highly distrustful in particular of people offering vaccines since it is a trojan horse rather than an act of charity.
> They are highly distrustful in particular of people offering vaccines
FTA
> Our investigation suggests that unsafe practices are in part driven by systemic pressures including a reliance on, and cultural preference for, injections as treatment.
> Pakistan has one of the highest rates of therapeutic injections in the world, many of them medically unnecessary. Members of the general public ask for them, including for their children, and doctors happily oblige, says Mir.
Vax program is common knowledge, literally everyone knows about that, and it was an intelligence program not an execution campaign. Your conclusion is made up
You're arguing against a straw man then. I didn't claim the "intelligence program" was an execution campaign against anyone but Bin Laden. The conclusion that it was a trojan horse, I think quite factual.
I did claim Pakistanis have executed vaccine workers ("circumspect people with needles").... because as I cited they have. In part because they have been used as CIA operations.
Does anyone have alternative archival sites? I want to switch away from archive.today because of the uncivil behavior [1] but can't find any other archival sites that can unpaywall websites.
One way to think of infection control best practice with needles like this.
The cost of a new needle, syringe or new gloves is quite cheap.
The cost of an infection is high.
The cost of a HIV infection is life altering.
So, its clear that whoever did this thought that whatever small savings they obtained from not using a fresh syringe was more important to them than the high likelihood their patients would get infections, including HIV.
It's not just this hospital, it's widespread ([1] report 38%)
[1] https://www.emro.who.int/emhj-volume-26-2020/volume-26-issue...
> An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar
> Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea.
> Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections.
> We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals
On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average.
If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
This seems like an excessive number of doctor visits, too. I can’t imagine a household where someone is going to the doctor almost every week. 45 doctor visits a year and they’re getting injections (of what?) most of the time?
I was shocked to see 500+ 'interactions' between me and the healthcare provider! However it turns out the majority of those interactions are very minor things - ie. "Patient received text message reminder about appointment". "Patient was sent letter with test results" etc.
When you count interactions like that, you can get a big number fast.
My doctor’s office even has a big sign in the waiting room saying they don’t prescribe antibiotics for common infections.
The last time I got strep throat the urgent care clinic was resistant to testing me but finally gave in. When it came back positive the doctor acted oddly like he was reluctantly willing to prescribe antibiotics for it.
For strep in particular, wiki indicates that not treating with antibiotics isn't unreasonable (presumably opinions will vary by doctor): https://en.wikipedia.org/wiki/Streptococcal_pharyngitis#Anti...
My friend who always used a naturopath would go on endlessly trying to diagnose herself with viral or bacterial to decide whether she should ask for antibiotics, but I definitely got the point.
I suppose many patients simply don’t know the difference.
On the other hand, the last time I got prescribed antibiotics was probably almost 10 years ago when I ended up in the hospital from an abscess.
Granted, my dad is old, but that part of the world still seems to expect doctors to do more for a common cold than just tell you to rest for a week and take an acetaminophen or phenylephrine if/when needed (even when that's really all you need).
FYI phenylephrine is effectively a placebo and the FDA has proposed ending its use in OTC drugs. (There've been HN threads on the subject, with many comments.)
Pseudoephedrine works great though.
My supervisor told me I could stay home for a day, but if longer than that, I would require a doctor’s excuse.
Now, that seemed fair from a labor perspective, but it is extremely unfair to someone like me. Because I do not own a vehicle, and seeing a doctor would involve boarding one or more buses and snorking the entire way there and back. Risking infection for everyone around me was exactly what I sought to avoid by staying home.
So what else could I do, but come into work and carry on? It is this sort of unreasonable requirement that fuels “presenteeism”.
I had a horrible tooth infection that anyone with a nose could tell was a bacterial infection yet I was massively gaslit and denied antibiotics until I went to the hospital at 11pm after a week of horrendous pain
Doctors very rarely do any kind of test in my experience (I would have thought oozing stinking green stuff would have been easy to test...)
Later
I am somewhat against antibiotics as I have a fragile/already destroyed gut. But there are times when I don't know what other solution there is after exhausting home remedies, other medication and waiting it out
UK seems very to be very cautious of over diagnosis, while my experience in Eastern Europe was opposite - my infant received 3 different kinds of steroids (potentially what stunned his growth).
IMO there is a huge amount of denial of treatment to save costs. The gaslighting over symptoms, the refusal to refer you to specialist, the refusal to order tests etc is all part of it. And they never ever say it's about costs - just a tight lipped, "I know what's best" attitude
Do you mean "developing?" This is not common practice in rich Western countries.
Additionally, as sibling has already pointed out, sterile disposable syringes are extremely cheap.
It's actually very easy. Sterilization takes place in a stainless steel container that has "windows" on it's sides. When the sterilization cycle ends, these "windows" are closed just as the container is taken out of the autoclave. The container will remain sterile inside until opened.
Also, simply opening the container to take one syringe from it doesn't make it dangerously contaminated. As demonstrated by the article, the biggest danger comes from other people's blood (HIV, HCV, HBV), not ordinary bacteria we have on our skin.
That's 4 cents per syringe. Seems quite reasonable to me. Seems they don't have economics as an excuse.
https://ailaaj.pk/products/apple-disposable-syringe-5ml-100s
When people complain about healthcare costs, they're not complaining about things that cost the same as a cup of coffee locally.
It's less about the money and more about the logistics of transporting and stocking these goods in a country that doesn't have decent basic infrastructure.
See?
It’s exactly the same way with contact lenses. When I was in college in the ’90s, I could get a pair of permanent contact lenses. They would cost a few hundred bucks, but they would last me several years if the prescription didn’t change. They were the same as glasses. You would clean them everyday and disinfect them, and they would serve quite well permanently.
But the contact lens industry decided that wasn’t good enough, and decided that they could sell subscription services for contact lenses that you would need to discard every night.
And those daily wear contact lenses, the disposable kind, basically forced out of the market the permanent ones and now the optometrist regards me as a Martian when I request permanent lenses instead.
* Or at least it should be. It seems that Pakistan is different.
And we had a big scandal locally. Were they doing a shoddy job of colonoscopies? Probably. But genetics left no doubt that they were using one needle per jab, but one syringe per patient. And drawing up from multi-use vials. Stick the hep C patient, in pulling back a bit ends up in the syringe. Discard needle, syringe is still infected. New needle, old syringe, draw from the vial again, vial is now infected.
So many products are bundled into purchase agreements at hospitals that you can't, in general, sensibly talk about per-unit costs.
That's driving the insistence on injections, and rural doctors/clinics cutting corners.
Sharia law, what could go wrong with these sets of rules, right? /s
This is the type of system where the design fails and effects of it are purely self inflicted by that society. It's pretty obvious that a population without education is easier to control, and that's the sole reason women still have no rights in those countries. It's just stupid when you need them to take care of your population's health then, huh?
Malala Yousafzai might disagree with that statement. You know, because she was shot in the head for advocating education for girls/women.
Just sayin'
Next door to other world leaders doing the same? Is that truly our motivation for not transferring the money? Some generals might illicitly buy houses?
> Until Pakistan cleans up its act
I'm sure "The Generals" are going to help there.
> giving it more loans it throwing good money after bad.
Abandoning them entirely as hostages is not acceptable.
Not gonna fix this with education if they won't admit to having a problem in the first place.
In the US your phlebotomist probably has a high school degree and a certification which required a few classes over one semester at a community college and passing an exam.
I doubt Pakistan has higher requirements than most US states do.
Too bad Elon got rid of it.
FTA
> Our investigation suggests that unsafe practices are in part driven by systemic pressures including a reliance on, and cultural preference for, injections as treatment.
> Pakistan has one of the highest rates of therapeutic injections in the world, many of them medically unnecessary. Members of the general public ask for them, including for their children, and doctors happily oblige, says Mir.
Stop making shit up
https://www.theguardian.com/world/2011/jul/11/cia-fake-vacci...
https://www.cgdev.org/blog/white-house-bans-cia-use-vaccine-...
killing of vaccine workers:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10185917/
Not made up. Although I would understand why people might think it's crazy enough that it would be.
This goes back to the polio vaccination campaign started in the 1990s. Bin Laden op happened in 2010-2011.
Polio workers were being chased away and lynched longer that. [1]
Still happening BTW [2]
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC2727330/ [2] https://www.rediff.com/news/report/polio-team-attacked-in-pa...
I did claim Pakistanis have executed vaccine workers ("circumspect people with needles").... because as I cited they have. In part because they have been used as CIA operations.
Does anyone have alternative archival sites? I want to switch away from archive.today because of the uncivil behavior [1] but can't find any other archival sites that can unpaywall websites.
[1] https://arstechnica.com/tech-policy/2026/02/wikipedia-might-...
If you're not willing to do that, it's "uncivil" to pirate their content, wouldn't you say?
It includes the website, the live streaming BBC News TV channel, and a library of documentaries.
The cost of a new needle, syringe or new gloves is quite cheap.
The cost of an infection is high.
The cost of a HIV infection is life altering.
So, its clear that whoever did this thought that whatever small savings they obtained from not using a fresh syringe was more important to them than the high likelihood their patients would get infections, including HIV.