“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

GLP-1 drugs are powerful tools that can improve health, but it comes with risks and caveats. While these are medical therapies, they are being misused as cosmetic products by cosmetologists, physiotherapists, dermatologists, among others.

To curb its misuse and improve public health, the Indian government today issued guidelines on its use, while also flagging risks around it.

In an official statement issued today, the government has stated that it will roll out stricter inspections to curb the misuse of GLP-1 drugs in the country and will punish those who violate the rules.

“GLP-1 drugs are a significant medical breakthrough in treating type 2 diabetes and obesity, but they are not without risk. The drugs carry a wide range of side effects - from common symptoms like nausea and vomiting to severe complications including pancreatitis, kidney injury, and bowel obstruction. These risks make it essential that GLP-1 drugs are only taken under the supervision of registered medical practitioners/specialists,” the statement said.

In the wake of its hype over weight loss, the country's regulatory authorities have taken firm steps to prevent unsupervised use and malpractices in the supply chain.

It has “strongly advised” patients and the public to” consult a qualified medical specialist before use, and to obtain these medications with prescription only through legitimate, regulated channels”.

“Stricter inspections and surveillance will continue in the coming weeks. Businesses that break the rules will face license cancellation, fines, and legal action,” the statement said.

Also read: GLP-1 Drugs: Why India Needs Stricter Rules Now

What Are The Side-effects Of GLP-1 Drugs?

GLP-1 drugs work to keep food in the digestive system for longer – making people feel fuller for longer, thus reducing appetite and inducing weight loss. Hence, the drugs are also prescribed to people with obesity.

However, when done without clinical oversight, it can lead to severe health complications.

There are various side effects to taking GLP-1 drugs, including nausea and dizziness, to pancreatitis and medullary thyroid cancer.

Some serious side effects include

• Pancreatis
• Thyroid Cancer
• Acute (Sudden) Kidney Injury
• Worsening Diabetes-Related Retinopathy
• Gallstone & Bile Duct Blockage
• Rapid loss of fat in the face
• Wrinkles
• Sunken eyes

GLP-1 medications may also complicate various health conditions, such as allergic reactions, with shortness of breath and low blood sugar.

Rush For Generic Weight Loss Drugs

The government's advisory comes as patent for semaglutide -- an active ingredient in diabetes and anti-obesity drugs, specifically Wegovy and Ozempic -- expired on March 20.

This has led to a rush among Indian pharma companies to launch cheaper generic versions, significantly increasing affordability and access for millions battling Type 2 diabetes and obesity.

Also read: CDSCO threatens action against pharma companies for promoting GLP-1 weight-loss drugs

Major Indian drugmakers who launched their generic semglutide injection in the country in March include Sun Pharmaceutical Industries, Zydus Lifesciences, Alkem Laboratories, and Dr. Reddy’s Laboratories.

WHO Guidelines on GLP-1 drugs

Amid the increasing prevalence of GLP-1 drugs, the World Health Organisation (WHO), late last year, acknowledged its role in treating obesity.

However, it warned that medications like GLP-1 alone will not solve the problem affecting more than one billion people worldwide.

The global health body also issued conditional recommendations for using these therapies as part of a comprehensive approach that includes healthy diets, regular physical activity, and support from health professionals.

Danish pharma giant Novo Nordisk has once again reduced the prices of its blockbuster drugs Ozempic and Wegovy in India. The strategic move is aimed at staying ahead of the entry of the low-cost generic competition in the country.

Starting today, the Ozempic price in India will be cut by 36 percent, while Wegovy has seen a steeper 48 percent reduction — limiting the base price below Rs 6,000 per month.

While Ozempic is available in three dose strengths of 0.25 mg, 0.5 mg, and 1 mg in India, Wegovy has five dose strengths.

Ozempic's and Wegovy's lowest doses of 0.25 ⁠mg will now be priced at Rs 1,415 for a weekly shot from Rs 2,200 and Rs 2,712 earlier, respectively, Novo Nordisk India said in a statement on Tuesday.

The average price reduction across doses is 23.8 percent for Ozempic and 27 percent for Wegovy, it added.

Speaking to the media, Novo Nordisk stated that the price cut will benefit a large section of people with diabetes and obesity in India.

The generic weight loss drugs will open up a huge customer base, especially in India, with a high burden of diabetes and obesity.

Novo first slashed Wegovy's price for the first time by up to 37 percent from its launch price last year.

In addition to the entry of generics, the launch of rival Eli Lilly's blockbuster diabetes and obesity drug Mounjaro in India in 2025.

Also read: Semaglutide Becomes Cheap In India: A Gamechanger Or Health Gamble?

Entry Of Generics In India

Soon after the end of Novo Nordisk's patent on semaglutide, on March 20, a host of companies in India launched generic versions of Ozempic.

This includes NATCO Pharma's Semanat and Semafull, priced at Rs 1,290 per month and Rs 1,750 — about 90 per cent cheaper than Ozempic, costing Rs 8,800 per month.

Eris Lifesciences also announced its plans to launch a multi-dose vial under the brand name Sundae at the same price.

Dr. Reddy’s Laboratories, Sun Pharmaceutical Industries, and Glenmark Pharmaceuticals have also launched their generic versions of semaglutide.

Dr. Reddy’s Obeda is priced at Rs 4,200 per month, available in 2 mg and 4 mg strengths.

Sun Pharmaceutical Industries will sell under the brand names Noveltreat (doses ranging from Rs 900) and Sematrinity (doses ranging from Rs 750). Meanwhile, Glenmark’s GLIPIQ vials range from Rs 325 to Rs 440 per week.

Zydus Lifesciences has also announced the launch of its generic version of semaglutide injection under the brand names SEMAGLYNTM, MASHEMATM, and ALTERMET. The average monthly cost of the treatment will be about Rs 2,200, the company said in a statement.

How Does Semaglutide Work?

Semaglutide works as a GLP-1 receptor agonist that mimics the GLP-1 hormone to regulate appetite and blood sugar. It slows gastric emptying and makes you feel fuller longer. It also signals the brain to reduce hunger and cravings, and triggers the pancreas to release insulin when blood sugar is high.

Also read: This Pill Is More Effective For Weight Loss Than Ozempic, Scientists Say

They work by increasing insulin release in a glucose-dependent manner, decreasing the liver's production of glucagon, and slowing down the emptying of the stomach, which helps lower blood sugar levels after a meal. They also act on the brain to suppress appetite and increase feelings of fullness, leading to reduced calorie intake.

In people with type 2 diabetes, notes Harvard Health, the body's cells are resistant to the effects of insulin and the body does not produce enough insulin, or both. This is when GLP-1 agonists stimulate the pancreas to release insulin and suppress the release of another hormone called glucagon.

These drugs also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time. These effects can lead to weight loss, which can be an important part of managing diabetes.

Health officials in the US have issued a risk of leptospirosis — a bacterial illness — in Hawaii, after the “Kona low” storm floods.

The Hawaii Department of Health (DOH) and the Hawaiian Humane Society (HHS) have urged residents and recovery workers to monitor for signs of leptospirosis that can affect both people and pets.

Leptospirosis is caused by bacteria Leptospira, which are carried in the urine of infected animals, including rats, mice, mongoose, livestock, and dogs.

The disease can spread via the urine of infected animals and can enter the human body through broken skin or through the mouth, nose, or eyes.

“Hawaii already has among the highest rates of leptospirosis in the country due to its warm, wet climate,” said HHS and DOH in a joint statement.

“Flooding events like the recent Kona low storm can dramatically increase exposure risk by spreading contaminated soil and water across a broad area,” it added.

The agency urged people to check out symptoms in pets, such as fever, decreased appetite, vomiting, diarrhea, and muscle soreness, and get medical help.

The risk of Leptospirosis outbreak is common after a storm, because the dead animals are likely to spread the bacteria. Further, flooding also forces rodents out of their burrows, leading them into homes, shelters, and debris piles where they shed bacteria more easily.

What Is Leptospirosis?

Leptospirosis is one of the most prevalent zoonotic diseases worldwide, often linked to poor sanitation and agricultural practices that involve contact with animals or contaminated water.

The bacteria can survive in contaminated water or soil for weeks to months, primarily spreading through the urine of infected animals.

Also read: With Rising Temperatures A Major Rat Infestation Is Taking Over The World- Why Is This A Health Hazard?

Humans can contract the disease through direct contact with infected urine or through contaminated food, water, or soil.

There are two main forms of leptospirosis: icteric leptospira, which presents with jaundice, and anicteric leptospira, a milder variant without jaundice. Leptospirosis can also manifest as Weil's disease, a severe complication.

What Are Symptoms Of Leptospirosis in humans?

Symptoms typically develop 2 to 30 days after exposure and can range from mild to severe. Initial signs often include

• high-grade fever,
• red eyes (conjunctival suffusion),
• calf tenderness,
• headache,
• dry cough,
• nausea,
• diarrhea.

In more serious cases, the infection can lead to complications such as

• jaundice,
• kidney damage
• liver damage,
• meningitis,
• respiratory issues,
• hemorrhages.

Pulmonary hemorrhage — acute bleeding from the lungs — can also occur, posing life-threatening risks such as respiratory and renal failure. The illness may last from a few days to several weeks, and without treatment, recovery can take months, according to the US Centers for Disease Control and Prevention (CDC).

What Precautions Should Be Taken?

To reduce the risk of leptospirosis infection, individuals are advised to take several important precautions. According to the CDC, it is essential to avoid wading through dirty rainwater, especially during the rainy season, and to wear gumboots in such conditions.

Proper care of any injuries or cuts is crucial, and frequent handwashing, particularly after handling food or working in potentially contaminated environments, is highly recommended. Additionally, individuals should avoid contact with animals that appear sick or are known carriers of the bacteria.

Vaccination is also vital—pet owners should ensure their pets are vaccinated against leptospirosis, especially if they are frequently exposed to water or wildlife. Staying hydrated by drinking plenty of clean water and preventing water stagnation around the home can further minimize the risk of infection.