Dr. Pilyulkin's competitor in fairy-tale works. Real medical competition as seen by a rich doctor

Dunno, Bobik and Barbos and 8 more funny characters by Nikolai Nosov
In his childhood and youth, Nikolai Nosov was interested in music, chess, theater, photography, dreamed of becoming a chemist and even set up a small laboratory in the attic. But the success of the talented “dreamer” was brought by children’s stories and novellas.
On November 23, 1908, 105 years ago, one of the kindest children's writers was born - Dunno's “father” Nikolai Nosov. Childhood and school years Nosov fell on hard times(First World War and Civil War), the whole family suffered from malnutrition and typhus (both the parents and four children suffered from it). However, in the works of Nikolai Nikolaevich there is not a drop of bitterness - they are always very touching and funny. Several generations have already grown up on Nosov’s stories, novels and novels, but children still adore him, and cartoons are made based on the writer’s books.

The most famous characters Nikolai Nosov - from Dunno to Bobik and Barbos.

Dunno. Trilogy about Dunno. The author wrote 3 books about the adventures of a “short man of average height”. According to Nosov himself, the hero has real prototype- a child “with a restless thirst for activity inherent in his age, an ineradicable thirst for knowledge and at the same time with restlessness, the inability to keep his attention on one subject.”

Vintik and Shpuntik. Trilogy about Dunno. Two cheerful brothers - jacks of all trades, never sit still and constantly come up with something: they are the ones who designed for the short ones balloon, rockets and a miracle vacuum cleaner. The inseparable inventors appear in all books about Dunno, as well as in a separate story (later they also made a cartoon about them).

Donut. Trilogy about Dunno. The life credo of a plump lover of buns and pies: “You can’t break your diet.” In the sublunary world, the short man tried to open his own business - selling salt, but local merchants ruined him.

Znayka. Trilogy about Dunno. A short scientist with a “cucumber head” discovered lunite and anti-lunite, invented a weightlessness device and participated in the Lunar expedition. Znayka’s favorite song is “A grasshopper sat in the grass.”

Pilyulkin. Trilogy about Dunno.Doctor Flower City treats according to the principle: “You need castor oil inside! And outside it’s not honey, but iodine!” He may smear the short guy with iodine “for educational purposes”: for example, so that he doesn’t fight. Wears pince-nez.

Bobik and Barbos. “Bobik visiting Barbos” Charming dogs, the boastful liar Barbos and the gullible Bobik, quite soon “moved” from Nosov’s story into a cartoon, and many of their phrases became catchphrases - for example: “The refrigerator is mine, and everything in the refrigerator is also mine !

Vitya. “Vitya Maleev at school and at home”
Shortly before the release of the story, Konstantin Piskunov summoned the author, Chief Editor"Detgiza". He knew that the book had been nominated for Stalin Prize, and asked Nosov to insert Stalin’s name into the text at least once. He refused to make concessions, but still received the bonus. At the same time, the writer himself was dissatisfied with the story - after publication, he practically rewrote it.

Stanislav Sazhin prepared for Rusbase on the topic of medical startups. Problems in the industry - with numbers and examples - and advice for those who are just about to launch their own project, from the founder social network for doctors “Doctor at work”.

We are publishing the article in parts, and today we have a conclusion about startups that the market will not accept. On next week Stanislav Sazhin will talk about more positive things: he will reveal areas where a new medical business can be launched and, most importantly, he will hint where the money for all this will come from. Don't switch.

Chapter 8. Startups from other areas of online medicine

To finish with online medicine, let's discuss some other areas.

– Professional community for doctors and pharmacists

In Russia there are many such communities for doctors, seven of them, including “Doctors at Work,” and three for pharmacists, including “Smartpharma,” which we launched two years ago. There are networks for patients, there are very simple model. Pharmaceutical companies pay for advertising aimed at professional communities. This advertising cannot be placed on end customers, on patients, because this is contrary to the advertising law, which prohibits advertising of prescription drugs. But this is precisely where such sites make money. And their competitive model is also very simple: the more doctors visit the site, for example, in a month, the more doctors can see advertising from pharmaceutical companies, the more the pharmaceutical company is willing to pay for it.

It becomes clear why, for example, “Doctor at Work” earns so much, and our closest competitor, “Doctor’s World,” earns so little. Because “Doctor at Work,” for example, was visited by more than 200 thousand doctors in July, more than 400 thousand are listed on the site in total, and “Doctor’s World” was visited by less than 20 thousand doctors in July, i.e. 10 times less, and in total about 100 thousand are registered on the site. The competitive model is very simple, understandable, due to the fact that the price of entry into the market is very high. If you now create a website for doctors from scratch, then average cost attracting one doctor will cost 1,000 rubles: to simply repeat the success of “Doctor’s World” and gather 100 thousand doctors, you will have to spend 100 million rubles. And after that you need to fight for the money of pharmaceutical companies.

On average, the period from the beginning of communication with a pharmaceutical company to the contract is one year. If you start now, you will have your first contracts in a year, after you have collected at least 100 thousand doctors.

Accordingly, first you invest 100 million rubles in doctors, then you will make your first sales - and this is against the backdrop of the fact that your competitors, “Doctor at Work” and “Doctor’s World”, are not resting, but are developing. Most likely, by the time you gather 100 thousand doctors, they will already be out of your reach - mainly due to clients, because they enter into long-term contracts with most products on the market.

– Analyzes in Russia

Several sites and services that allow you to find where to get tests done, deliver these tests, and receive them. Here you can highlight services such as “Analizmarket”. There you can find where it is cheapest, for example, to get a blood test, and where you can get a discount.

We can highlight a service that is a graduate of the IIDF - this is Unim. They allow the regions to send their sample of material from a potentially cancerous tumor that a patient may have to the central part of the country. At the center, the analysis will be carried out by doctors who assume that they are better than doctors in the region, and then report whether the diagnosis was made correctly in the regional clinic.

In fact, both directions do not seem promising to me. This is due to the fact that there are very few patients who are willing to pay out of pocket for tests and second opinions from oncologists.

Chapter 9. Other offline startups

Now let's talk about medical startups that are not related to the online industry. Several directions can be cited here.

– Genetic analysis

Most shining example here is the Moscow Atlas clinic, which does a genetic analysis of your saliva, and then, based on this, plans examination and treatment in the clinic. Interesting topic. My wife, for example, did such an analysis. But it is expensive and obviously not available to everyone. I don't think such a service will be widespread. For example, in America there is a similar startup, in fact, the founder of all the others - “23 and me”. He is not leading a very “successful” existence, especially after the American State Administration of Drugs and Nutrition banned “23 and me” from making predictions about the likelihood of contracting any diseases based on genetic analysis.

– Medicine production

At every state startup competition like Skolkovo Startup Village, I see many projects that make medicines in Russia. All I want to tell them is: “Come to your senses!”

Over the past 30 years, not a single drug has been created in Russia. Even those that are now leading in sales in pharmacies - Kagocel, Arbidol - were created before this. Now I can say that in Russia both the system of laboratories where molecules are studied and the system of clinical research have been destroyed. It's not the state's fault. For example, in the USA and Great Britain this is done by private laboratories, which often receive government grants. For us, this is rather an objective reflection of the situation in the economy.

The average cost of developing one innovative drug is $10 billion. Can you imagine – 10 billion dollars for medicines? And the process takes about 10 years.

Moreover, at the stage of these 10 years, dozens, hundreds of laboratories offer their molecules. Most of none of them pass tests, then new tests are carried out, new people, animals are looked for, again laboratories, a bunch of scientists, and in the end - a drug. This is a very long-term investment, a very risky business. This is why there are so few, about 20-30, large pharmaceutical companies in the world that make money from this. None of them are building laboratories for research into new drugs in Russia, and I have not heard of a single drug that is supposedly in development eventually reaching pharmacy shelves in Russia in the last 30 years.

It’s good that we have scientists who think they can create a new drug, but so far I have little faith in it.

– Creation of medical equipment, medical equipment

Here, again, the problem is in production.

For example, I know a good surgeon who came up with a special device to make a smaller incision on the patient's body than is currently done. But how can he experience it? How can he start production in Russia? It's practically impossible. He will most likely have to go to China, launch everything there, and then, when he does this, what will be the point for him to start a business in Russia? He will start doing this in the USA.

It is precisely because of this that I would not believe that now in Russia it is really possible to put the creation of medical equipment or medical instruments on stream.

– Test strips, various diagnostics

There are also many startups in this area. Here we need to objectively understand that we either copy Western experience, or we create something of our own, which, in fact, turns out to be of no use to anyone.

I have been working in the medical field for 6 years now, and I do not know a single example of a successful offline medical product created in Russia. Perhaps the only thing worth talking about is that in Russia the population has an increasing amount of money, and at the same time the desire to live longer. Therefore, the most promising area in offline medicine is clinics. There are few private clinics. Their number per capita is much less than in the world. Accordingly, if I were engaged in offline business, I would engage in private clinics.

Cover photo: Shutterstock.

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Low-carbohydrate diets are extremely popular in the world today. One of such nutritional systems is the one that was developed by the American cardiologist Robert Coleman Atkins by the early 70s of the 20th century. His creation, despite all its dubious moments, today has hundreds of thousands of fans all over the planet. What is the reason for such popularity?

How the diet came about

Perhaps the fact that the father of the famous cardiologist-nutritionist was a restaurateur also affected R. Atkins’ weight. By the age of 33, he weighed more than 100 kilograms. At the age of 25, the young man became a doctor of medicine and received a position as a cardiologist at the hospitals of two American universities. Data educational establishments in Rochester and Columbia specialized not only in the field cardiovascular diseases, but also practiced alternative medicine.

Carried away by the study of the causes of obesity, having studied many medical works and concepts, Atkins, in the fight against his own overweight adopted many postulates, the basis of which was the works of G. Azar and W. Bloom. Robert put into practice everything that he considered effective, and, having lost 28 kg, systematized the knowledge gained. In many ways, the doctor also relied on experience practical activities in his own office, which he opened in 1959. In 1972 everything useful information The new weight loss regime was published in R. Atkins's first book, which was called "Dr. Atkins' Diet Revolution." Over the course of his life, the cardiologist published 12 books, which were devoted to both the principles of the new diet and culinary recipes. Many of the books are still in print today.

According to the doctor himself, in his center of alternative medicine he was able to help more than 50 thousand people suffering from heart disease and complications caused by excess weight. Having opened the company Atkins Nutritionals in 1998, which promoted a revolutionary nutrition system (published books, brochures, produced diet bars and shakes), he was able to earn tens of millions of dollars. But... The company's success was not endless.

Competitors, doctors and even chefs have wondered: is a diet that works with virtually no restrictions really safe? “If you want to lose weight, eat as much as your body requires.” A very strange principle, isn't it? Doctors sounded the alarm, suggesting that the long-term effect of a system that does not include carbohydrate foods on the menu will not be as rosy as it seems at first. Atkins's company began to incur losses. The final collapse came after 2002, when a cardiologist, who seemed to have everything in order with his blood vessels, suffered cardiac arrest. And although Atkins official reason After he declared an infection, his attending physician was inclined to believe that there was a connection between the illness and an erroneous approach to nutrition. By 2005, Atkins Nutritionals was on the verge of bankruptcy after the death of its founder (he died in 2003 after slipping on ice). The corporation's losses then amounted to $350 million.

The essence of the Robert Atkins diet

Today, the Atkins diet can no longer be called unusual - there are many methods for losing weight by limiting carbohydrates. But at the time of its appearance, it was indeed very extraordinary. By declaring carbohydrates “persona non grata,” Atkins allowed his patients to consume meat, eggs, bacon, and other filling foods with virtually no restrictions. The feeling of hunger among those who want to lose weight has sunk into oblivion.

The essence of the diet was as follows. The cardiologist found that it is carbohydrates that influence the increase in sugar levels and, accordingly, insulin, which normalizes glucose levels in the body and converts excess glucose into fat, creating a feeling of hunger in a person and forcing him to eat again. So isn’t it easier to try to reduce such phenomena to a minimum?

Protein-rich foods do not cause such a sharp jump in insulin as carbohydrates (especially fast ones), so the emphasis is on them. A decrease in insulin causes ketosis, fats begin to break down, and excess lipids, passing into the blood, become fuel, from which energy is obtained. Thus, by consuming protein foods, a person loses weight.

Diet stages

In order to switch the patient to a new low-carbohydrate diet, and high probability loss of many extra pounds, Dr. Atkins broke his diet into two main phases.

First phase

It is very strict, lasts two weeks and is called induction. At this stage, you need to very carefully monitor the carbohydrates you consume. daily norm which should reach a maximum of 40 grams (you can easily calculate the carbohydrate content in 100 grams of any product using numerous tables in books or the Internet). It is more advisable to reduce this figure to 20. Then you need to start physical exercise.

The first phase of the diet is designed to rebuild the body to a new metabolism, when energy will be obtained from previously stored fat reserves. The basis of nutrition is fats and proteins, which are strictly forbidden to be eaten at the same time as acceptable norm carbohydrates. “Junk” food should be consumed at a two-hour interval from the rest.

To avoid stagnation in the intestines, it is important to drink at least half a liter of water per day for every 20 kg of your weight. But you need to drink separately from meals (40 minute interval). It is advisable to eat evenly – 3-5 times a day, and do not overeat.

Prohibited:

• any fast carbohydrates (flour, sweet, starchy (including vegetables), drinks with aspartame and caffeine),
• sugar and all products containing it,
• semi-finished products with unknown composition,
• sweet fruits, processed cheeses,
• alcohol,
• margarine and other trans fats.

Second phase

In two to two and a half weeks of the previous stage, the body has already gotten used to the greatly reduced intake of carbohydrates and begins to burn fat. Now restrictions on the amount of carbohydrates consumed are gradually moving to an acceptable norm for each person. You can add carbohydrates no more than once a week, and no more than 10 grams.

This is an individual indicator, depends on the characteristics of the body and on average equals 40-60 grams per day. It is determined practically when a person begins to feel comfortable and the symptoms of hypoglycemia disappear. You should stop when you notice weight gain.

The second stage requires daily weighing and recording of results. Measurements should be taken in the morning on an empty stomach. The loss of mass will occur more slowly than in the first phase. You can include more fruits and vegetables, black bread, and a little unsweetened alcohol (not beer) in your diet. Breakdowns in this phase suggest a return to the very beginning of the diet.

Very important so that even allowed carbohydrates are slow (not baked goods and starchy foods, but cereals, unsweetened fruits, vegetables), and consumed before 16-17 pm.

If the weight loss in the second phase is too slow, try to increase the interval of introducing additional carbohydrates. Or take less of them. For example, once a week increase the rate of carbohydrate foods not by 10 grams, but by 5. Or leave the same rate - 10 grams, but once not every week, but every two or three weeks.

The need to take any medications during this period will require a mandatory consultation with a competent doctor, since the author of the diet himself strictly prohibited the use of any medications.

When the norm of carbohydrate foods has been established, allowing you to maintain the desired weight, the consumption of prohibited foods is occasionally allowed, but in small quantities and so that it does not become regular.

After 4-6 weeks on the Atkins diet, you need to donate blood for sugar.

There is also the concept of four phases of a diet, when the first phase remains the same, and the second is divided into three - gradually increasing carbohydrate consumption until weight loss continues, stabilizing the result, maintaining shape with possible slight relaxations.

What worries doctors and nutritionists about the Atkins diet

Significant amounts of protein foods with saturated fats lead to digestive disorders, the gradual development of osteoporosis and problems with cardiac activity.

Artificially lowering blood sugar significantly increases the risk of developing diabetes, which makes periodic consultations with a doctor and monitoring of the blood picture necessary. In addition, a lack of glucose has a bad effect on brain performance.

Inevitable ketosis is the process of formation of products of incomplete breakdown of fats, which takes place under conditions limited consumption carbohydrates - is a provocateur of dizziness, loss of strength, irritability and insomnia. Since the processing of fats in such conditions is difficult, the author of the diet himself prescribed L-carnitine to patients, which helps speed up metabolic processes. In addition, Atkins recommended that clients over 40 take the Q-10 enzyme, which also stimulates effective weight loss. Chromium supplements and a vitamin complex will also be beneficial. But you should not resort to taking these auxiliary elements on your own; consultation with a professional is required.

This diet is completely unsuitable for athletes and people who regularly experience severe physical exercise. Energy reserves for such a lifestyle are too small.

Emergency removal of ketone bodies leads to loss of potassium and sodium reserves along with them, and general dehydration, which affects both bone tissue and heart function. This is why it is extremely important to maintain the recommended water intake and vitamin intake.

With a strict restriction of carbohydrates, the work of the liver and kidneys goes into literally “wear and tear” mode. The diet is strictly contraindicated for people with liver and kidney failure, any chronic and heart diseases, psycho-neurological disorders, pregnant and lactating women.

Undoubtedly, the diet has its advantages. With a reasonable approach, it really allows you to lose weight quite quickly and effectively, without suffering from hunger pangs. The need to count carbohydrates quickly turns from a complex task into an automatic action and does not cause inconvenience throughout the life of such a diet. In addition, for obese people, the Atkins diet helps normalize metabolic processes. All this can be achieved without loss to health by carefully following the recommendations, monitoring the condition of all body systems and regularly visiting your doctor for monitoring.

Example of a menu in the first phase

The list of allowed dishes in both phases is quite extensive, and you can come up with a lot of ideas for dishes with them. We present to your attention several simple options, based on which, you can create dozens of others, depending on personal preferences.

Breakfast

• A salad of two or three boiled chicken eggs, half a cucumber and normal fat mayonnaise (1 tbsp); herbal or green tea sugarless.
• Scrambled eggs from two to three eggs with 2 tbsp. l. grated hard cheese and the same amount of chopped greens.
• Omelet with one tablespoon of homemade heavy cream and two tablespoons of herbs.

Dinner

• Meat in any form, including homemade fatty minced meat - for cutlets; salads seasoned with mayonnaise from Chinese cabbage, radish, cucumber, celery and other permitted vegetables.
• You can cook meat and vegetable broth.
• You can make a salad from meat and vegetables (allowed, of course).

Dinner

• Stewed fish fillet.
• Fried flounder.
• Fillet of your favorite fish, breaded with eggs and grated cheese.

What do those who have experienced it say about the diet?

Many people are frightened by the unexpected feeling of weakness that appears in the first days of following a diet. Here it is worth remembering all the recommendations and preparing snacks in advance, or better yet, building a regime based on eating five meals a day. And under no circumstances should you neglect the required amount of water. Weakness goes away quickly as soon as the body adapts to the new conditions.

Some people complain about the monotony of food, especially in the first phase. But here you can counter with the fact that in many other diets everything can be much more modest.

Those “users” who have consistently and correctly followed the diet can boast that they have lost up to 50 kg in just over six months. The system is indeed very effective, but it must be approached, as they say, fully armed. Zealous followers, who have not only lost weight, but also maintained and improved their health, are well acquainted with physiology, the principles of the body's reaction to proteins, fats, carbohydrates and their combinations. They know everything or a lot about glucose, insulin, cholesterol and others important nuances, on which the Atkins diet is based.

But those trying to lose weight for the holidays or vacations often abuse restrictions, excluding not only carbohydrates, but also fats, and, moreover, greatly cutting down the amount of food in principle. The result is gastritis and serious health problems. By the way, if you remove fats from your diet, the burning of existing reserves will stop, and you will not achieve your goal very soon.

They emphasize that taking multivitamins is a must! Otherwise, the first stage may result in the loss of not only kilograms, but also hair and nail strength. And in order for the intestines to function well, it is recommended to take oat bran - one tablespoon three times a day (be sure to count them in total carbohydrates).

To lose weight or not to lose weight?

So, if you have no contraindications, and you are determined to lose weight, and are not ready to experience hunger pangs, Dr. Atkins’ diet is quite suitable for your goals. Prerequisite– discipline and responsibility. Without them, you will not be able to follow all the necessary recommendations.

If you make such a nutritional system lifelong, it may well provide beautiful figure And good health. You will learn to control your diet and choose healthy foods, regulate your weight, and monitor health indicators, which is important for any lifestyle.

Znayka, Avoska, Vintik and Doctor Pilyulkin grabbed Dunno and carried him home. Everyone thought he was already dead.
At home they put him on the bed, and only then Dunno opened his eyes. He looked around and asked:
- Brothers, am I still alive?
“Alive, alive,” answered Doctor Pilyulkin. “Just please lie still, I need to examine you.”
He undressed Dunno and began to examine her. Then he said:
- Marvelous! All the bones are intact, only there are bruises and a few splinters.
“It was my back that got caught on the board,” said Dunno.
“We’ll have to pull out the splinters,” Pilyulkin shook his head.
- Does it hurt? - Dunno was scared.
- No, not at all. Here, let me, I’ll take out the biggest one now.
- A-ah-ah! - Dunno shouted.
- What you? Does it hurt? - Pilyulkin was surprised.
- Of course it hurts!
- Well, be patient, be patient. It only seems so to you.
- No, it doesn’t seem like it! Ah ah ah!
- Why are you screaming as if I’m cutting you? I'm not cutting you.
- Hurt! He himself said that it didn’t hurt, but now it hurts!
- Well, hush, hush... There is only one splinter left to pull out.
- Oh, don't! No need! I'd rather be with a splinter.

- You can’t, it’ll break out.
- Whoa, whoa, whoa!
- Well, that's all already. Now you just need to anoint it with iodine,
- Does it hurt?

- No, iodine doesn’t hurt. Lie still.
- A-ah-ah!

- Don't yell, don't yell! You love to drive a car, but you don’t like to be patient!
- Ay! It stings!
- It will burn and stop. Now I'll put a thermometer on you.

- Oh, no need for a thermometer! No need!
- Why?
- It will hurt!
- Yes, the thermometer doesn’t hurt.

“You keep saying it doesn’t hurt, but then it hurts.”
- What an eccentric! Haven't I ever set a thermometer for you?
- Never.
“Well, now you’ll see that it doesn’t hurt,” Pilyulkin said and went to get a thermometer.
Dunno jumped out of bed and jumped into open window and ran away to his friend Gunka.

Doctor Pilyulkin returned with a thermometer and looked - there is no Dunno.
- So treat such a patient! - Pilyulkin grumbled. - You treat him, treat him, and he jumps out the window and runs away. Where does this fit!