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Despite initial enthusiasm from Page’s distributors, as an overall category, innerwear remained a low-profile product in retail stores. This would ultimately necessitate a high-pitched, pan-India advertising campaign from Page, but the costs were prohibitive. Competitive intensity from incumbents had already increased substantially during 1995–2000. When the company reached sales of Rs 21 crore in FY2000, Rupa and Maxwell were already at Rs 150 crore each. One level above them, in the mid-premium segment, brands like Liberty, Libertina and Tantex (TTK Tantex) were firmly ensconced. Associated Apparels (Liberty and Libertina) reported sales of Rs 100 crore during the same period. In a stroke of luck for Page, both TTK Tantex and Associated Apparels fell prey to labour strikes. TTK Tantex saw labour-related plant shutdowns in 1997 that lasted for two years, sending the company’s revenues into a steady descent (see Exhibit 55). The TTK Group had twenty companies across many sectors and, due to lack of management bandwidth to handle the crisis, sold the innerwear brand in FY02. In the same year, Associated Apparels had a labour strike in one of its factories that disrupted its supply chain. The exit of both TTK Tantex and the crippling of Associated Apparels played into Page’s hands as all the large innerwear retailers (dealers) in northern and western India shifted to Jockey.

By April 23, 2014, thirty-four cases and six deaths from Ebola in Liberia were recorded. By mid-June, 16 more people died. At the time it was thought to be malaria but when seven more people died the following month tests showed that was the Ebola virus. The primary reason for the spreading of the Ebola virus was the direct contact from one person to the next and the ingesting of bush meat. Soon doctors and nurses also became infected. On July 2, 2014, the head surgeon of Redemption Hospital was treated at the JFK Medical Center in Monrovia, where he died from the disease. His death was followed by four nurses at Phebe Hospital in Bong County. At about the same time two U.S. health care workers, Dr. Kent Brantly and a nurse were also infected with the disease. However, they were medically evacuated from Liberia to the United States for treatment where they made a full recovery. Another doctor from Uganda was not so lucky and died from the disease. Arik Air suspended all flights between Nigeria and Liberia and checkpoints were set up at all the ports and border crossings. In August of 2014, the impoverished slum area of West Point was cordoned off. Riots ensued as protesters turned violent. The looting of a clinic of its supplies, including blood-stained bed sheets and mattresses caused the military to shoot into the crowds. Still more patients became infected, causing a shortage of staff and logistics. By September there had been a total of 3,458 cases of which there were 1,830 deaths according to the World Health Organization. Hospitals and clinics could no longer handle this crisis and patients who were treated outside died before they could get help. There were cases where the bodies were just dumped into the Mesurado River. The Ivory Coast out of compassion, opened carefully restricted humanitarian routes and resumed the previously suspended flights to Liberia. Ellen Johnson Sirleaf the president of Libera sent a letter to President Barack Obama concerning the outbreak of Ebola that was on the verge of overrunning her country. The message was desperate, “I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us.” Having been a former finance minister and World Bank official, Johnson Sirleaf was not one for histrionics however she recognized the pandemic as extremely dangerous. The United States responded to her request and American troops came in and opened a new 60-bed clinic in the Sierra Leone town of Kenema, but by then the outbreak was described as being out of control. Still not understanding the dangerous contagious aspects of this epidemic at least eight Liberian soldiers died after contracting the disease from a single female camp follower. In spite of being a relatively poor country, Cuba is one of the most committed in deploying doctors to crisis zones. It sent more than 460 Cuban doctors and nurses to West Africa. In October Germany sent medical supplies and later that month a hundred additional U.S. troops arrived in Liberia, bringing the total to 565 to assist in the fight against the deadly disease. To understand the severity of the disease, a supply order was placed on October 15th for a 6 month supply of 80,000 body bags and 1 million protective suits. At that time it was reported that 223 health care workers had been infected with Ebola, and 103 of them had died in Liberia. Fear of the disease also slowed down the functioning of the Liberian government. President Sirleaf, had in an emergency announcement informed absent government ministers and civil service leaders to return to their duties. She fired 10 government officials, including deputy ministers in the central government who failed to return to work.

effect are base lies, I'll have you and your friend know! However—" he yawned again "—I've been up all day and so, purely coincidentally, I do find myself just a bit sleepy at the moment. The which being so, I think I should take myself off to bed. I'll see you all in the morning." "Good night, Alistair," she said, and smiled as he sketched a salute and disappeared into the night with a chuckle. "You two are really close, aren't you?" Benson observed quietly after McKeon had vanished. Honor raised an eyebrow at her, and the blond captain shrugged. "Not like me and Henri, I know. But the way you look out for each other—" "We go back a long way," Honor replied with another of her half-smiles, and bent to rest her chin companionably on the top of Nimitz's head. "I guess it's sort of a habit to watch out for each other by now, but Alistair seems to get stuck with more of that than I do, bless him." "I know. Henri and I made the hike back to your shuttles with you, remember?" Benson said dryly. "I was impressed by the comprehensiveness of his vocabulary. I don't think he repeated himself more than twice." "He probably wouldn't have been so mad if I hadn't snuck off without mentioning it to him," Honor said, and her right cheek dimpled while her good eye gleamed in memory. "Of course, he wouldn't have let me leave him behind if I had mentioned it to him, either. Sometimes I think he just doesn't understand the chain of command at all!" "Ha!" Ramirez' laugh rumbled around the hut like rolling thunder. "From what I've seen of you so far, that's a case of the pot calling the kettle black, Dame Honor!" "Nonsense. I always respect the chain of command!" Honor protested with a chuckle. "Indeed?" It was Benson's turn to shake her head. "I've heard about your antics at—Hancock Station, was it called?" She laughed out loud at Honor's startled expression. "Your people are proud of you, Honor. They like to talk, and to be honest, Henri and I encouraged them to. We needed to get a feel for you, if we were going to trust you with our lives." She shrugged. "It didn't take us long to make our minds up once they started opening up with us." Honor felt her face heat and looked down at Nimitz, rolling him gently over on his back to stroke his belly fur. She concentrated on that with great intensity for the next several seconds, then looked back up once her blush had cooled. "You don't want to believe everything you hear," she said with commendable composure. "Sometimes people exaggerate a bit." "No doubt," Ramirez agreed, tacitly letting her off the hook, and she gave him a grateful half-smile. "In the meantime, though," Benson said, accepting the change of subject, "the loss of the shuttle beacon does make me more anxious about Lunch Basket." "Me, too," Honor admitted. "It cuts our operational safety margin in half, and we still don't know when we'll finally get a chance to try it." She grimaced. "They really aren't cooperating very well, are they?" "I'm sure it's only because they don't know what we're planning," Ramirez told her wryly. "They're much too courteous to be this difficult if they had any idea how inconvenient for us it is." "Right. Sure!" Honor snorted, and all three of them chuckled. Yet there was an undeniable edge of worry behind the humor, and she leaned back in her chair, stroking Nimitz rhythmically, while she thought. The key to her plan was the combination of the food supply runs from Styx and the Peeps' lousy communications security. Her analysts had been right about the schedule on which the Peeps operated; they made a whole clutch of supply runs in a relatively short period—usually about three days—once per month. Given

Closing borders would be of no benefit either. It would be impossible to shut down trade, prevent citizens from returning to the country, etc. That would shut down the entire economy and enormously magnify supply chain problems by ending imports—including all health-related imports like drugs, syringes, gowns, everything. Even at that, models show that a 90 percent effective border closing would delay the disease by only a few days, at most a week, and a 99 percent effective shutting of borders would delay it at most a month.

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Migraine, like my patient Sarah had, also correlates closely to poor metabolic health. In the ENT otology clinic, we often saw this condition and had limited success in treating it. Sufferers of this debilitating neurological disease—about 12 percent of people in the United States—tend to have higher insulin levels and insulin resistance. A comprehensive review of fifty-six research articles identified links between migraine and poor metabolic health, pointing out that “migraine sufferers tend to have impaired insulin sensitivity.” The review supports the “neuro-energetic” theory of migraine. Additionally, evidence suggests that micronutrient deficiencies in key mitochondrial cofactors may also be a contributing factor of migraine. Research has suggested that migraines could be treated by restoring levels of vitamins B and D, magnesium, CoQ10, alpha lipoic acid, and L-carnitine. Vitamin B12, for instance, is involved in the electron transport chain responsible for the final steps of ATP generation in the mitochondria, and studies have indicated that high doses of B12 can help prevent migraine. These micronutrients usually have fewer side effects than other drugs used to treat migraines, making them a promising option for relief, which can be obtained through a diet rich in these micronutrients, or supplementation. Having high markers of oxidative stress, a key Bad Energy feature, is associated with a significantly higher risk of migraine in women, with some studies suggesting that migraine attacks are a symptomatic response to increased levels of oxidative stress. Less painful and more common tension-type headaches are also linked to high variability (excess peaks and crashes) in blood sugar. Hearing Loss The same story of metabolic ignorance in the ENT department unfolded for auditory problems and hearing loss, one of the most common issues presented to our ENT clinic. We’d typically tell our patients that their auditory decline was inevitable, due to aging and loud concerts in their youth, and we would suggest interventions like hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing as you age because of poor energy production in the delicate hearing cells and blockage of the small blood vessels that supply the inner ear. One study showed that insulin resistance is associated with age-related hearing loss, even when controlling for weight and age. The likely mechanism for this is that the auditory system requires high energy utilization for its complex signal processing. In the case of insulin resistance, glucose metabolism is disturbed, leading to decreased energy generation. The impact of Bad Energy on hearing is not subtle: A study showed that the prevalence of high-frequency hearing impairment among subjects with elevated fasting glucose levels was 42 percent compared to 24 percent in those with normal fasting glucose. Moreover, insulin resistance is associated with high-frequency mild hearing impairment in the male population under seventy years of age, even before the onset of diabetes. These papers suggest that assessing early metabolic function and levels of insulin resistance is essential in the ENT clinic and counseling individuals on the potential warning signs is paramount.

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