The Philippine Medical Association in the service of drug companies
The Inquirer reported a spokesman of the Philippine Medical Association saying that “doctor-members were considering a walkout from their jobs” if Congress passed the Cheaper Medicines Bill without deleting a provision that limits doctors “to prescribing only generic names of drugs to patients.”
Dr. Bu Castro said, “We were wondering why it was placed there.”
The Inquirer adds, “He said that experience had shown that different brands under one generic category were capable of causing different effects, delayed effects, or allergic reactions to different patients.”
“Bullshit, Bu!”
When a pharmaceutical company discovers a new wonder drug every other drug company produces a slightly different version of the same drug claiming that its effect is the same or better than the original. Drug companies hand out samples to doctors and encourage them to prescribe their magic pill.
Name one medicine that is sold under only one brand name. Think cholestrerol pills, high blood pressure pills, heart pills, liver pills, headache pills even erectile dysfunction pills and tell me that there is only one brand, one formulation that does it right.
It’s the basic ingredient that counts, not the brand name. Kaya nga generic ang tawag, Dr. Torpe!
Dr Bu Castro and his PMA in the service of drug company overlords legitimized Terri Hatcher’s one liner about Filipino doctors on the TV show Desperate Housewives.
“Can I just check those diplomas because I just want to make sure that they are not from some med school in the Philippines,” she said.
Beware of drug company representatives masquerading as doctors.
on January 18th, 2008 at 8:56 am
Because the provision is not needed.
In the present practice, when doctors write prescriptions, both the generic and the brand names of the drugs they want to prescribe are written down. When patients bring this prescription to the drugstore, they have the OPTION whether to buy the said brand or to choose a cheaper brand. Some doctors would even write out several brands that he thinks are good so that his patients have the CHOICE which to purchase.
If you’re going to limit the doctors to writing down the generic names but not the brand names they prefer, you’re restricting their medical decision. There are reasons why they choose a certain drug. As you’ve said, these brands, whether cheaper or expensive, share the same thing: the active ingredient. But you forgot to mention the carrier or the salt carrier of which these drugs are manufactured. They’re not the active ingredient, of course, and aren’t the source of the mechanism of action of the drug, but the carriers are also important as it can cite certain side effects for different patients. And doctors draw from both knowledge, derived from medical and school and recent journal studies, and clinical experience their decision as to which drug they prescribe their patients.
Not all doctors are slaves to the pharmaceutical companies.
on January 18th, 2008 at 11:50 am
Dear Prudence,
The law does not prevent a doctor from telling his patient his preferred drug while writing its generic name on the prescription. So what’s bothering the PMA?
What the law aims to prevent is a written “instruction” from a doctor to his patient and the pharmacy to use one specific brand to the exclusion of all others. The doctor can still tell the patient what he believes is the better brand that suits the patient’s constitution and has no ill side effects.
“Not all doctors are slaves to pharmaceuticals companies.”
and it’s easy to tell who are because those that are come up with spurious arguments that work more for the interest of drug companies and their doctor salesmen than the patients who are prisoners in the world’s most expensive drug penitentiary.
on January 18th, 2008 at 12:02 pm
To Prudence’s specific scenario of possible allergic reactions, Vic (over at mlq3’s blog) made this comment:
“If proper screening is done the doctor will find out that Generic Brand will cause adverse effect on his/her patients and can make a notation in the RX of no substitution if it does.”
on January 18th, 2008 at 1:25 pm
Some doctors don’t even follow the present prescription protocol. They simply write the brand of the drug.
Drugs of a certain category have the same active ingredients. All other things are just enhancers of the drug’s potency or longevity. It’s the responsibility of the doctor to tell his patient about the possible side effects, if any, of a plain-vanilla drug on the patient’s specific case. I’m not a doctor, but I would think that if there’s anything that could cause side effects, it would be the enhancers, because if it were the active ingredients, then all the category drugs would have the same effects no matter what the brand is.
The more important thing here is for the government to ensure that BFAD gets the proper expertise and capability to bar fake generics from the market.
on January 18th, 2008 at 2:35 pm
“If proper screening is done the doctor will find out that Generic Brand will cause adverse effect on his/her patients and can make a notation in the RX of no substitution if it does.”
Unfortunately, not all doctors are thorough or updated. And not all patients are willing to pay for a battery of tests. I’ve personally seen some cases where there was a need to switch brands due to unpleasant side effects and it was just an incidence of trial and error as far as the doc’s concerned.
True, they should simply write just the generic name on the scrip, then on a separate paper, jot down whatever brand names they’d like to pimp. The rule the PMA’s making a fuss about isn’t really going to drastically change the status quo, but it would be make them more professional. Personally, it’s already unprofessional enough that every square inch of their clinic’s waiting room is covered with pharma knicknacks, so let’s get some semblance of neutrality during the consult.
on January 18th, 2008 at 3:00 pm
Tumpak ka diyan Uniffors. Tama na nga ang mga dahilan ng mga makabayani nating mga manggagamot, palibhasa walang junket sa US o Europe o walang pagkain, appliances, “meetings” sa Shangri-la na makukuha mula sa mga generic drugs. Aminin na natin, nasanay na ang mga doktor natin dito sa mga balatong kinakalat ng mga drug company.
on January 18th, 2008 at 3:47 pm
There’s a provision in the House version which mandates physicians (as well as veterinarians and dentists) to “write prescriptions using the generic name of the drug or medicine only and its brand name shall not appear on any part of the prescription” amending the current Generics law. This is what Dr. Castro and PMA are protesting.
Bioequivalence is not guaranteed on same generic drugs since an “inventor” would not share his notes with the others, and working on a new drug for the purpose copying it is allowed currently after the patent expires. Laymen should realize this. Clinical research trials are needed to prove bioequivalence. Is BFAD capable of this with its limited funds? Or is it relying on clinical trials done by USFDA?
One local hospital did a study on the duration of signs and symptoms of typhoid during treatment using generic Chloramphenicol vs. branded and the results were disappointing with the generic. This news spread like fire among the pediatricians in 1990’s. Can the proposed bill guarantee the hard-earned license of physicians?
What the politicians should do is to strengthen first BFAD with funds from their pork barrels before coming up with sensationalize “cheap” medicine bill like this one, to guarantee a physician that every generic drug in the market is safe and efficient because no physician will oppose any drug that is cost-effective.
on January 18th, 2008 at 5:20 pm
Dr Henry,
Sorry I don’t buy your argument. The problem does not lie with BFAD, It lies with drug company salesmen masquerading as doctors, They are the enablers of high drug prices.
on January 18th, 2008 at 5:40 pm
drhenry, in developed countries, chloramphenicol has not been used in the treatment of typhoid since the discovery of quinolones in the early 1980’s. please cite a more scientific study next time you attempt to defend your pathetic dependence on drug companies. next time you have dinner at ShangriLa, try paying for it yourself. this would be a good first step in rendering care to your patients.
on January 18th, 2008 at 6:20 pm
Amen! that’s like having a dairy company extolling the virtues of breastfeeding… oh wait, that’s what they do here pala
on January 18th, 2008 at 8:08 pm
holyfather, you’re citing developed countries. The bill is for the Philippine islands. Secondly, I’m talking about pediatric patients. Most pediatricians still use Chloramphenicol for typhoid since it is cheaper. It’s still being recommended by WHO. Third, I’m not pathetically defending drug companies. I’m not a doctor bought by drug companies to promote their products. (You watch your barbaric statement being a “holy”father. You presume too much. Have you seen me eating at Shangrila?)
That’s the point. No locally published studies on this issue of generics vs. branded drugs were done. (Can you cite one?) How would you convince physicians to use them being in the era of evidence-based medicine? Have you experienced the embarrassment with patients complaining of using a generic Paracetamol made in India that their fevers couldn’t be controlled? Mind you, there are other similar experiences. How much more with cases of pneumonia using generic antibiotics with unknown bioequivalence?
BFAD should show clinical trials to prove cost-effectiveness of generic drugs. Did anyone hear Bu Castro saying that all generic drugs are inefficient? PMA is just protecting physicians’ practices here. And many members use cheaper dugs seeing that patient compliance is one of the problems in treatment failures.
I’m prescribing a certain generic Glibenclamide who showed me their own study done in Singapore proving similar bioequivalence with Euglocon. And its 1/3 cheaper. Why wouldn’t I prescribe it? How sure am I that my patient will buy that certain generic Glibenclamide seeing there are hundreds of Glibenclamide generics in the market if I am not allowed to write the brand name of that “generic” drug?
Yes, big drug companies will definitely ride on the issue of efficacy of generics but would the govt or anyone here just simply ignore their point while there are “imitations” which fail clinically? And physicians are the main character in patients’ management, not the drug reps, not the politicians, not GMA. Can the proposed bill guarantee physicians not being sued if a patient happened to have allergies or unfavorable reactions to generics, being pushed not to put brand names on prescriptions?
Cheap medicine bill is not a major solution to Philippines’ dying health care as what these politicians are portraying. And it’s not a mere jingle for 2010 elections. People’s lives are at stake here.
on January 18th, 2008 at 8:48 pm
to manuelbuencamino:
“What the law aims to prevent is a written “instruction” from a doctor to his patient and the pharmacy to use one specific brand to the exclusion of all others.”
— As I’ve said, it’s needless to write a separate law for that as it is already covered in the Generics act. What is the harm, then, of allowing doctors to write down their preferred drugs, if the patient is still left with the choice which brands to buy when they get to the drugstore? And to inform you, written prescriptions with both brand names and generic names do not mean that the pharmacist should only dispense that particular brand. If for example, a patient goes to the drugstore, with a prescription with generic names and brand names on it and finds out that the said brand name as prescribed by the doctor is too expensive, he has the OPTION not to buy that branded drug and ask for the cheaper one with the same generic name. That’s precisely the point of having the generic name of the drug in the prescription. However, I’ve to admit that there had been experiences when some drugstores would refuse to dispense any other brand for a particular drug but the brands that “they” preferred, especially in cases of senior citizens using their IDs to avail of their discounts in buying their medications. To clarify, this is not a good practice and it is unfortunate that it happens.
It’s not up to the government to restrict such aspect of practice of medical doctors. What they should think about is how to develop a national drug industry here in the country, as promoting competition with the multinational companies will lower down the cost of medicines. It is all right to import cheaper medicines from another country, but it certainly would be better if this country can manufacture its own drugs. That is what this Cheaper Medicine bill should be about.
on January 18th, 2008 at 9:03 pm
Re: What they should think about is how to develop a national drug industry here in the country, as promoting competition with the multinational companies will lower down the cost of medicines.
Sounds sensible to me — why can’t this be done?
on January 19th, 2008 at 10:27 am
anna de brux
Competition is not possible for these reasons:
1. We have a govt which encourages import liberalization.
2. Our exchange rate is not competitive. We have a govt which relies on a weak dollar to properly manage public debt.
3. Philippines has one of the highest cost of doing business (high utility rates, pampered workers’ union, weak trade facilitation, bureaucratic red tape)
However, there is one provision in the Senate version which redefines “inventive step” which will lead to working on drugs still on patent (early working) which encourages market competition. But this must be given help by solving problems cited above.
on January 19th, 2008 at 11:03 pm
Prudence and Dr. Henry,
Assuming what you say about generics versus brand names is true, the law does not prohibit the doctor from telling his patient what brand name he favors. The law only prohibits the doctor from writing the brand name on the prescription itself.
At the end of the day, it’s only paperwork. The patient will still know what brand his doctor favors. So what’s the problem?
And PMA members are going to walk off their jobs over that?
on January 20th, 2008 at 2:00 am
Thanks for the info Dr Henry. And how about inviting pharma cos to invest in the Philippines — no the giants but the smaller ones which have a catalogue of excellent generic products.
France and Belgium are heavily into generic medications following the draconian measures being imposed by the govt regarding reimbursments. Less stiff on the social security purse.
Medications produced by medium scale pharma companies.
on January 20th, 2008 at 8:09 am
drhenry, no published studies comparing the efficacy of generic vs branded drugs are forthcoming because the moneyed multinational drug companies are terrified by the conclusions every self-respecting doctor knows: generic drugs are equal to branded, overpriced branded products. you yourself stated physicians rely on evidence-based medicine for clinical decision-making. stop patronizing us with your pitiful anecdotal experience. and yes, I absolve you for your anger and for labeling my statements “barbaric”.
on January 20th, 2008 at 8:35 am
anna:
Because of trade’s full liberalization, it would be generally cheaper for me to import drugs than to manufacture them. Wonder why our shampoos, toothpastes, etc. are now manufactured to nearby countries instead of here? (Read the labels of Pantene, Colgate, Palmolive, etc.) UNILAB actually subcontracts manufacturing of some of their anti-diabetic drugs from companies in India or China, if I’m not mistaken. And some antihypertensives are tied-up with MNCs as main distributors here, meaning UNILAB prefers importing them rather than researching and manufacturing them here. The cost of doing business here is very high.
You’ve mentioned reimbursements in other countries. That’s socialize health service the reason it is effective. But in this archipelago where practice of medicine is liberalized, that’s impossible. Is Philhealth giving full subsidy to health care? Nope. Not even 30% of the whole costs. Is govt’s spending to health service adequate? Nope. For 1999-2004 alone, it had only spent an average of 0.325% of country’s GDP for health service. (While the allotment of LGUs got 3.5%!). Neighboring countries spent >3% of their GDP to health.
manuelbuencamino:
I understand your point but this is just a petty issue compared to the whole problem of health care in the country. These politicians are just pretending that they’re solving a big part of it, well in fact it’s just a puppet show for 2010.
The reason PMA is up on their feet is because the burden of liability and costs is being placed solely on doctor’s shoulder. Prescriptions are documentary evidences in courts, the reason we are signing them with our licenses and PTRs. Judges wouldn’t buy the argument that the drug written on prescriptions are “not specific” and patient has a choice. His doctor is the prime director of his health. (Who is being sued if a surgical instrument is left on patient’s abdomen after surgery? Is it the OR nurse who does the counting of the instruments, or the surgeon who is the “captain of the ship”?) If a patient got allergic reaction or the drug that he bought doesn’t work, to whom the patient complain to? To pharmacists? And if this happens, who is losing the practice?
I wouldn’t be hypocrite, yes, drug companies give perks to doctors, and mind you, some doctors even own drug stores. But that’s the result of govt’s neglect of the basic necessity of its people. But, please, don’t put all the blame to us. We have families, too, that needs food, shelter and education. Enough with the legend that doctors are generally rich. For why would many of our colleagues sacrifice their professions and leave the country if that myth is true?
IMHO, “Cheap Medicine Bill” is not one of the solutions. It’s a political campaign for the coming elections. It’s a waste of time. It will not bring down the cost of medicines just like its father, the Generics Law.
I would prefer increasing the govt’s budget to health so that the middle class (who pays taxes) would be lighten of their burden. Start from there.
on January 20th, 2008 at 9:25 am
holyfather,
Aren’t you getting the point?
Even if you don’t give perks to doctors, they will still “patronize” (I used your term) your MNCs drugs. In reality, your MNCs marketing is not afraid of the generics. They are afraid that they would loose sales to competitor MNCs.
And don’t criticize “pitiful anecdotal experiences” because neither you have head-on generics vs branded RCTs on your hand.
on January 20th, 2008 at 2:32 pm
Dr henry,
“The reason PMA is up on their feet is because the burden of liability and costs is being placed solely on doctor’s shoulder. Prescriptions are documentary evidences in courts, the reason we are signing them with our licenses and PTRs. Judges wouldn’t buy the argument that the drug written on prescriptions are “not specific” and patient has a choice. His doctor is the prime director of his health.”
The reason is specious Why?
Because the law mandates doctors to write generics only. A doctor cannot be held liable for obeying the law. You don’t need to be a lawyer to see that.
I do agree that the health care problem in this country is huge. Would you agree that doctors and pharmaceuticals are part of this problem? Of course government, medical and pharaceutical schools, and insurance companies are part of the problem too.
What we all want is better health care at affordable rates. Where do you propose we start?
on January 20th, 2008 at 3:21 pm
manuelbuencamino:
“…………Would you agree that doctors and pharmaceuticals are part of this problem? Of course government, medical and pharaceutical schools, and insurance companies are part of the problem too.
Yes, I agree with you on this. That’s why I don’t insist that doctors are faultless being prime directors of their own patients’ health. But the govt created this situation by liberalizing, instead of socializing, public health care. And it’s not only the legal aspect PMA is looking into. Physicians’ practice is compromised. He will definitely lose patients. We value the sacredness of the doctor-patient relationship
As I’ve said, govt should start increasing budget to health care. DOH purchases drugs for public hospitals and clinics and govt doctors prescribe them. Because of lack of funds, they easily ran out of drugs (in my experience, starting the 2nd quarter of the fiscal year). So patients will buy them when this happens, and in this area drug companies start their marketing. This is already a loophole in govt service. So imagine the “business” when people start seeking health consult thru private.
In Australia, all health concerns of her citizens are subsidized thru Medicare. A physician is forced to prescribe Medicare-accredited drugs since his patient will complain if it can’t be charged to Medicare. Philhealth is way too far.
State should start delivering good service and not by regulating because only the govt can bring down the cost of health care, not the physicians. With this, govt should strengthen its institutions, DOH/BFAD.
on January 20th, 2008 at 4:29 pm
Dr Henry,
Why are the prices of drugs in the Philippines very high compared to many other countries?
Can physicians charge less for their services or must government interfere?
I too am for universal heathcare. I think government should make providing free healthcare for its citizens its ultimate goal
on January 20th, 2008 at 9:45 pm
I think thousands of physicians in our country are moving to other countries because of poor salaries. So it would be hard to imagine that they charge even less for their services.
on January 21st, 2008 at 9:29 am
hahaha
quinolones for pediatrics!
with the advent of quinolones, less use of chloramphenicol. for treatment of typhoid
BUT, quinolones are CONTRINDICATED for pediatric patients, so the use of chloramphenicol is still indicated.
and it doesn’t mean that when a doctor prescribed chloramphenicol, he /she is not updated. this regards best with the confidence a doctor has on certain medicine for certain disease.
treatment of a pateint is AN ART. it doesn’t mean that person A and B who have the same disease must have the same treatment. What is best for pedro may not be best for juan.
on January 21st, 2008 at 10:46 am
Drhenry,
Why would a judge fault you for prescribing just the generic term for a drug if that were what the law said? You could only be accused of malpractice if you prescribed the wrong generic medicine, but not for writing just the generic term for the right medicine on the prescription, if that were what the law provided.
Doctors are not generally rich? The reason why doctors leave the country is not poverty. How does “greed” grab you?
on January 21st, 2008 at 11:15 am
Manuel,
MNCs practice monopoly of the drug market using legal loopholes of patent law. At present, even the off-unpatent drugs are being imported here only by “authorized” third-party (which are, of course, these MNCs). MNCs make threats of suing any other companies (aside from them) who would do trading with the off-patents. In fact, PHAP sued PITC when the latter imported off-patent drugs from India which were manufactured by MNCs counterparts. They contend that these actions constitute infringement of patent, trademark and tradename rights.
Another is in manufacturing of patent drugs. Our patent law allows 20 years of this privilege. MNCs engage in the practice of filing new patents for each demonstrable “new use” of previously patented drugs. This prolongs the monopoly they enjoy through the patents over their medicines, say 20 years more of monopoly.
IMO, these are the major loopholes that these MNCs took advantage for years to monopolize the market. And they’ve been doing this only in Philippines as far as Asia is concerned. There was no competition in the local market. Doctors’ prescriptions are minor. That’s why the Generics’ Law didn’t work.
Government interference should start with subsidizing cost of medicines since this cost about 80% of the total costs of healthcare. They shouldn’t regulate doctors’ fees since, for one, they are already generally low, and two, this move will not lower the cost because it constitutes only a small percentage of the total cost. Also this is not economically sound since it lessens the income of a vital sector of the economy. And it is hard to implement. Better force these doctors to prescribe “Philhealth accredited drugs” in a setting that these drugs would be reimbursed by the patient from the govt.
I guess this is a better move than cutting or suspending taxes. Benefit would be clear and direct to the lower class.
on January 21st, 2008 at 11:53 am
Dr Henry,
Government subsidy for the cost of medicine is good for the patients but it will not bring down the price.
Drug companies don’t care who pays for their expensive drugs, whether government or patient, as long as they can maintain their high price.
So forcing doctors to prescribe only Philhealth approved drugs will only transfer the immediate burden from patient to government but will not address the long term burden because sooner or later the cost of a subsidy will be passed on to the taxpayer.
As you said the cost of drugs is artificial - as opposed to market driven. Thus those artificial factors have to be eliminated to get a price people are willing to pay or, as economists would say, at true market price.
How can this be addressed?
As to doctors’ fees. There are those who overcharge and there are those who do not.
Those who do not overcharge are being lumped with greedy doctors and that is unfair.
So the question is, what can the PMA do to protect not only the reputation of ALL its members but also the welfare and pockets of its clients?
Let’s face it, there are a lot more people in this country who are poor so the medical profession cannot be as lucrative as it is in more developed countries.
Poverty of patients is a moral issue that the PMA has to take into account when considering doctors’ fees.
Is there any way for the PMA to regulate doctors’ fees based on the capacity of their patients to pay?
on January 21st, 2008 at 1:21 pm
Manuel,
With regard to doctor’s fees, in a setting of a liberalized practice of medicine, it’s very hard to control, even now that we have shortage of doctors. In this, PMA is short-handed. Mind you, a lot of doctors are already sacrificing their PFs for their patients. It’s not a joke that many patients pay their doctors with PNs (promissory notes) with a term of “forever”. The real solution is with the govt: increase govt spending for development, not repayment of debts.
To address market competition, the Senate bill has a provision which will amend the Patent law to clear the way for parallel importation (revising domestic to international exhaustion), patching loophole in the “new use” issue to prevent abused prolonged patent rights, and encouraging “early working” which will allow early analysis of drugs still on-patent to shorten the time before other companies can “copy” them. Similar amendments in India were done before. The main character here is the “parallel importation” due to reasons I’ve cited in my previous posts regarding doing business in the country.
To address doctors’ concern on the efficacy of generics, BFAD should do head-on local clinical trials b/n generics and branded. Most doctors worldwide practice evidence-based medicine. Drugs are tried first among subjects before they are recommended for use. And studies like these, need govt support for funding. This is part of science research and development.
on January 21st, 2008 at 1:46 pm
Dr Henry,
Thanks for enlightening me on the Senate version of the bill. Those provisions do address market competition.
As to the doctors’ fees, I have no quarrel with those doctors you mentioned. It’s the greedy ones who give the profession a bad name that I was hoping the PMA would address. I guess what you’re saying is the PMA is powerless to do anything about this.
The solutions you propose are long term solutions and they look like they will have long lasting positive effects.
My problem is with the NOW. The price of medicine is too high. The Cheaper Medicines Bill provision on prescription addresses the cost problem NOW.
Time may come when the cost of generics and branded medicines may not be too far apart, when the effects of Senate provisions kick in, but for now we have to take drastic measuresto break the monoooly of drug MNCs.
Maybe the PMA should suggest how the problem of high drug prices can be addressed immediately or as a stopgap while we wait for market forces to do their thing instead of threatening to go on strike.
We, meaning doctors and patients, all see the problem. We know who is causing it. My beef is the PMA as the conduit of branded medicines to patients is not leading the charge against high drug prices. Why?
on January 21st, 2008 at 2:15 pm
drhenry, be humble enough to admit that you, the PMA, the overwhelming majority of medical societies rely on drug companies for “educational grants” that range from books, office supplies, medical equipment, professional samples that augment a struggling physician’s heroic practice, trips and accomodations while serving as “resource speakers” for overpriced branded drugs, etc. THESE are the root causes of the problem.
physicians, particularly heroic Filipino physicians find themselves hopelessly dependent on the largesse these greedy, solely-for-profit drug makers strew along the road, like scrap food for homeless dogs.
on January 21st, 2008 at 3:02 pm
Manuel,
Well, the truth is, it’s not only doctors who have reservations with these generics, generally, even patients have.
But I can only judge PMA with the position paper that they submitted to Senate. Here are some their points:
1. The need to increase the national budget for health to help ease the out-of-pocket expenses of patients;
2. The need to improve the negative investor outlook at the local pharmaceutical market and the purchasing power of the Philippine peso;
3. The need to strengthen the local pharmaceutical industry to enable it to
compete with multinational companies. This can be through increased
government support in the form of tax exemptions for active substance
drugs, technical assistance, loans, parallel importation, discounts or
exemptions from regulatory fees;
4. The need to strengthen public confidence in the local generic industry;
5. The need to strengthen, enact and enforce regulatory and supervisory laws and regulations to ensure the safety and efficacy of drugs, particularly the charter of the Bureau of Food and Drugs;
6. The need to promote research and development in public health.
7. The need to develop the local generics industry’s capability to manufacture more complex drugs (is. higher generation antibiotics,
cardiovascular drugs, cancer chemotherapy drugs, or hyperalimentation);
8. The need to develop the local pharmaceutical industry’s capability to
develop drugs from endogeneous or local sources; and
9. The need to identify and develop sources of raw materials to lessen dependence on importation.
Critical measures to address, I suppose, are the items 4 & 5. But I can’t find them on the proposed bill. And they have the amendment of the Generics Law, violating the ancient dictum, “Primum non nocere”. Maybe that’s why PMA is against it. But the latest is Villar talked to his colleagues in the bicam to look into this provision, cooling the PMA.
on January 21st, 2008 at 4:40 pm
Dr. Henry,
I hope you don’t mind but I have sort of annotated your last response.
No. 1 would not be necessary if medicines and doctors’ fees are affordable. The prices are set by drug companies and doctors.
Nos 2 ,3,4, 5, 7, 8, 9 are corrective measures made necessary by high health care costs which are totally within the control of drug companies and doctors.
But I would add that of course it’s good if we have our own drug industry regardless of the cost of healthcare.
Take the case of Cuba where they do research and development despite the fact that they they have socialized medicine. Some of their research is so good Americans are learning from them.
And that’s why No.6 is a necessity in and of itself.
Ideally government should stay out of the private sector. But it has to step in when the private sector engages in activities that go against the public welfare. I believe that is what is happening to health care in this country.
I insist the PMA can do a lot more to police its own ranks and to restrain the drug companies.
The PMA knows the industry best and the entry of government interference in terms of laws that seek to restrain and regulate certain practices shows that the PMA has fallen short of what it’s supposed to do: self regulation.
The PMA cried foul when the government stepped in but the government had to respond to public clamor because the “industry” was unresponsive.
So now you have a situation where politicians, ill-equipped on health matters, have to write laws to protect their constituents from predatory practices.
The solution lies with the doctors. The entire system is based on doctors. They, not the government, are the vital link in the cost of healthcare. They prescribe the drugs, they set the fees, they own the hospitals. They, through feedback, drive research and development of pharmaceuticals and new forms of medical procedures. Such is the power of doctors and the PMA should not be shy about flexing its muscle.
on January 22nd, 2008 at 9:28 am
Manuel,
I cannot answer for PMA. Mind you, it’s a weak organization just like its uncle, the DOH. I can only give you what my convictions are.
In my own practice, no one can dictate to me what I would like to write on my prescription. I put my name, license, and PTR on it, meaning, it is my own clinical judgment. I am responsible for it, not only legally but also (the more) morally. I can’t only deal with what are “cheap” drugs but first of all, will this drug prescribed here cause more harm than good? “Cheap medicine bill” may (or may not) release me of my legal obligation but can it secure my moral obligation? Because I know, for sure, (because I was trained hard for it) what is cost-effective for my patient. The govt should make it clear the way for me to choose what are safe and effective, and low-cost (these factors must go together) drugs. Because with the weak institutions the Philippines has, I am not sure that of these factors going together, being a man of science.
Yes, there are unscrupulous individuals being humans just as you can’t free the press from irresponsible information that they are releasing to the public. But they still cry for press freedom. But if the govt curtails information, then it’s not anymore free. It’s similar with our profession. The more, we are responsible for the lives of our patients. It’s not a simple matter of reading “Amoxicillin” as the same spelling with “amoxicillin”.
Politicians are working below when they should be starting from the top. They are just plugging the hole. Very soon, since the pressure continues to build up, the “band-aid” will detach by itself.
Your last response here is misleading. The reason we have these problems is due to the govt’s reliance on the private sectors (i.e. doctors and pharmaceuticals, as you’ve said) in dealing with the nation’s healthcare, for decades. Yes, we have a culture that adulates doctors as “gods” but generally we don’t assume to be. And we don’t have the resources to manage country’s healthcare by ourselves, even now that we have tight resources handling our families. And some have given up and left the country. The muscle has atrophied. (FYI, there were only 250 examinees for the National Medical Admission Test {NMAT} last year. About 1/4 of them will finish the course in 2012. Soon you will see Indian or Cuban doctors manning public clinics.)
State should bear the costs of basic services. But history of privatizations of services proved that they are failures in lowering the costs. (See what happened to electricity and water?) If it’s too late with NAPOCOR and MWSS, I believe that it’s not with education and health services. But I would agree that it is hard to start all over again.
on January 22nd, 2008 at 12:14 pm
Dr Henry,
Thanks for making it clear you are speaking for yourself and not the PMA and that your position on the presciption issue is morally motivated.
Re: your second paragraph. I think you misunderstood me that’s why you called my reasoning misleading. When I said doctors have immense power in the healthcare industry I did not mean that you should fund it. My point was and is the same as yours. You can use moral suasion and leadership to keep healthcare affordable. You can even go further by telling drug companies or hospitals who overcharge that you will not patronize their products or their hospitals if they don’t shape up.
What do I mean? Maybe for a particular disease a specific drug or hospital is the only option. There’s nothing you can do about that. However there are a myriad of other medical problems that require care but do not need a specific drug or hospital. This, I believe, is a pressure point. When you make it known that for these situations you will use alternatives I think they will listen. But that’s just me.
Like you I would like to see states bear the cost of basic services. We have no disagreement on that.
i think our disagreement lies in my appreciation of the potential power of doctors and their failure to recognize it which has led to government interference and your view that doctors do not really have that much power and government interference is taking away whatever discretion doctors have over doing their jobs properly.
on January 23rd, 2008 at 9:13 am
Manuel:
“……..When I said doctors have immense power in the healthcare industry I did not mean that you should fund it….”
When a policy has a purpose of alleviating the cost of a poorer sector of an economy, it entails burden on the other sectors. And I’m sure the govt is not the one bearing the burden with this proposed bill. I’m not implying that MNCs perks to doctors give better income but for sure the less perks will affect allocations of budget. But the most important thing is doctors will definitely lose patients. People are buying branded items. Jollibee wouldn’t have growth if people are not buying brands. I even have patients that would tell me, “Doc, effective ba yan eh generic lang yan?” The issue is very sensitive and critical to our medical practice.
“…..You can use moral suasion and leadership to keep healthcare affordable. You can even go further by telling drug companies or hospitals who overcharge that you will not patronize their products or their hospitals if they don’t shape up…”
This is ethics and professional organizations’ intervention is very crucial on this. But I guess, PMA is not the only prof org in the country that has difficulty implementing ethics among its ranks. And besides, “overcharging” is vague. The general sentiment of my colleagues is, “How come no one question the exorbitant fees practiced by other professions?”
“Maybe for a particular disease a specific drug or hospital is the only option. There’s nothing you can do about that. However there are a myriad of other medical problems that require care but do not need a specific drug or hospital. This, I believe, is a pressure point. When you make it known that for these situations you will use alternatives I think they will listen. But that’s just me.”
Hospitals and doctors follow guideline protocols that are world widely accepted, evidence-based medicine. Yearly, in conventions of every specialty society, these are updated. We even have medical audits in hospitals which are generally done every month to make sure protocols are followed. Of course, there are certain cases that guidelines couldn’t be applied strictly but for sure, the usual basis is cost-effective management of patients.
I can understand the general sentiments and misgivings of the public with regard to our sector. I know our sector is the most misunderstood sector in the society. Not only that our general handwriting is bad but medicine is not quite easy to comprehend. And leaders in our ranks are not good politicians because we are not trained to be one. We are trained to be secluded in the 4 corners of hospitals. But one thing I’m confident of: we are fully trained to take care of our patients within that 4 corners.
I’m not also implying that we are perfect, or even almost. Yes, there are rotten individuals. But the govt’s poor health budgets for decades made the imperfections in our sector to pop out. We are imperfect, yes, but I wouldn’t agree that the biggest fault of high cost of medicines (or even a bigger share of it) lies on us. For why would some of our colleagues will sacrifice their 10 to 20 years hard-earned profession for lower status just to leave this country?
on January 26th, 2008 at 2:24 pm
DELETE GENERIC-ONLY PRESCRIPTION
I’ll vote for the deletion of the generic-only prescription in the Cheaper Medicines Bill on one condition…
If our beloved doctors could prove that there are MORE people who died because they took generic medicines than those who died under their scalpels or as a result of their wrong diagnosis!
Cut the bull doctors! Even if the generic medicine you prescribed does not work, you NEVER assume responsibility! Have you ever heard of a doctor getting convicted here for malpractice? None! So let’s not be hypocrites here!
This is a question of A-C-C-E-S-S-I-B-I-L-I-T-Y! Not efficacy because all generic drugs that pass thru BFAD are bio-equivalent (http://www.fda.gov/cder/ogd/) and your claim that they are not is not supported by scientific evidence or hard facts. Speculation! That’s just it.
Generic medicines have more advantages than branded ones — BFAD
…
“Prescribing branded medicines is based on experience of doctors on their efficacy to patients. It is not pharmaceutical companies that dictate their effectiveness,” Santos said. (PMA VP)
Really now Dr. Santos? Sige nga, between branded generic drug A backed up by a trip to a medical conference in the US and pure generic drug B certified by the FDA (http://www.fda.gov/cder/ogd/) that is way cheaper but is not “incentive”-backed by big pharmas, which would you prescribe?
Let’s stop the hypocrisy. Mas “EFFECTIVE” ang gamot na may magandang med rep na nagpopromote at nagbibigay ng free trips abroad sama asawa at tatlong anak at may pocket money pa!
Once in your life admit that you prescribed “incentive”-backed drugs over affordable generics. The issue is not about bio-equivalence or efficacy. It’s about accessibility! What you have been prescribing are just not affordable to the poor majority. And you doctors have been causing this lack of access for so long.
“The PMA also said the provision on the Cheaper Medicines Bill that prohibits doctors from issuing branded drugs will endanger patients as their proper medicinal prescription will now lie on the hands of sales clerks of drugstores.”
As if this cannot be done today??? With or without the bill, any pharmacist or pharma clerk can recommend a high-mark up brand. They do it!
The bottom line is, some doctors do not give a damn whether one can afford a prescribed medicine or not. And this has to end.
Give the power of choice back to the patients esp. those who can’t afford branded drugs!!! Take it away from the abusive doctors! Because unlike doctors, patients are just after getting well and being A-ok and not after free trips abroad, or free prescription pads (cheap), or free aircon (if they chose not to go abroad), or free ballpen (cheap), or free concert ticket (ka date yung med rep na sexy), or free hotel accommodation (ka date ang kabit), or free drug samples that they (doctors) sell to patients (cheap)!
(Excuse me to those GOOD DOCTORS who support the bill, I know you number more than the PMA-class, selfish, greedy, trash)
on January 29th, 2008 at 5:41 pm
What’s being cited here are US FDA approved generics. Remember we are in the Philippine islands, where smuggling is rampant. And people are not protected from these smuggled generics, not even after being approved by BFAD.
We are not doubting the efficacy of US FDA approved generics but is our drug market free from “dangerous” generics?
Please, don’t doubt the sincerity of many Filipino doctors. It doesn’t mean that we only prescribe expensive branded medicines as there are cheap branded-proven-effective drugs that we likewise prescribe. If everybody here is after the “scalawags” then, I tell you, the “generics-only prescription” would affect the sincerity of good doctors.
And besides, in a liberalized health sector, sexy marketers wouldn’t be avoided. Once the govt start subsidizing the cost of medicines, I guess these marketing activities would be minimized, if not die naturally.
Why not start rallying and demanding from the govt your right to health care since you are paying taxes? Let the govt pay your antibiotics.
on February 9th, 2008 at 7:23 pm
hi, maybe it will be good for everyone if instead of fighting for genereics only prescription, a lwa should be passed on no prescription no drug sale. with every bottle where the name of the patient, age, generic name, brand name and dosage are included.
on February 9th, 2008 at 7:23 pm
hi, maybe it will be good for everyone if instead of fighting for genereics only prescription, a law should be passed on no prescription no drug sale. with every bottle where the name of the patient, age, generic name, brand name and dosage are included.