Wednesday, April 15, 2009

Drug money

This is my column today.

Drugs are often more than a necessity. They sometimes represent the thin line between survival and death. We know, too, that the prices of drugs in this country are so much more prohibitive than those in other Asian countries.

I know these because like everyone else, I have parents in their old age who need to take regular medication. I also take maintenance medicines for various medical conditions. I used to travel around the region regularly and whenever I did, I would make it a point to hoard up on medicine in Bangkok, New Delhi, even Kuala Lumpur. The prices of drugs in these cities were easily at least 40 percent cheaper than what they would cost in the Philippines. Some were even cheaper by as much as 80 percent. For example, the drug that I usually take for gastritis costs around P140 per tablet in Manila. In Bangkok, the same medicine at the same dosage costs the equivalent of around P80. You bet the price difference is not negligible.

Drug companies are some of the most profitable firms in the Philippines. Small wonder that they raised a major howl when some people proposed that we import cheaper medicines from India. This is why they also threw a major tantrum, kicking and screaming all the way, when the Generics Law was passed.

There are many reasons why medicines are more expensive in our country. The drug companies usually churn out this sob story about the high cost of research and development as if they have to recover the whole cost from only one country and all within a year’s time. Yes, they spend billions to develop and improve a drug but they conveniently forget to tell people that they sell the same drug under different names in various countries globally and for all intents and purposes, forever.

The other reason that’s usually cited as the culprit is high operating costs. This is probably true, as we all know that manpower costs are higher in the country than in others. Still, it’s not a foolproof argument because the counter-argument also makes sense. Operating costs can be lowered.

One obvious way is to go for more cost-effective advertising. I don’t mean to impose my own biases upon the pharmaceutical industry, but it’s a sad reflection of our times that even the pharma industry has become celebrity oriented. For example, I am aware that John Lloyd Cruz’s dimples bring joy to the lives of millions in this country but surely getting him to endorse a paracetamol and paying him gazillions in the process is superfluous. The drug in question is already widely popular anyway. Think about it: Do we need someone heartbreakingly handsome to tell us that paracetamol cures headaches? It’s not going to make anyone look as handsome as he is, that’s for sure. In the same vein, one can only wonder how many millions were spent to get Manny Pacquiao to deliver those tongue twisters (nagkapulupulupot, try saying that three times in quick succession) in support of a muscle relaxant, or to get Robin Padilla to admit to his polygamous nature in order to sell food supplement.

And then there’s the matter of representation expenses. Of course drug companies have to hire sales people— medical representatives—whose job description is to ensure that doctors prescribe to their patients the drugs they are selling. Someone has to talk to doctors and explain to them the benefits of a particular drug. The assumption of course is that med reps use their persuasive abilities to influence the prescribing habits of doctors through ethical ways. From what I gathered from colleagues who were med reps in their previous lives, this was mostly done through the provision of samples and simple giveaways such as token ballpens, stickers, and on rare occasions, a simple snack at the hospital canteen.

I have known for quite sometime now that the practice has been elevated to an art form more complicated than the geisha system in Japan. Med reps are now involved in promotions programs targeting doctors through various means, usually through the use of lavish and extravagant gifts. A number of my doctor friends confided that most drug companies dangle foreign trips, expensive gifts such as down payments in condominiums, accommodation and dinner at five star hotels, etc. It is now standard practice for med reps to treat the more popular doctors and their families to dinner on special occasions such as birthdays and anniversaries. What is quite scary is that it is obvious that drug companies have a dossier on each doctor of significance in this country.

This poses a serious ethical question: If doctors are beholden to drug companies, what happens to the interest of patients? I see a lot of angry doctors in my horizon, all ready to shoot me with vehement protestations about how committed they are to uphold the rights and welfare of their patients. I am willing to give them the benefit of the doubt and say that in many cases, the interest of business and patients can be congruent. But it’s not a perfect world and there are times when one has to make painful choices. In fact the choices are not always obvious—many doctors simply prescribe high-end and therefore more expensive medicines to their patients without even considering the financial capabilities of their patients. So yes, the practice does affect the way doctors prescribe medicines to their patients.

It is in this light that we take note of a new bill party-list representative Nicanor Santiago III is strongly pushing for immediate passage. According to news reports, House Bill 6063, known as the Medical Gift Giving Ban Act of 2009 seeks to prevent health manufacturers from having too much influence over doctors. According to Santiago, “the possibility of having conflicts of interest may exist between a physician’s duty to prescribe a proper drug against an ineffective one manufactured by a pharmaceutical producer who has influenced the physician through the gifts given.” Thus, the proposed law seeks to prohibit drug companies from “giving, offering to give, anything of monetary value to medical practitioners and encourage them to issue prescriptions for the manufacturer’s drugs.”

“We must stop drug money’s influence on medical treatment,” Santiago said. “Free dinners, luxury trips and other gifts to doctors serve to improperly distort treatment decisions and diminish patient care.” According to news reports, the bill proposed to punish violators with a fine of P1,000 but not more than P10,000 or imprisonment of not less than two months but not more than one year or both upon the discretion of the court.

I have no argument with the intent of the proposed bill. However, given the economic power of drug companies, I expect vigorous lobby against the bill. I am not sure though that a law is enough to curb the practice, or that putting a law in place is necessarily the best solution. God knows this country has more than enough laws already against corruption but that doesn’t mean corruption has been eradicated.

I think the more viable long-term solution is for all parties to come together and arrive at more workable programs of action. Self-regulation is always the better option. Educating patients about their rights is another long-term solution. Unfortunately, creating yet another law seems to be our knee-jerk reaction to most problems in this country.

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