COMMENT: An Unholy Alliance?

Continued the editorial: “It’s no surprise that the pharmaceutical industry is appalled at proposals to set up a national registry of its gifts and payments to doctors.” One such proposal is in Congress.

Why the shock, the dismay? “Too much information might lead patients to suspect that their doctors are choosing costly medicines out of gratitude to the manufacturers rather than for the best medical or economic interest of their patients.”

No! The newspaper is not Philippine Daily Inquirer, Philippine Star or any other Manila daily. It’s The New York Times and the proposal is in the U.S. Senate.

While the editorial did not categorically state so, it presented facts to support suspicions of an unholy alliance. To quote or cite the facts:

 

·         “The drug companies ply doctors with a wide range of gifts, everything from free lunches for busy doctors and their staffs.”

·         Drug companies’ “sales representatives extol the virtues of their latest drugs” to doctors who are invited “to subsidized trips to vacation spots for conferences billed as education events” including generous stipends.

·         “The companies also pay large sums to doctors for consulting or for conducting research. These payments, which can mount into the hundreds of thousands of dollars over a period of years, look suspiciously like inducement to promote or prescribe the companies’ drugs.”

·         “Although medical societies and the industry’s association have adopted voluntary guidelines that are supposed to limit payments and gifts to modest proportions, they typically still allow doctors to be paid as consultants or speakers, leaving plenty of room to lavish favors upon them.”

“Several states,” the editorial said, “have tried to rein in abuses by requiring some form of disclosure” but they have failed “to make doctor-specific data readily available to the public”.

Two senators, Herb Kohl and Claire McCaskill, both Democrats, “said they would push for a national registry that would force drug and medical device companies to report their gifts and payments to physicians”.

“The legislation,” the editorial commented, “ought to require electronic reporting of all payments to individual doctors for posting in a registry that could be easily searched from home computers. If there is nothing wrong with such payments, neither the doctors nor the industry should object to public disclosure”.

That The New York Times took up the issue in its editorial indicates a growing concern about an apparent unholy alliance between the medical associations and the pharmaceutical industry. Some states have noted the abuses and tried to rein them in without success. The U.S. Congress has taken cognizance.

A social legislation, it will have bipartisan support in both the Senate and the House especially that the 2008 presidential election is heating up. But don’t celebrate yet. If it breezes past hefty lobby, the pharmaceutical companies will not take it lying down. They will go to the courts – up to the Supreme Court.

Does this not appear familiar in the Philippines?

During his first term in 1995, Sen. Juan Flavier, a physician, sponsored a bill mandating the development of herbal medicines. As a rural doctor, he had known herbal medicine to be cheap and effective, too. The bill was blocked by the pharmaceutical and medical associations.

Later, Congress passed a law mandating the use of generic medicines despite strong lobby. The law required two labels on branded medicines made by multi-national drug companies – the brand name and the generic name. Doctors specify both names in their prescription slips.

Patients can opt to buy, if they so desire, generic medicines which are very much cheaper – 50 percent or more – than branded medicines. But multi-national drug companies make branded medicines only and they control the supplies of drugstores and hospitals — about 70 percent of the Philippine pharmaceutical market (INQUIRER.net, May 8).

And, they control the sales through private doctors whom drug representatives regularly visit for updates in latest brands and some orders, too. They also provide private doctors with samples, free prescription pads, and some other office articles.

Do private doctors receive gifts and other perks from multi-national drug companies for prescribing their products like that in the United States as seen in The New York Times editorial? Anybody is free to speculate. With stiff competition in the drug market, there must be incentives for the promotion of products.

How do multi-national drug companies control the Philippine pharmaceutical market?

They manufacture their medicines, most if not all, in the Philippines under a patent that while existing, no “Filipino pharmaceutical firm can import or produce cheaper alternatives” to the patented medicines. (INQUIRER.net, May 8)

Only small drug stores of the “botica sa barrio” class affiliated with the Department of Health sell generic medicines that the government imports or subsidizes. These are across the counter medicines for common colds, cough, asthma, etc. There are some generic anti-biotics.

In the last Congress, both the Senate and the House had bills proposing to lower the cost of medicines. The Senate was able to pass its own version but the House failed to during the last days of the regular session due to the lack of quorum.

The House bill must have been snagged by the strong lobby of the pharmaceutical companies. During the second reading of the bill, the lobbyists failed to stop the approval of the bill; they approached the wrong congressman to have the session adjourned for lack of quorum. In the third reading, they must have taken care that there would be no quorum.

Is there a way to break that control?

The present Congress should urgently take up the same bills to lower the costs of medicines not passed by the last Congress. Senate Bill 2263 sought to amend RA 8263 or the Intellectual Property Code [the medicine patent law] to break the strangle-hold of the multi-national drug companies.

Related to this, state-owned Philippine International Trading Corporation (PITC) wanted the patent on amlodipine besylate or Norvasc held by Pfizer not renewed on its expiration last month so that Filipino pharmaceutical firms can manufacture cheaper alternatives.

In India, PITC said, Norvasc costs only 10 cents while in the Philippines it is the equivalent of one dollar. Without the Pfizer patent, Filipino firms can import Norvasc from India.

Our doctors may not be tied to drug companies but they are tied by them.

("Comment" is Mr. Patricio P. Diaz' column for MindaViews, the opinion section of MindaNews. Mr. Diaz is the recipient of a "Lifetime Achievement Award" from the Titus Brandsma for his "commitment to education and public information to Mindanawons as Journalist, Educator and Peace Advocate." You may email your comments to [email protected])

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