The promise of cheap medicines & the cries of the poor

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After three contentious years, the senate and congress have finally reconciled two bills into one. It’s grandly called the Universally Accessible Cheaper and Quality Medicine Act of 2008, a piece of legislation which has been delayed because of absenteeism among our legislators, the drug industry’s insistent lobby to protect their monopolistic turfs, the doctor’s resistance against prescribing “generics only” medicines, and the persistent distraction we suffer from many corruption charges in our government.

If there is one litmus test that we must hurdle, so we can say we’re successful, the cheap medicine legislation must bring down the cost of medicine for the poor and the middleclass which account for at least 85% of our population. But even before President Gloria Macapagal signs it into law, controversies roil. Cautious optimism from the law’s framers and their supporters is peppered by doubts which only time (when the law is implemented) can answer.

What does this cheap medicine law promise?

Parallel Importation: The law permits medicine importation from other countries making cheap medicines available to compete with the expensive branded ones in the market. Medicines from abroad will be allowed to enter the country, yet the law doesn’t provide for a plan to develop our own local drug industry.

The law-makers believe more competition among imported medicines especially within the same drug category will eventually bring down prices. However, in the wake of our current rice shortage, importation has been questioned. Regardless of the product, we now learn it’s dangerous to rely on importation which is enticing when the cost is low. But in the long term, we know prices go up and in times of shortage, we’re at the dictates and mercy of foreign sellers.

Isn’t this contrary to our nationalist aspirations? As we rue over our rice shortage problem, does setting up laboratories for locally-made essential medicines (developing our own drug industry) make sense? Of course it does, if we have the initiative to pursue a dream and we have the money to fund it.

Drug Quality: Although not all cheap medicines are of poor quality, the influx of many imported medicines in the country will create greater burden on the Bureau of Food and Drugs (BFAD) tasked to ensure the safety of our medicines. If BFAD, Bureau of Customs, Police Enforcement, and Pharmaceutical Industry fail to do their jobs well, the problem of ineffective and fake drugs could worsen.

According to Dr. Suzette Lazo of UP Department of Pharmacology & Therapeutics, BFAD must be strengthened since only a few of the country’s generic drugs have been tested for their efficacy. It must be a cooperative work for all of us to bring down prices and make medicines safe.

Our past experiences with the lack-luster “Generics Law of 1988,” and fake medicines which plague us for decades, augur badly on our ability to control the medicine trade. It’s appalling that estimates show, as high as 30% of medicines in the market worldwide are of dubious quality or downright fakes, mostly in poor countries. It is mind-boggling to think how many deaths and injuries are ascribed these ineffective medicines.

Generics Drugs: Majority of our doctors aren’t confident using generic drugs. This is one reason why they stick to costly branded medicines sold by multinational companies who practically monopolize the local drug industry.

Unlike in Europe and America where generics are widely popular, the local doctors worry over their quality. The preference for branded names which they believe to be of “higher quality,” frustrates the use of the cheaper generics, making market competition lopsided at the onset.

Drugstores have been found remiss in posting the names and prices of generic drugs for consumers as ordered by law. Some stores are inefficiently manned by often-absent pharmacists, leaving only caretakers with little knowledge to advise patients what drugs are apt to buy. This lowers the chance of getting a cheaply priced effective medicine (as intended by the law) to help the poor get back their health.

Cost of Medicine: There are those who blame the high cost of medicines to restrictions from patents and intellectual property rights, but others think otherwise since 99% of the drugs in the World Health Organization (WHO) essential drug list have been reported to be out of patent. These drugs, many unavailable to poor patients, can be produced as generics without infringement of patent law.

Aggressive advertising of multinational drug companies has also been blamed for the high cost. Many believe doctors who patronize expensive brands receive drug company perks and “charity donations” whose accumulated cost is passed on to consumers. Advertising therefore requires social conscience, discipline, and restraint from both the drug companies and doctors if they want to help lower the cost of medicines.

Part of the drug cost comes from product research and development which is pricey and labor-intensive. Without a balance between expenses and profits, there’ll be little incentive for bright minds to advance drug discovery, innovation, and production. This reminds us of our duty to set aside money for our basic healthcare which is neglected in our society.

Columnist Bievenido Oplas, Jr. reveals imported drugs in our country are heavily taxed—5% and 12% for import tax and VAT respectively. In a well-reasoned write-up, he asserts that drug innovation, competition, and a tax reduction, especially when done in concert, can bring down the cost of medicines. If this happens, some wonder where the government will recoup their revenue losses.

According to the new law, price ceilings are to be pegged by the president and the Department of Health (DOH) chief. This runs against the recommendation of some sectors like the non-governmental groups Kilosbayan Para Sa Kalusugan (KSB,) the Community Medicine Practioners and Advocates Association (COMPASS,) and Council for Health and Development (CHD), that we need a drug regulatory board to decide on an issue that’s highly susceptible to bribes and corruption.

Cries of the Poor: The old winsome advice, “Bawal magkasakit,” seems less benign now than when first said by DOH’s Dr. Juan Flavier years ago. In spite of the cheap medicine law, we have 15 million of us who cannot afford to get sick. We don’t have money to buy medicines.

For those who have some money, we only have 2,000 pesos per person/year to cover for all healthcare expenses. Therefore, if we get sick, we run the risk of dying, before even thinking whether we’ll plunge into penury or bankruptcy.

The well-intentioned law will be in the books, but who’ll buy the cheap medicines when we’re unable to do so? =0=

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