It’s been almost 4 months since my last update on the still highly debated issue of Quality Affordable Medicines Bill or more popularly known as Cheaper Medicines Bill (see my other post too). And it seems a lot of people (and doctors too) are still confused over the provisions of this bill. But I think what everybody wants (including the doctors) is that something should be done with the high cost of medicines in this country.

According to Newsbreak, Congress has already passed the law (see the full article here).

It is expected that this law will result into increased competition, by allowing parallel importation of drugs from another country selling it at a lower price, without necessitating permission from the patent holder, and allowing local companies to start developing generic versions of the more expensive innovator brands earlier. It will also require drugstores to carry competing products, not only few products from selected large pharmaceutical companies. Price monitoring and control mechanisms are all set to be new responsibilities of DOH secretary.

I am glad that the provision requiring doctors to write ONLY the generic names has been removed. I still stand by my belief that requiring doctors to do so impinges on their right to preference. Prescriptions are already written with the generic and brand names and there’s absolutely no need to limit doctors to writing only the generic names as the patient still has the CHOICE whether to avail of the cheaper generics or the branded ones when they’re at the local drugstore already. At this point, I’ve to say, though, that I know of several cases in which the drugstore (which I will not mention the name anymore) refused to dispense the generic version of the drug, simply because the patient (the acquiring customer) is a senior citizen using his senior citizen card, and that the prescription, included a brand name of a specific drug. I find this rather ironic, for there were already several instances that drugstores do dispense prescription drugs even without the prescription. Selective implementation? It bewilders me, both as a citizen and as a doctor, why some drugstores intermittently tend to be unnecessarily strict when it comes to senior citizens buying their medications and using their senior citizen priviliges.

As I’ve said in my previous posts, people have to realize that it’s not actually the doctor’s prescription that is hindering them from availing cheaper medicines, but rather it’s the drugstore where they acquire their medicines. There were also instances when patients have difficulty looking for specific brands of medications (of which they’re already used to) because drugstores in the immediate vicinity only carry few brands of that particular medication. This is the part in which I agree that drugstores should be required to carry many brands in their stores, so that patients will not have a hard time looking for their maintenance medications.

But I’m more worried about parallel importation and the possibility that there will be no strict regulation of the quality of medicines manufactured. Since even private sector will be allowed to import drugs from other countries into the Philippines (as long as they follow BFAD guidelines, which remains to be elaborated), this will result into flooding of the drug market and thus, increasing competition, which is good. The problem, however, is if quality control will be stringent. BFAD should be responsible in analyzing which medications are good and which are fakes or not good. As what Dr. Marcelo Imasa, industrial pharmacist and medical practitioner, affiliated with one of the many generics pharmaceutical companies in the country, said in his talk last Tuesday on bioequivalence studies, there are still few bioequivalence studies of generics products conducted. Also, it is important that, if a pharmaceutical company producing a new drug (or a generic version of an innovator drug), it should undergo bioequivalence studies only in accredited research centers, such as those in University of the Philippines, University of Santo Tomas, and De La Salle University. Bioequivalence studies are important because it measures whether a specific drug is a pharmaceutical equivalent (same active ingredient, same dosage form, route of administration, identical strength or concentration) of the innovator drug. Meaning, it can be switched with the innovator drug (switchability) and will give the same expected results or better. Otherwise, it may be a pharmaceutical alternative (same therapeutic moiety, different salts, esters or complexes of moiety, different dosage form or strength). In simpler terms, the bioequivalence study determines if Drug B 5 mg can give the same effect as Drug A 5 mg. A drug is a pharmaceutical alternative if for example, Drug B 10 mg will only give the same effect as if using Drug A 5 mg. Bioequivalence studies measures liberation (release of drug from the dosage administration form and variable release mechanisms employed) and absorption (rate and extent of the drug entry into the systemic circulation of the user quantified by bioavailability) of the drug.

Dr. Imasa’s talk on bioequivalence was enlightening and interesting and I sort of wished that all the congressmen and senators were there to have listened to it, before wasting months of debate uninformed and misinformed of the important information needed to be able to make this law work at best and for everybody’s good (Dr. Imasa, if I recall it right, did admit to the fact that, of all doctors-researchers involved in these bioequivalence studies, none were invited to deliberate with the congressmen and senators regarding this bill, which, in my opinion, all the more show that our lawmakers might have been uninformed and/or misinformed during the deliberation of this law and this we ought to keep in mind as we observe, hopefully, its progress).

However, since it’s already been passed to law (if the article is accurate), then I guess what we should work on next is to be able to follow through with proper and strict implementation of the law, with careful attention to details that might need revision or removal.

Addendum:

• See Inquirer’s article on the newly ratified Cheaper Medicines Bill.

Tags: cheaper medicines, cheaper medicines bill

There are three little stories I’d like to share for this week’s TBR.

One is that, when I was a clerk, there was this one time during a 24-hour duty that I found myself smoking some Marlboro outside the hospital with a co-clerk. We could have been slapped with an out-of-post demerit of 7 make-up 24 hours duties just for being found outside the hospital without permission. But then, those were times that we felt we needed a break from the stress inside. And so we were there, near the vendors’ stalls in front of the hospital.

Then we saw a fellow (a doctor in training for a subspecialty) still wearing his long coat hovering near us. I thought we were goners, as he might just tell our residents that he caught us outside the hospital on unofficial business (official business being buying the residents food, school supplies, and the like). But then, he simply waved at us to come near him and asked us to smoke with him. And curiously, I looked at the name embroidered on the upper left pocket of his long coat and discovered that he’s actually a Pulmonology fellow.

“Doctor, isn’t ironic that you’re a Pulmonology fellow and yet, you’re smoking?” I asked him.

“It may be so. But it’s just a choice, really. As long as I don’t smoke in front of patients, I don’t think it should be a problem.”

The second story is that one time I was in the OB/Gyn OPD section of the hospital. The usual practice is that the clerk sees a patient first, ask the history and do his own physical examination and refer the patient’s case to the consultant-in-charge for the day so he could advise what management to do. I was with a patient with a fellow clerk presenting the patient’s case to the consultant. Then the consultant told me, in the presence of the patient and my fellow co-clerk, that I should be losing weight because I’m already obese. Though he was telling the truth, I found it tactless that he should be telling me that in front of the patient and other people. But being just a medical clerk at that time, I didn’t think I could repulse him in any other way, without being too “disrespectful” in my school’s standards. And so he rumbled on about being and looking credible in the eyes of the patient by following what we preach, how he also do the things he advises his patient to do, being active and such. After 10 minutes of such, he finally laid down the management plan and the patient’s prescription was accomplished. Then he left.

I think of the two doctors I’ve mentioned, I’d rather have the smoking Pulmonology fellow as my doctor, rather than the feather-fluffing, arrogant, pompous OB-Gyn consultant. The OB-Gyn consultant may be strict in following what he deems as “following what he preaches” but in his intentional effort to show that he walks the talk, he’s put himself in that moral high ground (which I think he really wanted to do) and show that he’s “better” than his clerk and even his patient. And in my opinion, it didn’t really help me or the patient to listen better to his advice.

I remember that there was this one cardiology consultant who died of myocardial infarction. I’ve heard a lot of people say, “Cardiologist siya? How come she died of a heart disease? Hindi niya nagamot sarili niya?” and those words weren’t said in jest. I found it idiotic and superfluous. I’m speaking of a cardiology consultant who had so many patients in one day that she needed to be at the clinic at around 8 a.m. so she could finish attending to all her patients, both outpatient and inpatient, before 7 p.m. She’s quite well-known around the province and even in Manila. And it didn’t matter that she also had hypertension, diabetes, and was overweight. Patients flock to her because she’s a good doctor.

My point is this: being able to follow one’s own preaching doesn’t necessarily mean that one is a better doctor.

I think these all boil down to one word, CHOICES.

It would be a hypocrisy to say that I follow everything that I’ve been advising my patients to do to maintain or improve their health. I mean, would anyone really believe me if I say I don’t eat cholesterol-laden foods, have 3-4 scoops of ice cream on a sugar cone, or drown myself with several mugs of coffee in one day or several bottles of beer during a party? I guess not. But for all these “sins”, it was my choice and I guess, for all other patients, they shouldn’t fault their doctor for being “sinful” every now and then. And it’s not because we’re only “human”, but rather it’s because of personal choices. And those should be respected, just like doctors have to respect patients’ choices in matters of their personal medical health, though he may have to reprimand them at times.

Tags: choices, THE BLOG ROUNDS

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That was fast. But I’m grateful that Blogger.com looked into this ASAP and took specific actions to fix it . Maybe the plagiarist had enough sense to delete the post and save himself much trouble.

I know he could simply make another blog and plagiarize, yet again, some bloggers. But at least, he knows now that he cannot easily get away with it and that bloggers whom he plagiarized from aren’t going to take it sitting down.

Tags: plagiarism, plagiarist, plagiarized blog post