Conflicts of interest

Almost the same time last year, I had talked at the postgraduate course of the Department of Pediatrics, University of the Philippines-Philippine General Hospital on the continuing saga of the doctor and the pharmaceutical industry.

I had mixed feelings giving the lecture. After all, the audience were doctors. They are all my colleagues and many are my friends. Choosing the right words to say was going to be a challenging task. My talk was eventually published in the Philippine Journal of Pediatrics last year.

The issue of conflicts of interest has touched raw nerves in the medical-pharmaceutical community in the Philippines.

Over a decade ago, the Philippine Daily Inquirer ran an article entitled "The Med Rep is OUT - with the Doctor". The article highlighted the extraneous relationships between the physician and the pharmaceutical industry through the medical representative. With the increasing scandals involving various forms of gift giving of the industry to physicians, many pharmaceutical companies and medical organizations are dissuading physicians from getting entangled in situations that may question their credibility due to conflicts of interests.

The other day, I overheard in a meeting that a bunch of doctors had decided to boycott a pharmaceutical company because the company did not accept their request to go to a convention somewhere in Europe! The doctors arrived at the conclusion that since the company had not supported them to conventions in the last 2 years, the accumulated 2 years was equivalent to a convention in Europe. Now that took a lot of gall, if not KAPAL NG MUKHA on their part and I felt ashamed that there are doctors that stoop this low just to attend a convention.

Let me call a spade a spade. You may want to un-friend me in your Facebook account after reading this blog. It is my final blog for the month and while I have been quiet, I also thought deeply about writing this entry.

First of all, the fact that doctors are wined, dined and given gifts is NOT an obligation by the company. WE DO NOT HAVE RIGHTS or ENTITLEMENTS to what the company gives as dole outs. If we accept these gifts, so be it. If we don't, then so be it as well. No one coerces us to prescribe a drug. It's not like they put a gun in our heads and then threaten to annihilate our families if we don't provide them the number of prescriptions they ask for. If we prescribe a drug in exchange for a gift, it is a form of indirect bribery. As doctors, we are already paid by patients our professional fee. That is payment in itself. Prescribing a treatment for our patient entails due ethical and medical consideration of the whole clinical spectrum or condition of the patient, before we write down what medicines they need to buy. If the drug is not needed, we should desist from writing down a prescription only to pay back or please the last pharmaceutical company that sent us to some out-of-town lecture or pleasure trip to never-never-land. If the patient does not need a prescription, tell the patient that. Our prescriptions should not be clouded by the incentives or perks that come along with the "field trips" or "excursions" or "lunch baskets" provided the industry. I will go direct to the point - there is no gift that is given without an exchange awaiting. The bigger the gift, the larger the investment of the industry, the larger the expectation.

These conflicts of interest have begun to be scrutinized lately by several ethical, academic and governmental institutions both abroad and locally. Ironically, while it is the industry that now calls on the moratorium to the excessive spending and lavish wining and dining to doctors, it is also the industry that started this marketing ploy that has now caught them in between the devil and the deep blue sea. Like rearing children, the industry has spoiled the kids rotten. The phrase "spare the rod and spoil the child" aptly describes the old disciplinary method of not punishing children when they are caught doing something wrong. As a matter of fact you will hear tales from the industry that doctors literally ASK for anything under the sun - from cars to trips to furniture to laptops to mobile phones to sponsoring their annual dues or convention fees to driving them to and from the airport or picking up their children to school or asking med reps for personal "favors" in exchange for keeping a "close relationship" with the rep in particular and the pharmaceutical company in general. But that's because they allow it and that's because the industry is so deeply mired in this traditional exchange "gift" that the marketing people have not changed the old "tactics" of selling a product.

I tell my students that a good drug, sells itself. A bad drug, needs a gift to go with the bag.

Some of my friends who practice in the United States once asked me how some of my colleagues here are in several conventions in the U.S. or Europe or Asia in a year. When I asked them how they know, they tell me that they read it as "shoutouts" with matching pictures of various tourist destinations from some of our colleagues almost every other month! Some of them even post the pictures on Facebook with the signage of the drug product they were asked to pose and promote.

One of the biggest contributors to sponsorship as an indirect form of bribery are the various organizational societies themselves. Touted as pillars of the medical circle, some of them violate ethical boundaries by demanding from pharmaceutical companies sponsorships in conventions which they collect convention fees and some threaten companies of boycott if they do not "contribute" to the success of said conventions. When the pharmaceutical company agrees to sponsor an event like a convention, the society must maintain its unbiased position by ensuring that the sponsors do not in any form pose bias in the promotion of its company's products by unduly providing more exposure than the other sponsors with lesser financial means. If the society cannot police itself at the get go, how will it expect its members to follow suit?

The National Pediatric Infectious Diseases Seminar (NPIDS) sponsored by the Baylor College of Medicine in Houston spearheaded by Infectious Disease pillars Drs. George McCracken and John Nelson had discontinued their program after almost a quarter of a century of providing unbiased CME programs because they decided to adhere to more ethical standards in the conduct of the seminar. Because industry did not want to sponsor events where there would be less exposure to their products, the pharmaceutical companies threatened to pull out sponsorships if the organizers refused to give them more exposure. Because the cost of running the program without the aid of the industry was a tall order and prohibitive, the organizers decided that it was time to end the program rather than give in to the coercion of the industry. I used to attend this seminar for over 10 years until it closed down several years ago. It was a great loss but I admired the organizers for taking a stand.

The issue on conflicts of interest are not solely the problem of doctors. Each professional field is mired in its own conflict, but the medical field is the only one wherein a second person or more persons are affected by the decision made by the primary person whom that conflict is borne upon - a decision that can affect life, cost/benefit outcome in limited or scarce resources scenario, and burden of treatment or diagnostic procedure when the latter is not required.

During a meeting with one of the pharmaceutical companies, they had expressed exasperation at the attitude of some doctors whom they could not provide "gifts" to. Some of the doctors were either angry or in denial or were bargaining (agreeing to sponsorships for local conventions instead of foreign ones) and I was shocked that some even had the temerity to reply, "paano na ngayon?"

Truth be told, the doctors are one of the highest paid professionals - locally or abroad. Let's face it, our patients know that. They see how grandiose some can be - toting a Hermes or LV or Prada, driving an Audi or Porsche or Pajero, living in posh villages, wearing signature clothes with matching shoes, belts and bags and bling, dining in 5-star hotels or expensive restaurants. The mere fact that we flash around all these largesse and yet ask pharmaceutical companies for "gifts" in any form leaves a bad taste in the mouth.

I am not saying that we don't accept a gift. When a gift is given, it should not expect anything in return. After all, if it is a sincere gesture, it should not expect payback. If the gift provided is part of an exchange deal, then it should not be accepted. It is unethical to demand anything from a company. What the industry provides or gives us is a privilege and not a RIGHT!

Today's changing landscape in the pharmaceutical industry should be a reason why there needs to be a paradigm change on the Filipino physician's role with the industry. There needs to be a concerted effort at preserving the dignity of each of us in spite of the pressure of some sectors of the industry putting a carrot in front of the rabbit to make the rabbit hop!

After 10-15 years of studying to be the most distinguished profession in the world, we cannot let conflicts of interest destroy our integrity. At the end of the day, our patients should benefit from our judgement. They pay our professional fees, put food on our table, a house over our heads, send our children to good schools. They deserve nothing less than the best standard of care without undue influence from the pharmaceutical industry.

He said, she said....I say!

There's been so much exchange in opinions on various issues - from economics to politics to entertainment to health - in the newspapers lately.

Here are some of the news that made the headlines this week and while I post each side's viewpoint, here's my take on the them:

1. PACMAN AND STEROID USE.
He said: Mayweather tweeted a link to an obscure boxing news site that had an article claiming that a former sparring partner of Pacquiao, who happened to be Filipino, claimed that he was the one injecting steroids to Manny at the Wild Card Gym, and that it began before the Oscar De La Hoya fight (according to an ABS-CBN report)...

Pacman said: "An anonymous post on an Internet forum claims an unidentified former Filipino sparring partner injected me with steroids before my fight with Oscar De La Hoya and in subsequent fights. This is completely false, totally fabricated, and, not surprisingly, leveled by someone who will not even identify himself. I did not even have a Filipino sparring partner during my training for the fight against De La Hoya or for any fight since then."

"I have never taken steroids, HGH, or any banned performance-enhancing drug. Period. My success in the ring is due to hard work, belief in God, and the support of my fans.

"Like every boxer, I am required to take drug tests in connection with every professional fight in the United States. I have passed every one, including my fight against De La Hoya and my most recent victory against Shane Mosley."

"I will fight to protect my hard-earned good name and reputation."

I say: This allegation has been running around in circles for the last few years. Mayweather refuses to fight Pacman unless Pacman has a drug test done. While Pacman claims that he has "passed" the drug tests for every professional fight, there's still the question of why he refuses to take the appropriate drug tests Mayweather is asking of him as a requirement to their "dream match". And it's not true that taking a little amount of blood would make one weak. I mean, really now. Gimme a break! And just because he is Pacquiao does not give him the right to whine like a baby regarding this. Of course, there are the nincompoops who believe that we should give Pacman a break on this issue. After all, to them, he is king of the ring. Who the fuck cares if he fights well? Give us a real fight Congressman MP! Idiots are making him rich over these sissy, one-sided, entertainment galore! Take the challenge of Mayweather. Have the goddamn blood test done. And give us a fight that will shut up the world!

2. 300 Private Schools to Raise Tuition Fees this coming School year.
He said: The CHED announced Friday that close to 300 colleges and universities in the country will hike tuition this year...69 private colleges and universities in Metro Manila are expected to hike tuition this coming school year, with St. Luke’s College of Medicine eyeing a 12-percent increase.

Meantime, the University of the East-College of Medicine, Ateneo de Manila University, Ateneo Graduate School of Business, Miriam College, Assumption College and OB Montessori will increase their tuition by five percent.

On the other hand, University of Santo Tomas, De La Salle University and UE-Manila will have increases of 3.75 percent, 3.5 percent and 4.35 percent, respectively.

They said: They need it to improve the quality of education and the rising cost of maintaining a school.

I say: You ever wondered why it's these Catholic- and church-run schools that actually raise tuition fees year in and year out? And the teachers only earn a pittance compared to the staggering cost of the tuition fees the parents and families have to shell out. It ends up with only those who can actually afford these mind-boggling sky rocketing tuition fees (READ: THE RICH AND THE VERY RICH) that can send their kids to school. What is actually weird is that church run schools have tax incentives and holidays and rebates compared to private schools that are not under the domicile of a religious order.

A larger majority have to contend with government run institutions, but then again, the government run schools are now being infiltrated by the rich! Once upon a time, the University of the Philippines had more poor and deserving students. But because the quality of education there is excellent, the rich now shove their way into the state-run university so that their kids can get good education at the lowest possible cost.

Two solutions: CHED must investigate if these church-run schools are actually making a large profit from the tuition fees collected. If so, the church-run schools MUST pay taxes accordingly. NO exceptions to the rule. Government and state run schools must proportion the number of enrollees to benefit the mission and vision of the republic. Fix the admission rate at 75/25, where 75% are poor and deserving and 25% are the rich and deserving. The latter 25% should pay 400% of the actual tuition fee to cover the cost of enrolling 75% of the poorer but deserving students. After all, they can afford this.

3. Intravenous Glutathione warning from Philippine FDA.
He said.
With the new age of advance skin science, you can now have a celebrity skin and put an end to DARKness!

Glow2Thione™ Skin Whitening and Age Defying Supplement, with revolutionary L-glutathione: the Body’s Master Antioxidant, Detoxifier and Tyrosinase Inhibitor.

Now you can easily achieve the complexion you have always wanted.

This is the ad that you see on superwhiteningpills.net. And this is the exact same claim as all the other glutathione products in the market.

The Food and Drug Administration said.
Food and Drug Administration of the Philippines warns the public against the possible side effects of glutathione injection as whitening. Glutathione injectibles is not an approved skin whitener. High dosage might cause skin rashes, severe abdominal pain, steven-johnson syndrome, toxic epidermal necrolysis, derangement in thyroid function, kidney dysfunction and failure and gastrointestinal pain. When administered orally, it is hydrolyzed by gastric juices…Intravenous injection delivers very high doses directly into systemic circulation and may overload the renal function. Glutathione is an antioxidant, whitening the skin is just a side effect.

I say.
Glutathione comes in two forms - oral and parenteral. The oral formulation is rapidly and extensively destroyed by the gastric juice. Which means that taken orally, only a small amount of glutathione is present in blood. The parenteral or IV preparation is not legally commercially available or approved for skin whitening use because of the very high dosage it carries and that it is not registered as a drug or indication for this use in the Philippines. While it claims to have "antioxidant" properties, like all "food supplements", this carries a tag where there is "no approved therapeutic indication" for skin whitening.

I have given lectures on the scientific merits (and demerits) of "food supplements" and I have blogged about it already. The key word here is "supplement". Which means, that unless sound and scientific clinical trials have been thoroughly conducted on a product which purports to provide a clinical indication for treatment, the product is labeled as a supplement which has no approval as a DRUG. Supplements, undoubtedly have a larger margin of safety and hence, go through the back door approval of being approved for supplemental use at LOWER DOSAGES. Increasing dosages pose treatment problems because as the dosages are increased, so are side effects.

Which goes to the advertisements of these products. ALL supplements do not carry black box warnings, and neither is the public informed about their adverse events. The danger here is that the public is led to believe (or deceived) about taking more than what is recommended as a food supplement. The public (and some doctors) tend to think that increasing doses will provide more rapid and definite benefits.

Vitamin C for example, taken more than 1 Gm a day increasing the risk to formation of kidney stones. In the same vein, glutathione at the recommended oral dosages may provide some anti-oxidant effect. However, at the larger intravenous doses, which are by far experimental and have no scientific evidence (or clinical trials conducted), reports on allergic reactions resulting in death, destruction of the thyroid gland, renal dysfunction and congenital malformations during pregnancy are cause for alarm.

The only indications for giving the intravenous high dosages for glutathione so far are adjunct treatment for patients with Parkinson's Disease and as complement for ameliorating the toxicity among patients receiving Cisplatin (an anti-cancer drug)

Clinical trials serve as the backbone of the pharmaceutical industry because they not only provide evidence of efficacy, based on scientific data of the correct dosages for drugs (lowest dose to give the optimum effect), but on the safety of the products as well.

There is no one drug (or supplement for that matter) that is universally safe and it is wise to remember the saying that one man's medicine, is another man's poison.

I am thrilled that at least the local FDA has put out this notice and pray that the public heed the warning. There is no need to get that glitter white look by taking medications or supplements that may not suit you or have not been studied well enough, at the expense of developing fatal complications later on. You have enough time to look pearly white when you're dead.

"Her best friend's name is Zoloft"

My world currently revolves around a company that markets drugs for mental disorders in general, anti-psychotics and major depressive disorders in particular. It has been the reason why I have learned more about depression than I could have ever learned in medical school or in my psychiatry rotations during clerkship or internship.

Depression is not the same as sadness. There are days when we are down and out and perhaps from time to time feel sad. This is not unusual. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but depression is much more than just sadness.

Depression is more than just sadness. It engulfs your daily life. People who suffer from clinical depression are hampered with interference of normal activities of daily living. Feelings of helplessness and hopelessness dominate most of their daily lives. While clinical depression varies from patient to patient, common signs and symptoms include the following:


1. Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation.
2. Loss of interest in daily activities. No interest in former hobbies, pastimes, social activities, or sex. You’ve lost your ability to feel joy and pleasure.
3. Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month.
4. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia).
5. Irritability or restlessness. Feeling agitated, restless, or on edge. Your tolerance level is low; everything and everyone gets on your nerves.
6. Loss of energy. Feeling fatigued, sluggish, and physically drained. Your whole body may feel heavy, and even small tasks are exhausting or take longer to complete.
7. Self-loathing. Strong feelings of worthlessness or guilt. You harshly criticize yourself for perceived faults and mistakes.
8. Concentration problems. Trouble focusing, making decisions, or remembering things.
9. Unexplained aches and pains. An increase in physical complaints such as headaches, back pain, aching muscles, and stomach pain.

Depression has many faces. Younger patients have a different clinical presentation from the elderly. Men compared to women have a different presentation as well. Though women are at higher risk for depression, men who present with depression have a higher risk of suicide. Depression also takes various forms - major depressive disorder, atypical depression, dysthymia (recurrent, mild depression), and seasonal affective disorder. Then again, depression may be part of a bipolar disorder, presenting as only one side of the coin.

There are many causes to triggering clinical depression - loneliness, lack of social support, traumatic life experience, financial problems, relationship disagreements, early childhood trauma or abuse, health problems, unemployment - to name a few. Finding the key trigger is vital in the treatment of depression. Unfortunately, identifying the exact cause is difficult as many of them stem from complex factors and the contributing factors are like going through the spider's web.

Acceptance plays a key role in recognition of depression.

When my mom was diagnosed to have clinical depression, I knew that aside from having to take the daily pills to control her hypertension and blood sugar problems and dealing with life in the elderly, there would be a need to provide stronger family support. And while the latter is given to her on a silver platter, her dysthymia is something we need to live with.

There are various treatment options - which include psychotherapy, changes in life style, emotional building skills and drugs.

While I know that there are those who rely on self-help and googling the internet for answers to questions they don't know, studies have shown that the internet is not a reliable source for finding answers to questions that even science has no answers to. The internet will provide a whole conundrum of pros and cons on drugs and self-help aides to combatting depression.

The key here is identifying the cause and using appropriate resources including drugs in helping treat the problem.

Like all drugs and diseases, life style changes are mandatory. Hypertensive patients need to watch their diet and stress factors. Diabetic patients need to change their eating habits. I tell my mom that we are all patients eventually. Drugs may not be the solution to the problems of our lives and they will not change the underlying condition to why we eventually become afflicted with the illness - whether it is hypertension, cancer, diabetes or mental disorder. If you're in such a rut because you have a dead end job or that you're stuck in the worst kind or relationship or that you fear dying because you're aging, one needs to get out of this rut by exploring other options in treatment aside from the drugs.

For those that are already on antidepressants, it is a known fact that only 30% of patients who are already on anti-depressants go into full remission after therapy. The greater majority will need to: continue their medications sometimes for life, change their medications, combine other drugs to the current one they are taking or increase the dosage of their current medicines. While I fully understand those who refuse to continue taking the pill, we need to face the reality that we are all not born perfect. Eventually, some of these physical and psychological frailties take a toll on us and expose our illnesses - whether it is mental or physiological.

Like all drugs, there is no drug that does not have a side effect. Side effects of most newer antidepressants are generally mild, but can be bothersome in some people. They include stomach upset, sexual problems, fatigue, dizziness, insomnia, weight change, and headaches. One must remember, however, that taking drugs is a risk:benefit decision. If the benefits outweigh the risk of complications of the disease process, then the drug is worth the risk of the side effects which are mostly minor and inconsequential.

Depression recovery begins with positive daily lifestyle choices. If you cultivate supportive relationships, challenge negative thoughts, and nurture your physical health, you can help yourself, slowly but surely, overcome your depression.

I guess it is easier to discuss about depression than be in the same shoe as the patient who experiences it. Like all disease states were are in, we need to challenge ourselves on the road to recovery. I blog from an outsider's perspective and I guess all the self-help guides are onlookers as well. We encourage people to seek help and to help themselves. We serve as the cheering squad for those whom we care for and love.

At the end of the day, my mom will always have a best friend with her even when I am not around 24/7 to watch over her. Her best friend is with her in both good and bad times. Sticks to her and listens to her when she feels deep down shitty. And when fears overcome her, sometimes creeping into her skin in the middle of the night, her best friend allows her to forget some of the pain and anxiety so that she can continue her normal activities of daily living. Like many other people in this world, she shares her best friend with them.




Her name best friend's name is Zoloft.


[For more information on depression - http://www.webmd.com/depression/guide/optimizing-depression-medicines;
Help information for lay -http://www.beyondblue.org.au/index.aspx?link_id=89]

The difference between entitlements and entanglements

Before I joined the pharmaceutical industry three years ago, I had a different perspective of the physician. Now that I wear two hats and three years later, I share with you a different perspective that I had learned while in the industry.

I do not know how to write this blog without probably touching some nerves among the doctors in the community. But I will try to discuss briefly the debacle between entitlements and entanglements of the Filipino physician (or most physicians at that) in the era of cheaper medicines and generic equivalents.

Entitlement is defined as the state of condition of being entitled; it is a right to benefits specified specially by law or contract. Entanglement is getting entwined or involved in a perplexing or troublesome situation. These two words pose problems in their relationship with the pharmaceutical industry and must be delineated.

A decade ago, I had given the plenary talk to the Philippine College of Physicians regarding the relationship between the pharmaceutical company and the physician. I have to thank Tony Dans for "forcing" a pediatrician to talk about a topic that a lot of physicians would prefer to keep quiet over. While it was well received and that I had to give a repeat talk on the topic at Makati Medical Center a year or two later and at the Philippine Dermatological Society as well, I guess just like the seeds that fell on good ground, some fell on deaf ears.

Now more than ever, the issue of entitlements and entanglements in the industry has captured the eyes and ears of every patient and every government official. In short, we just need to answer the inquiry - SHOULD DOCTORS RECEIVE GIFTS FROM THE PHARMACEUTICAL COMPANIES?

I initially took a poll at Facebook but only a handful of my doctor friends gave their honest to goodness opinion. The rest remained quiet (or dead to the world). This issue is an anathema and may spark changes in entitlements that the pharma companies provide to the doctors in terms of convention trips, lavish gifts, dinner and shows, and other "marketing gimmicks".

It is clear that the industry is partly to blame for the current thinking of some doctors who believe that they are "entitled" to gifts from the industry. While the industry tried to police itself through the Pharmaceutical Association of the Philippines following "ethical" guidelines on "gift-giving" to doctors, some of the drug companies, especially large local generic companies refused to join the association. A "me-too" company has no research and development expenditure. They merely wait for patents of multinational companies to expire and just "copy" a generic version of the drug. No drug development fees. All information that is being utilized by a generic company are actually studies from the originator or innovator company. After all, they are already public material because they have been published. Naturally, with every new study that the innovator company comes up with, the generic company simply quotes the results of that study. With RA 9502 on the Cheaper and Quality Medicines Act, one cannot help notice that the word Quality comes after Cheaper. Time and again, I remind everyone that the most expensive drug is the one that does not work. And Quality Assurance as a pillar in ensuring quality generic equivalent drugs in the market is still a distant dream for the local Food and Drug Authorities. In the meantime, many generic companies spend most of the "marketing strategies" NOT AT DEMONSTRATING their products are equal to the innovators, but rather at sending doctors on "junkets" and sponsoring drug stores and retail outlet owners to "extravagant" trips through "gifts" disguised as an assurance that their companies are in the "playing field" as the rest of the world.

Then there are the bad eggs in the profession. There is the doctor who thinks that the drug company "owes" him a trip to Jerusalem or should be "up there" with the other big prescribers. There are "stories" of doctors asking pharmaceutical companies to pay for their birthday parties, dine outs, lap tops, office equipments and other sorts of remuneration for a prescription. Then there is the evil thought of banning the pharma company that "forgot" to sponsor him to the annual convention or paid his annual dues. What the physician has forgotten is that these are ENTANGLEMENTS and not ENTITLEMENTS. None of us are entitled to what the industry MAY give. That is why these are called conflicts of interest.

Specialty societies also demand from pharmaceutical companies "sponsorships" for annual meetings so that they organization has money to run its projects. Some societies end up being very harsh and demanding. If the companies refuse to sponsor an activity, the officers consider "banning" the company from the "corporate friends" of the society.

The harsh reality is that there is a need to rethink about this scenario. A paradigm shift in this changing era of consumerism and cheaper and quality drugs should be the focus of all concerned. This shift is a wake up call to all that the ethical and moral obligation of the medical professional is upon the better good of his patient and not of his own frills and follies.

The recent news of Pfizer paying a record $2.3B settlement for illegally promoting 4 prescription drugs sent a shockwave not to the medical community, but to the public. The public became enraged when they found out that "to promote the drugs, authorities said Pfizer invited doctors to consultant meetings at resort locations, paying their expenses and providing perks. "They were entertained with golf, massages, and other activities," said Mike Loucks, the U.S. attorney in Massachusetts.

"Pfizer's corrupt practices went so far as sending physicians on exotic junkets as well as wining and dining health care professionals to persuade them to prescribe the company's drugs for patients in taxpayer-funded programs." In the Philippines (and in the world might I add), it is not only one company that has engaged in unethical detailing of drugs, but this marketing tool of wining, dining, and gift-giving to the physician has bloated not only the budgets of the companies and sent the prices of drugs soaring, but has bloated the egos of doctors who think that they are "special" in the eyes of the pharma industry.

We need to remember that in the corporate world, "gift giving" requires an exchange in the end. No one is asking us to be a saint. The next time the gift giver provides us an extra happy meal, let's try to remember why the meal comes in a special wrapper.

The devil once asked, "So, how much is your soul worth today?"

Branded vs. Generic Drugs

The government plans to bring the cost of branded (innovator) drugs by half. The top 20 drugs in the market will be the testing ground. This means, for example, that if Lipitor by Pfizer currently sells for P62, it will then cost the consumer P31 if this plan pushes through. Minus the 20% senior citizen discount, it will total P25 at retail price.

This is part of the Cheaper Quality Medicines Act of 2008. A maximum retail price CAN BE imposed by the government for drugs that are highly needed in times of an emergency situation.

Which goes to the question - are these drugs whose prices are to be lowered being done so in an emergency situation? Lipitor, an antihyperlipidemic agent, for example is NOT classified as such because there are other statins that work the same way and are abundant in the market.

It also poses the question that while the intentions may be good, it defames the very purpose of having generic equivalents available in the market. Does that mean that the government is "forcing" the industry to bring down the cost of branded drugs because the generic equivalents in the market are lousy and they are not effective at all?

Of course, the industry will simply follow what the government will impose, but this will not be a healthy business environment for the pharmaceutical industry in the Philippines. It will mean that when the cost of drugs are cut, so will the jobs of those in the pharmaceutical business.

One cannot but help wonder if the DOH is being pressed to do this to gain points for the current health secretary in the upcoming elections should he plan to run for senator.

As secretary of health, he must swallow the bitter pill and not join the bandwagon of political nincompooops who are capitalizing on pleasing an ignorant public on a law that is all wrong in the first place.

Alabang Boys...

Who's not heard of this story of three young men from the Alabang area who were caught peddling more than 60 tablets of Ecstasy pills, and other prohibited drug paraphernalia last September 2008?

Their story just gets better and better everyday with allegations of bribery in the highest government authorities on the demand to release these boys. The bribe charges range from P3M to P50M.

What strikes me and irks me is the fact that we treat the rich differently from the poor. Had the press not got wind of the release order from the Department of Justice, the three boys would have gone scot free. Someone from the Philippine Drug Enforcement Agency (PDEA) had probably spilled the beans in order to abort the release of these boys. Much to the dismay of the parents, it was ironic that the lawyer of the three boys had "drafted" a release letter/order to be signed by the DOJ secretary! I mean, really now. Can Justice Gonzales not write or is he so ignorant that he needed the lawyer of the accused to write for you? And the lawyer of the three boys had the temerity to say "what will they charge me with, stealing one piece of paper"? Come on...give us a break.

And how stupid can one of the fathers get when on TV he admitted that his son is a drug user but not a pusher. What kind of father is that?

Drug us and abuse have destroyed not only the lives of those who use them, but those whom it is sold to. The greater sin is peddling them.

The stories of drug use and abuse are not confined to the poor. Once in a millenium comes a high profile case like this which should leave the public wanting to draw blood. The question is, with the Arroyo administration, that has so much graft and corruption up its sleeves, this will be a test case on whether justice will actually be served or will it remain blind?