Skin deep

One of my favorite columnists Conrado de Quiros had a very interesting column today in the Philippine Daily Inquirer.

While I may disagree with him at times, I agree with him often as well.

The topic is titled Black and White.

"Jojo Binay came out last week painting it black. That was after the local Food and Drug Administration banned a shipment of skin whiteners from China containing high levels of mercury and steroids. Binay applauded the move but demanded to know why we needed skin whitening products at all, whether they contained safe amounts of chemicals or not. 'We are brown and should be proud of it'."

And I agree!

The other week I had a mother at my clinic asking me if it was alright for her 12 year old daughter to start on these skin whitening preparations. I retorted that there is no scientific evidence to this claim. As a matter of fact, glutathione is approved in Europe as an adjunct to the treatment of Parkinson's disease. It's side effect - it whitens the skin!

This mother went on rambling that her daughter was a fish out of water. She loved to swim! But she is dark colored. Then chastised her daughter by saying in front of me that the color did not look good on her. I felt like slapping her, because the girl was almost ashamed of her mom berating her in front of me. Dang this mother! Of course, I gave her a piece of my mind, which probably did not sound too well with her.

I told her that the natural color of our body is the color of our butt. That's the only one that's really not exposed to sun. And so what was so wrong with being brown? I've always wanted that darker hue, but my genetic make-up will not permit. I only burn when I attempt to get a tan. Boohoo!!!

But the commercialization of endorsers has actually made every Tomas, Ricardo and Haribon want to become 'white'! Even a gay boy has come out in an ad splattered all over the billboards, on the glutathione effect. My maids buy papaya whitening soap and insist that only Belo touches their skin. Never mind if they don't have money for food, as long as their skin is as white as Juday's! Dang!

What sells is that these endorsers seem to be making a killing at the financial gains, but the consumer is the ultimate dud who buys these stuff, even if there are no approved therapeutic claims.

And you can say the same about almost every product in the market - children who are fat (and at times obscenely obese) advertising hotdogs, multivitamins that will make you taller (even if your parents are Mura and Mahal), a Fit and Right drink that contains 70 calories per bottle but supposedly should make you get abs, or herbal preparations that will make you piss all those toxic waste or suddenly you can walk again, or even soft drinks that can make you happy just by opening the can!

de Quiros goes on saying that "No wonder we are the laughing stock of Asia. It's not just that we cannot keep up with our neighbors' prosperity, it's that we cannot crawl out of our caves. Hollywood of course has much to do with it. But even as Hollywood is slowly getting out of it, as indeed the US itself which voted its first black president a couple of years ago, we are not. While Hollywood is toasting the stars of "Slumdog Millionaire" and the Chinese actors and actresses of Ang Lee and Zhang Ziyou, we still think that being born to a mixed marriage, specifically with one of the parents being white, is a natural entitlement to becoming a star of the Philippine movies."

Those Fil-Ams or children from mixed caucasian marriages seem to be at an advantage when it comes to on screen appearance, but that's being superficial. Many of them get opportunities at local TV breaks, but stars like Charice Pempengco and Arnel Pineda are making a name for themselves in more competitive territories, while these lackies are trying their luck at the local channels.

We keep complaining about being discriminated against in other countries on the basis of color and height, openly or subtly depending on the country, and yet that's what we do right at home. We don't need other people to make us feel inferior, we do a perfectly good job of it ourselves. We laugh at the dark-skinned, the short, the kinky-haired, the flat-nosed, the beady-eyed, which are the characteristics of our race, and which did not prevent Jose Rizal from becoming one of the greatest men who ever lived. Why shouldn't other people treat us as inferiors when we deem ourselves to be so?

There is, after all, nothing wrong in trying our best to look beautiful exteriorly. At the end of it all, however, what matters most is how beautiful we are - skin deep.

The endorsers - part II

If there is one thing that I can not stand, it's people in media, who brag around a "holier than thou" attitude, yet practice the most deceitful form of advertising.

What am I talking about?

The other day, on channel 26 (Philippine Cable), I happened to chance upon DZMM radio, live on TV. DZMM happens to be the AM channel of channel 2 (ABS-CBN). What struck me was that they have this show called "Magandang Gabi Dok" (Good evening doctor), and they have a doctor whom they are interviewing over the telephone, for phone in questions by "patients".

These gullible doctors (I hate putting my colleagues on the spot) are really dumb! Not that they don't know what they're saying, but are actually conned into answering queries about patient's conditions on the air. Don't get me wrong. I have nothing against theoretical professorial antics by these doctor specialists who perhaps do not know what they are getting into. Perhaps, they want a little fame. But there is no greater fool than the fool that was fooled by a con artist.

The con artists? They are two radio announcers or DJs if you'd like to call them, who after interviewing the "gastroenterologist" on live AM radio, blast out advertisements and "endorsements" on how good Liveraide is for patient with hepatitis B infection or those who have liver problems. They go on adding on where it is available and the claim that it is absolutely safe! The other day, they had a "rheumatologist" live in the station booth and she didn't even budge when they blatantly advertised Arthrocin on the air. Right beside the clueless doctor. Clueless is a kind word to describe the dumb dumb. She even greeted her friends on the air! Ano ba iyan?

The temerity of these people! If you think the endorsements of the popular personalities are bad, this has got to be the height of ethical dilemma and malpractice.

These doctors should shut up and not put up with these con artists who get paid for the announcements and pronouncements that these supplements actually are drugs that cure. In fact, the government should just translate to the local language what the words "No approved therapeutic claim" is on the label of these supplements! The public should be guided by the local translation "Walang bisa itong gamot na ito"!

At the rate that the advertisements are going, it is no wonder that these supplements are selling like hotcakes at the detriment of the health of the Filipino people.

Someone, please shoot the radio announcer!

The Endorsers

There's a lot of buzz going around about "complementary alternative agents" in the market and milk and medicines being "endorsed" by personalities.

Kidney care, heart care, liver aid, a vitamin that will make you complete, follow-on milk formulas and milk for the child who's a picky eater, whitening soaps, beautifying agents whose bodies can't be touched except by a specific product, over-the-counter medicines and whole lot more.

"Endorsers" are popular personalities who are PAID millions to say something, even if they have NO KNOWLEDGE on that particular product. I have nothing against endorsers. We all need to make a living. What I cannot stand is the fact that the endorsers make the complicated look simple and the simpleton in the Filipino will swallow what they say - hook, like and sinker!

On "complementary alternative agents"

There is no scientific evidence that supports the fact that these can serve as substitute to current therapeutic agents that people take for their illnesses. It is understandable that the Filipinos are in search of cheaper, alternative drugs to treat or prevent disease. It is also deceitful of the herbal industry to claim that their drugs are "safe" or "safer" and that because it is "natural", is seemingly devoid of side effects. From a pharmacological standpoint, there is NO SUCH THING as a safe drug.

"Alternative agents" abound in the local market. A few years back, this million dollar business has become a billion dollar market. Thanks to the ENDORSERS and the gullible public.

The argument is that, since these herbal drugs are BFAD (Bureau of Food and Drug) approved, then they must be safe AND effective. Two issues that the public do not understand. Remember: Herbal preparations come into the market with an application with the food and drugs authorities as FOOD SUPPLEMENT and NOT as a DRUG. Hence, there is the imprimatur at the side of the box that says "No approved therapeutic claims". Second, because of the latter, these products are at best supplementary and many DO NOT have large clinical trials compared to standard therapy to support that claim.

In short, what may be effective for patient A, may not work for patient B, given a 50% therapeutic efficacy. Which makes "testimonial advertisements" defective and deceptive. In the long run, not only will patients end up spending more for failed therapy, but because the disease has run its complications, they end up with greater morbidity and mortality.

While there is nothing wrong with TRYING out an herbal SUPPLEMENT (read the word, SUPPLEMENT), the patients must disclose this to the health provider, who in turn must be knowledgeable about herbal drugs so that they can help the patient decide on the treatment plans for patients into homeopathic care. It is with caution therefore that these herbal supplements are recommended, because they have a great potential to cause drug-drug interaction with conventional medicines and can be fatal in the end.


On endorsers

Which goes to the second point of this blog.

Now that I have explained the pharmacological viewpoint above, it is ridiculous that the public believe in the "endorsers" claim. After all, these people are paid to be the megaphones of the company. Notice that their claims are only for the supposed effectiveness and use of the medication. There is NO WARNING on how patients should deal with the side effects, should one occur.

Who do you run after should you develop a fatal adverse reaction? To Juday, to Boy, to Edu? I bet my life they will always say, "I was only paid to say that".

With so many endorsements in advertising nowadays, I firmly believe that the Department of Health together with the Advertising organization of the Philippines must instill some moral aspect into what comes out as advertisement and put more teeth to the victory cry "Truth in Advertising". The public deserves nothing less.


On over-the-counter drugs

Drugs are considered OTC (over-the-counter) medications (read - paracetamol, mefenamic acid, carbocisteine, phenylpropanolamine/guiafenesis, ibuprofen, etc.) because they have been in the market for a long time and that the side effects to these drugs WHEN USED PROPERLY make it safe for patients to decide if symptomatic treatment of mild illnesses which can be managed at home, they are marketed as what is called OTCs. What makes these endorsers credible? They have no knowledge of drugs, they are not even medical professionals or have a degree that certifies them to render an expert opinion on drugs and the treatment of diseases.

As in all drugs, they are lethal when abused and not taken correctly. Do you know that Paracetamol or Acetaminophen is the number ONE cause of drug-induced hepatitis worldwide? Not that it's not safe when taken correctly, but when abused can lead to fatal consequences. The US FDA has warned the public regarding phenylpropanolamine and asked the companies to withdraw voluntarily the ingredient in cough and cold preparations. But the local industry is profit-oriented and will always reason why it should stay in the market. The lethal cocktail combination of gullibility, illiteracy and endorsements is fatal. This is what happens when laymen do not understand the miniscule information provided in a 30 second flick. Herbal preparations can cause drug interactions with OTCs and lead to a condition that results in six feet under the ground.


On other endorsements


Advertisers and companies will always claim that their advertisements are TO SELL a product. Whether it is for human consumption or for use. Milk formula preparations abound with various claims attached to it. There is the milk that is a substitute for the picky eater. Or the milk that will enhance brain development. Or the milk that will make a child a prodigy. All that crap! There is no iota of truth to these claims. Picky eaters are due to bad parenting. Having said that, I challenge the parent who claims otherwise. Eating is a habit that is learned! This has got to be the message ingrained amont those wo think otherwise. The American Academy of Pediatrics does NOT recommend electronic baby sitters (read - TV) to children during feeding time. They are distractors and can be detrimental to appropriate feeding practices. Why do you want to give the child a milk formula because he/she refuses to eat? In the Philippines, I see patients who are still on the bottle after 1 1/2 years old! I tell the parents to remove it and they frown on me, saying that the child will cry in the middle of the night and they can't sleep. Now isn't that really stupid? No child has died crying! All infants go through a "manipulative" stage. They are wittier, trying to find out who will give in to their whims and caprices. If they "win", both parties (parent and child) are losers in the end.

They become "picky eaters", malnourished (undernourished or obese), disciplinary problems later on, and end up losing all their "baby teeth" before they reach the age of 3. Then they refuse to feed solid food because of the dental caries and the vicious cycle is perpetuated.

Why do you want to spend more on milk formula which becomes more expensive because of the millions of pesos companies spend on endorsers (their professional fees range from 2-7Million pesos or about USD$50K USD$170K) for each contract depending on how long these commercials will last! Discipline is FREE! And discipline should be both FIRM and CONSISTENT. The extending family in the Philippine setting is a major factor in instilling discipline and the setback on this is taken advantage of by both the manufacturing companies, the advertisers and of course, the Endorsers!

And the demand by the public for Ascorbic Acid is crazy. One company sold P1.2Billion on vitamin C alone in 2007. Patients think they won't come down with an infection by taking vitamin C! If this is true, why not just buy oranges or calamansi? Or the vitamin preparations that claim that patients "grow" taller if they are on a vitamin that contains "chlorella growth factor". Growth factors don't work and growth hormones are not absorbed orally. They have to be given by injection to work. Let's get real, look at your parents and lineage. It's genetic my dear! Growth is based on the quality of food you eat not the vitamin supplements you give.

Yes, vitamins stimulate the growth - of the pharmaceutical industry!


For the information of the public, the Department of Health, Bureau of Food and Drugs has issued Circular 2008-004 on March 28, 2008, reminding the public on claims of FOOD SUPPLEMENTS.

DOH-BFAD circular 2008-004

"Ang mga food supplements ay HINDI nakakagamot ng anumang sakit"


Dahil sa dumaraming bilang ng mga "food supplements" sa pamilihan at sa mga patalastas o mga patutoo tungkol sa mga diumano'y epektong medikal ng mga ito, mahigpit na pinapayuhan ang publiko na ang mga produktong ito ay nagbibigay lamang ng karagdagan nutrisyon at walang pakikinabangang medikal o sa madaling salita, ANG MGA ITO AY HINDI NAKAKAGAMOT. Walang sapat ng siyantipikong pag-aaral o katibayan na makapagpapatunay na ang mga ito ay makapagpapagaling ng isang partikular na sakit o karamdaman.

Ang publiko ay pinapayuhan na ang pag-inom o paggamit ng "food supplements" bilang kapalit ng regular ng medikasyon para sa isang karamdaman ay hindi tamang gawi at maaaring makapagdulot pa ng mas malubhang kumplikasyon o karamdaman.

Ang paalalang ito ay inilathala upang pangalagaan ang kalusugan at kaligtasan ng publiko.

Now that the health authorities have spoken, time for the advertising sector to take a moral responsibility on the issue.

The public has been warned.