Is the party over?

Jessica Soho's 'State of the Nation' TV news show had editorialized the age-old dilemma of the relationship between the physician and the pharmaceutical company.

The following day, several newspapers had featured the press release of the PHAP (Pharmaceutical and Healthcare Association of the Philippines) on this entanglement between the industry and the doctors.

The press release, which I think should NOT have been released and was done in very bad taste by PHAP through its President, Mr. Reinier Gloor (a former executive of Zuellig Pharma Corporation - a distributor for pharmaceutical products) focused on two evils - the DOCTOR and the INDUSTRY.

First, let me point out that I have nothing against policing entanglements between the physicians and the pharmaceutical industry, I just think that the PHAP is not the proper organization to trump the say-so in having to police the rank of the industry. Fine, so the 44 pharma companies under the PHAP umbrella are banding together to rid the industry of the so-called "corrupt practices' of bribery and influence in prescribing habits by peddling under the guise of junkets and free gifts or rebates to doctors.

What I am peeved about is that the doctors who are the recipients of this are made to look like crooks. Well, yes, so there are some of us in the medical profession who have sold their souls to the devil and have no ethical boundaries. That's a given. What's strange is that the same people who have formed PHAP and bounded together in the fight against this abusive practice are the same idiots who created the problem in the first place!

It's not a chicken and egg scenario. The early years of the pharmaceutical industry saw a boom in business via prescription peddling through backdoor channels - a trip to the Swiss Alps here, a tour of Honolulu there...a gift basket here, payment for convention registration there...

Seriously? My early formative years in medical school and then in residency training made me realize that the pharmaceutical companies were willing to bend over, and yes, even dance on their heads - in exchange for a prescription. I saw this most blatant display of commitment by the pharma players in the milk companies! Talk about milking a cow dry - the Philippines should make it a capital punishment to be even endorsing milk products (but hey, Kris Aquino is an endorser so I doubt if PNoy would even blink before considering this).

I cringe at the fact that I have colleagues that literally ask OR beg the industry for trips and gifts. Mind you that this was not only in the Philippines but in the United States as well! But the carrot was put in front of the rabbit a long time ago. Cognitive psychological impact on the behavior of doctors was altered the day the doctor stepped out of medical school and began his medical practice. The dilemma of the pharmaceutical companies coercing the physician on entanglements was NEVER taught in med school. It became an intricate web that the physician had to fight over (like good and evil in the Garden of Eden) in his heart and soul with the pharma devil placing the temptuous apple in front of the doctor.

Finally, is the fact that this statement of policing itself is only true for pharma companies under the banner of PHAP. There are several key players in the local pharma business that are NOT under the PHAP organization. Which means that the PHAP members are simply restricting themselves and it's really not an all out effort to curb the ethical conflicts of interest between the doctor and the industry.

In short, as long as this is not a government initiative there will still be sponsors for the merry making to continue. Whether it is without Astra Zeneca or GSK or MSD or other big name companies - it's not going to matter. The party will continue until government steps into the bigger picture to ban the parties forever!

In the meantime, Jessica Soho can eat her shorts for all I care!

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?"