Monday, January 28, 2008 Dumaguing: A closer look at the Cheap Medicine Bill By Victor Dumaguing To Your Health
THE past few days saw my cell phone ringing from calls of readers and patients alike asking what is the real issue in the so-called cheap medicine bill, their voices laced with apparent anxiety and worry about the supposed impending "hospital holiday".
Admittedly, this columnist is not well versed with the legalese out politicians use in the executio9n of their duties but as a physician looking into the matter, let me share my 1-cent worth of idea.
Apparently, there are two versions of the Bill. The House of Representatives version is authored by Representative Ferjenel Biron and is known as the Cheaper Medicine Bill, whereas the Senate version is known as the Proposed Quality, Affordable Medicine Bill.
Filipino physicians of various shapes and stripes have raised a strong opposition to a particular part of the House version which required, with corresponding penalties and possible revocation of license, that doctors should abide with the "generics only provision" where the prescription must only contain the generic name of the drug so that the patient can choose from among the many generics in the list posted in drugstores and pharmacies.
To this, Senators Pia Cayetano and Manuel Roxas, chairpersons of the Senate Committee on Health and trade, respectively, clarified that the Senate version did not contain such provisions.
The Philippine government ahs an agency to coordinate with the Department of Health to import and sell generics and cheap drugs, which enter as parallel imports from countries where they are sold at supposedly lower prices.
Generic drugs, also called non-proprietary drugs are labeled by a name that is known, recognized worldwide.
Trade name or brand name is the specific name a pharmaceutical company gives to its particular medicine, the name of which may not be known by doctors in other countries.
The rationale for the existence of generics is to provide medicines to the majority of the consuming public at cheaper, democratic and affordable prices.
Well and good because under this scheme, the majority of patients who are not in the stratospheric financial level of the rich and powerful, can avail of the medicine of his choice, proportionate to the contents of his pocket.
However, many questions cropped up and indeed, if we for a while rise above the emotional content of the issue and look at them from a neutral and objective point of view, then there's validity, if not legitimacy to the opposition towards that specific "generics only provision".
At the moment, does our government have the capability to evaluate, test and assess every generic drug or those that come from parallel importation to make sure that the medicine Juan dela Cruz buys is not fake, expired, substandard or possibly even adulterated, hence harmful?
Is there a regulatory body staffed by experts in pharmacology, toxicology, biochemistry and medicine that strictly monitor the bioavailability, bioequivalence and most importantly, the therapeutic or curative properties of the generic drug vis-à-vis the innovator branded drug?
Bioavailability is the fraction of administered drug that reaches the systemic circulation of the blood.
Bioavailability is expressed as the fraction of the given drug what gains access to the blood after giving it through the mouth.
For example, if 100mg of a drug is given through the mouth and 70mg of it is found in the blood, then bioavailability is 70 percent.
Bioequivalence is achieved if two related drugs show comparable bioavailability and similar times to achieve peak blood concentrations.
Therapeutic equivalence is attained if two similar drugs have comparable efficacy or effectivity as well as safety profile.
However, clinical effectivity often depends both on maximum blood levels of the drug and how fast is taker to reach maximum peak concentration.
Therefore, two drugs that are bioequivalent may not be therapeutically equivalent!
It would be simplistic and naïve to generalize that branded drugs as superior and that generic drugs are inferior.
Facts show that many multinational pharmaceutical firms, who have spent millions in research and clinical trials on a particular drug molecule, end up withdrawing their branded drug because of serious adverse effects.
On the other hand, the Philippine has reputable and respectable pharmaceutical firms, which manufacture off-patent medicines and even generic drugs, which can stand head-to-head with the multination drugs.
It is heart-warming to note that the media and the press have been objective in handling the sensitive issue, with some insightful journalists even commenting that "most of the authors and advocates of the many versions of the cheaper medicine bills are motivated more by their political ambitions, rather than real concern for the poor."
Isn't it a shame that some political wannabes want to ingratiate themselves to the masses by supposedly championing their health care, in the guise of a cheaper medicine bill? Makes me wonder.
The Oath of Hippocrates of Physicians states in part "the health and life of my patient will be my first consideration. I will not allow consideration of race, religion, nationality, party politics and social standing to intervene between my duty and my patient."
Poverty is not the issue here but life, which is a magnificent gift from God. The anatomy of the rich is the same as the anatomy of the poor.
In the Philippines, the medical practice is more of a vocation than a profession. Whether branded or generics, let's give the Filipino patient the best!
