Saturday, September 22, 2018

Luczon: Into rabbit holes and chasing deadlines


IT DID not take too long for the implant contraceptive to arrive in Northern Mindanao.

As early as July, it was said that “Implanon NXT,” the brand name of subdermal contraceptives was administered to mothers that started in Bukidnon, and recently in Cagayan de Oro through the Commission on Population (PopCom), in time when the agency is observing the National Family Planning Month this August.

When Kiesha Marie Hinaot decided to take the implant, all she wanted was to finish schooling, despite having a two-month old baby. At 18, she would be the youngest contraceptive recipient among 40 other mothers who volunteered to get implants inside the PopCom Region 10 office last week.

Implanon NXT, with a generic name “Etonogestrel,” is injected in the recipient’s skin layer usually in the arms. It is said to take effect within three years before recipients can decide to be injected again with another implant, in order to prevent pregnancy.

With budget constraints and avoiding skipping the daily intake of contraceptive pills, this was probably the reason why Kiesha decided to go with Leonora Pedimonte, the Barangay Health Worker (BHW) of Consolacion village, in Cagayan de Oro City. She has served the barangay since 2007, and has been advising mothers within her area to practice family planning.

“In 1,000 (estimate) mothers, there are around 800 who use different artificial contraceptives, and only one who follow natural family planning method,” Pedimonte said, and those figures come from District 3 of the barangay where she was assigned. Barangay Consolacion has seven districts.

In the region, there are already 1,079 clients who availed the subdermal implant. And between July and mid-August this year, there were about 729.

You must have wondered why PopCom-10 was into this, when it was supposed the Department of Health (DoH) should be the one spearheading the administration of free contraceptives to clients.

PopCom-10 has started a new function that aimed to support the DoH and BHWs deliver reproductive health services by allowing its in-house nurses administer sub-dermal contraceptives.

PopCom regional director Jeremias Gupit, said that this is so far the first in the country after recent organizational changes that made his agency aligned with DoH.

"We're also doing this to draw public awareness of this particular (birth control) method, but just to let the public know there are also other methods available," he said.

PopCom’s additional function to support DoH operations in administering free contraceptives to the people is tell-tale sign that they are up to something: they are saving these contraceptives from getting thrown away when these reach its expiration dates.

For instance, Implanon NXT - contrary to earlier reports that it will expire in 2020, what indicated in the carton labels exclusive for DoH use was its expiration date will be March 2019. And this is the reason why DoH tapped PopCom - an agency which has a mandate to information dissemination and demand generation - as additional help in administering these contraceptives.

As Gupit also said, since they are already in the function of lecturing family planning methods, might as well their agency be a supporting agency to give contraceptives in line with DoH’s goals.

If you are reading this article online, you can see PopCom’s activity last week and Implanon NXT’s packaging through the photos shown.

Implanon NXT is one of the many other contraceptives nearing expiration dates. Based on consolidated media reports, there are already 37 artificial contraceptive brands that expired since DoH purchased them in 2015. There will be five more, starting September, that are about to get expired this 2018; another five to expire in 2019.

The race in beating the expiration dates began when pro-life groups,Alliance for the Family Foundation Philippines, filed a petition in the Supreme Court (SC) in 2015, with an aim to stop the administration of artificial contraceptives including Implanon NXT, because these groups believed that it is abortifacient drugs.

It was only in 2017 when the SC lifted the Temporary Restraining Order (TRO) from administering these contraceptives, after the Food and Drugs Administration of DoH has issued a report that the said contraceptives in question are non-abortifacient or drugs that can not induce or be used in abortion.

By the time SC lifted the TRO, there are already 27 contraceptive brands went expired, and that means hundreds of millions lost for DoH since these were never used at all. Gupit shared that during the time of Secretary Paulyn Ubial, it was said that she plans to donate it to other countries instead of throwing these contraceptives away unused.

Scrutinizing Implanon NXT’s parents Implanon NXT was manufactured by NV Organon, a Netherlands-based pharmaceutical company specializing in fertility, gynecology and selected areas of anesthesia, as per public information. But Organon is just one of the many subsidiaries of pharmaceutical companies worldwide as its umbrella company is Merck Sharp and Dohme (MSD) or Merck and Company, Inc. In the United States.

Based on the Implanon NXT packages exclusive use for DoH, MSD has a Philippine office located in Paseo de Roxas, Makati City. MSD is considered the seventh largest pharmaceutical company in the world.

“Interesting” things came out while checking the background of these companies:

In 2014, Organon USA Inc. has agreed to pay $31 million to settle allegations from the federal government and several states, including New York and Kentucky, that it underpaid rebates to state Medicaid programs, in addition to some “kickback” allegations through offering improper financial incentives to nursing home pharmacy companies, and misrepresented drug prices and promoted drugs for off-label, according to the state attorneys general.

Meanwhile, it was New York Time reported that from 2002 through 2005, Merck’s Australian affiliate allegedly paid Elsevier, an information and analytics company and one of the world's major providers of scientific, technical, and medical information. This means that Merck paid a certain amount to Elsevier to publish eight issues of a medical journal, the Australasian Journal of Bone and Joint Medicine.

The content of the researchers appeared to be independently peer-reviewed but it turned out that Merck had paid for it, and the journals in question actually reprinted articles that originally appeared in other publications and that were favorable to Merck.

The misleading publication came to light in 2009 during a personal injury lawsuit filed over Vioxx, which is also known as Rofecoxib, a nonsteroidal anti-inflammatory drug that has now been withdrawn over safety concerns. It turned out, nine of 29 articles in the Elsevier journal’s second issue referred positively to Vioxx. This later prompted the Chief Executive Officer of Elsevier's Health Sciences Division, Michael Hansen, to admit that the practice was "unacceptable.”

For most academics in the Philippines, to have their researches published in one of the journals of Elsevier, it is something an achievement of wide proportions. And here we are that even as a scholarly prestigious organization like Elsevier - can be bought by the big pharma industries of the world.

Then here’s another rub, the DoH also purchased Implanon NXT’s cousin, the Merck-produced “NuvaRing,” a condom-like vaginal ring inserted inside women’s vaginas to prevent pregnancy within a month.

But NuvaRing has pending lawsuits in the United States because it claimed to have some serious side effects in some users. Data from showed that Merck & Co. has to settle a total of $100 million with 3,800 claimants in 2014. There were a total of 1,992 lawsuits filed against the company, and 86 are still pending in the US courts.

Complainants sued the company because of cardiovascular injuries, blood clots, pulmonary embolisms, and worse, that caused some deaths.

However, at the end of the day, people like Kiesha Marie - a teenage mother - could care less about the background of these pharamaceutical companies like Organon and Merck, even would not be so much interested how DoH get to procure contraceptive products, as long as she has decided not to get pregnant because she still wants to finish schooling.

“Mag grade 10 naman unta ko; gusto ko lang mahuman og skwela (I am supposed to be in Grade 10 now, all I wanted is to finish school),” she said. The father of her newborn baby is 31-year-old Joseph Gonzales, a college dropout, who sidelines as an electrician. He must be busy working that’s why he was not with Kiesha to go with her when she was injected with Implanon NXT.

As for BHW Leonora, she was just doing her job despite there were times that her honorarium got delayed for a while. As long as he has reached to family having difficulty in getting access to public health. She may not be too concerned with the effects of contraceptives introduced to the families as they just follow what the DoH has told them as well.

But as members of the public, we should know that millions of pesos have already been wasted, and while it is in good faith that DoH and PopCom are saving the last cents of the remaining millions, we should also be mindful of how are contraceptives are being bought from pharmaceutical companies - not only the justified prices, but also the health effects it can cause to Filipino recipients.

And don’t you notice as well? These contraceptives - most of them - are interventions for women only. This can be traced to the whole industry of contraceptives, where most products are directed towards women, and seldom of it are for men.

While we were given choices to choose what is good for our health, our government should give us the options and clearly choose by providing us transparency on the pros of cons of the things we choose. Let’s start by asking expiration dates. (