Friday, January 25, 2008

Docs up in arms

...in protest of the amendment to the Generics Act Bill.

There’s been an uproar lately, among doctors throughout the country. It’s about the new amendment to the Generics Act Bill.

What’s the Generics Act Bill?

Simply put, it behooves doctors, dentists and veterinarians to prescribe drugs using generic names instead of brand names.

Why?

So that the patient can choose which brand he or she will buy.

Why is there a need for this?

Well, in the market, there is a wide range of prices for any particular drug. For example, the antibiotic cephalexin can be as expensive as 30 pesos per 500 mg capsule for a branded version, whereas the unbranded/generic version would sell for only 16 pesos.

Why is it like that?

(Ahmmm… why don’t we ask the pharmaceutical companies??)

Is this a new bill?

Actually this has been implemented in 1988 yet. That’s like 20 years ago.

And so what’s the fracas all about today?

It’s the amendment to the bill. Which says it will now be a criminal act if doctors WRITE the brand name of the drug instead of just letting the generic name stand for itself.

Uhh… whats’ the problem with that? Can’t the generic name indeed stand for itself?

Well, yes and no. Technically, the generic name should be able to stand for itself. Cephalexin 500 mg should be cephalexin 500 mg no matter what it’s brand name may be. But that is technically and theoretically. The reality is: not all cephalexins are created equal. Hello! That is the sad truth.

Hmm… would you care to elaborate on that?

See, there’s this thing called QC. Not Quezon City where I spent 15 years of my life in, but Quality Control. The reality is big pharmaceutical companies, who have a name and reputation to protect, have GOOD quality control measures to ensure that all the drugs that come out of their factories are able to pass muster. Meaning if it says on the label 500 mg of active ingredient then each tablet or capsule really contains 500 mg of active ingredient. AND there is the matter of the inactive ingredients. The inactive ingredients could spell the difference between an allergic reaction, shelf life and bioavailabity.

On the other hand, the smaller pharmaceutical companies also have smaller budgets for quality control. Therefore, there is a greater chance that the drugs that come out of their factories are not at par with the drugs that come out of the big, established pharmaceutical companies.

It sounds logical but umm… have there been studies to prove this?

Studies? Yeah… I don’t know. All I know is that most if not all the doctors here in Dumaguete will tell you that they have a bad experience with generic drugs. Their patients don’t get well!! Their patients get worse. And so after several days of putting the patient on generic drugs, they eventually insist on the branded drugs and that is when the patients start to get well. If you were the patient, would you rather go through the generic trial period or would you rather go directly to the point?

Okay, at this point forward, I’m going to stop giving my own personal opinion on the subject matter and point you to the Official Position Paper of the Negros Oriental Medical Society, the Negros Oriental Chapters of the Philippine Academy of Family Physicians, the Philippine College of Physicians, the Philippine Medical Women’s Association as well as the Negros Oriental Hospital Hospital Systems. It’s a combination of medical jargon and legalese so it might not be so easy to read. But for those interested, I think it’s a necessary read.

Incidentally, this past week, the proponents of the above Position Paper have been holding meetings, rallys, motorcades and press conferences to publicly declare what we perceive as an atrocity, an insult, a desecration, a travesty of the practice of medicine in the country. All the conferences and rallys were well attended, seldom do we get such a solid gathering of doctors from both the government and private sectors alike. And this coming Sunday, there’s going to be a motorcade beginning at the Silliman Medical Center to increase public awareness of the doctors’ protest against the amendment to the Cheaper Medicine Bill.

My only lament: there was no debate at all. Everyone was on one side. I would have wanted to hear (and boo) the arguments of the people who authored the bill. Which, may I just add, one of whom, Ferjero Biron himself, owns a generic pharmaceutical firm. O_O

And here are some interesting discussions about the amendment to the Cheaper Medicine Bill:

Prudence, MD

Ang sa wari ko...

Surviento

And from Biron's Alma Mater, the West Visayas State University.



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1 comment:

Purdoy said...

DELETE GENERIC-ONLY PRESCRIPTION

I’ll vote for the deletion of the generic-only prescription in the Cheaper Medicines Bill on one condition…

If our beloved doctors could prove that there were MORE people who died because they took generic medicines than those who died under their scalpels or as a result of their wrong diagnosis!

Cut the bull doctors! Even if the generic medicine you prescribed does not work, you NEVER assume responsibility! Have you ever heard of a doctor getting convicted here for malpractice? None! So let’s not be hypocrites here!

This is a question of A-C-C-E-S-S-I-B-I-L-I-T-Y! Not efficacy because all generic drugs that pass thru BFAD are bio-equivalent (http://www.fda.gov/cder/ogd/) and your claim that they are not is not supported by scientific evidence or hard facts. Speculation! That’s just it.

Generic medicines have more advantages than branded ones — BFAD


“Prescribing branded medicines is based on experience of doctors on their efficacy to patients. It is not pharmaceutical companies that dictate their effectiveness,” Santos said. (PMA VP)

Really now Dr. Santos? Sige nga, between branded generic drug A backed up by a trip to a medical conference in the US and pure generic drug B certified by the FDA (http://www.fda.gov/cder/ogd/) that is way cheaper but is not “incentive”-backed by big pharmas, which would you prescribe?

Let’s stop the hypocrisy. Mas “EFFECTIVE” ang gamot na may magandang med rep na nagpopromote at nagbibigay ng free trips abroad sama asawa at tatlong anak at may pocket money pa!

Once in your life admit that you prescribed “incentive”-backed drugs over affordable generics. The issue is not about bio-equivalence or efficacy. It’s about accessibility! What you have been prescribing are just not affordable to the poor majority. And you doctors have been causing this lack of access for so long.

“The PMA also said the provision on the Cheaper Medicines Bill that prohibits doctors from issuing branded drugs will endanger patients as their proper medicinal prescription will now lie on the hands of sales clerks of drugstores.”

As if this cannot be done today??? With or without the bill, any pharmacist or pharma clerk can recommend a high-mark up brand. They do it!

The bottom line is, some doctors do not give a damn whether one can afford a prescribed medicine or not. And this has to end.

Give the power of choice back to the patients esp. those who can’t afford branded drugs!!! Take it away from the abusive doctors! Because unlike doctors, patients are just after getting well and being A-ok and not after free trips abroad, or free prescription pads (cheap), or free aircon (if they chose not to go abroad), or free ballpen (cheap), or free concert ticket (ka date yung med rep na sexy), or free hotel accommodation (ka date ang kabit), or free drug samples that they (doctors) sell to patients (cheap)!
(Excuse me to those GOOD DOCTORS who support the bill, I know you number more than the PMA-class, selfish, greedy, trash)