Wednesday, July 15, 2009

Uncontrolled Emotions in Drug Price Control

Yesterday afternoon, the Coalition for Health Advocacy and Transparency (CHAT), co-sponsored by the Affiliated Network for Social Accountability (ANSA) and the Transparency and Accountability Network (TAN), held a forum on drugs maximum retail price (MRP) and drug discount cards. The event was held at the conference hall of the Ateneo School of Government, Ateneo de Manila University, Katipunan, Quezon City.

In the morning session, the topic was about the Access to Information bill -- passed in the House of Representatives, pending at the Senate. Vince Lazatin, Exec. Director of TAN eloquently explained the need for citizens' greater access to certain government records, and the important provisions of the bill.

The forum on drugs MRP, the agenda was prepared by HealthWatch, an NGO headed by former Bulacan Gov., former DAR Secretary, and former PITC President, Obet Pagdanganan. The speakers were (1) former Sec. Obet Pagdanganan, he presented a general situationer on the Philippine pharmaceutical industry, (2) Rose Trajano of 3CPNet, she narrated to us what happened in the July 8 (last Monday) meeting of the Congressional oversight committee on cheaper medicines law at the Senate, and (3) Dr. Robert So of the DOH, he explained the scientific basis for the 21 molecules that the DOH recommended for issuance of MRP. It was a very informative presentation by the 3 speakers.

I also spoke and narrated that during the 2 DOH advisory council meetings on price regulation last June 5 and June 26, they at the DOH were also in favor of "voluntary compliance of large price cut by multinationals if necessary" because the DOH recognize the big problem and logistical requirements of full enforcement of MRP. See my account of those 2 DOH meetings below, late June.

The VP of HealthWatch, Cecile Sison, who prepared the agenda for the afternoon forum, asked me if I can be the facilitator of the open forum later, and to write the draft statement of CHAT later on the subject. I said No because I am a highly opinionated participant to become a facilitator, but Cecile and other CHAT leaders there insisted that I can write the draft statement, so I later said Ok.

To be a forum or round-table meeting facilitator can be tough. For one, I would be forced to listen carefully to the sentiments of all participants, which means I could not go out of the room anytime. Then I would have to cut some sleep to prepare the draft statement that captured the general sentiments, the points which were most agreeable to all, and they would be waiting for that draft statement that evening!

CHAT has about 25 member-NGOs, including network of NGOs themselves. But by afternoon, only 7 NGOs were represented. The sentiment went like this:

YES to the issuance of MRP by the President the soonest possible -- HealthWatch, 3CPNet, and Kilos Damit.

NO to the issuance of MRP if voluntary big price reduction by pharma companies will happen -- Natl. Pharma Foundation (NPF), AGAP, Minimal Government Thinkers, and ANSA.

With that mixed opinion and sentiments, I wrote the draft statement. I prepared 1 page long and posted in the CHAT googlegroups by around 1am today. I will not post that full draft statement here for now because it is still subject to further revisions and changes. Will post it later, along with the final draft. The Final Draft will be written by Fe Remotigue, CEO of the National Pharmaceutical Foundation (NPF), which is the franchisor of "Health Plus" village pharmacies.

Anyway, portion of the draft statement I made went like this:

"While some of us, member-NGOs of CHAT, directly and openly support the issuance of MRP by the President, others do not see the move as the priority action. Even the DOH has some reservations in such move mainly because of the huge logistical requirements for its enforcement nationwide on a sustained basis.

We welcome therefore, the agreement between the government and the pharmaceutical companies whose products are among those in the 21 medicines for issuance of MRP, for voluntary price reduction by the latter of those medicines by at least 50 percent...."

Then Edwin Santiago of the National Consumers Affairs Council (NCAC) leaped and posted a long, all-Filipino posting, attacking the draft statement that I prepared. He said,

"Hindi makatotohanan ang statement na ginawa ni Nonoy. Puno ito ng sintemyento na pabor sa mga MNC's na tinatamaan at tatamaan ng MRP....HINDI PO AKO SANG-AYON SA NILALAMAN NG STATEMENT NA GINAWA NI NONOY."

(Translation: "What Nonoy wrote is not true. It is full of sentiments in favor of MNCs that are hit by the MRP... I do not agree with the draft statement made by Nonoy.")

This guy has been watching my postings in the CHAT googlegroups then launch counter-arguments, almost always, cc various individuals that I do not know. Fine, the googlegroups is an avenue for members of CHAT to post their opinions and ideas.

This guy has 3 problems.

One, while everyone in CHAT, including him was invited to the forum and meeting, he did not show up. He would just appear in the ggroups to launch counter-comments to almost anything that I will post there.

Two, he is attacking a draft statement that captured the general sentiment of the 7 NGO leaders who were there yesterday, not just the sentiment of Nonoy Oplas.

And three, his organization, NCAC, is not an NGO. It is a government office and bureau under the Department of Trade and Industry (DTI).

NCAC is one of the 8 bureaus under the DTI: BTRCP, BPS, CIAP, CMDF, IPO, NCAC, PAO and PSB.

I actually raised that issue with CHAT ExeCom -- if NCAC can become a member of CHAT, fine, no problem with me. CHAT should also invite representatives from DOH, BFAD, PITC, PhilHealth, Senate, House of Reps, WHO, ADB, WB, etc.

Well it's an issue that the Execom has not acted yet. I dont want to bug them on it because those guys should be busy with various other concerns too.

The guy posted another attack on me, with a parting slogan,
"Mabuhay si Nonoy at ang mga MNCs!"
(Translation: "Long live Nonoy and the MNCs")

I replied that his sloganeering was insufficient.
He can add also,

Long live Nonoy and capitalism! 
both foreign capitalism and domestic capitalism!
Long live Nonoy and globalization!
Long live small government intervention and big market competition!"

More complete ingredients, longer sloganeering, alright!

About the draft statement I made, there was nothing, zero, nada, that I said or implied, that it cannot be criticized. I expicitly said that after that draft, then it was open to expansion, reduction, changes, etc. And that is precisely why I limited the draft to only 1 page, to give more allowance for more insertions and changes, provided that the final draft should not be more than 3 pages, as agreed upon by those present in the meeting.

There was also nothing, zero, nada, that I said or implied, that those who did not attend cannot introduce any change or shoot their gun. Precisely that after I wrote the draft, I posted it for everyone in the CHAT googlegroups to make any comment, addition, subtraction, multiplication or division.

So if I never mentioned, implicitly or explicitly all the above charges or innuendos made -- that those who were not there cannot introduce any change or revision, that the earlier draft can never be altered anymore -- it only means one thing: deep insecurity on the part of the accuser to just criticize and attack even without any basis.

Meanwhile, I remember Dr. Robert So himself expressed reservations of the capability of the DOH to fully enforce the MRP very quickly. Like putting the sticker "price not to exceed P___" in ALL medicine bottles, in ALL blister packs, in ALL capsule/tablet packs, in ALL 10,000+ drugstores in ALL cities and municipalities in the country. Dr. So even mentioned that it will take at least 2 to 3 months AFTER the President has signed the EO issuing the MRP, before the DOH can enforce and implement the MRP.

Thus, assuming that President Gloria will sign the EO this coming Saturday, July 18, the agreed-upon deadline for the multinational pharmas to produce a voluntary drug price cut scheme that will be acceptable to the Executive branch (OP, DOH, DTI, BFAD, etc.), the soonest time that the DOH can implement that EO will be September 18 to October 18 (ie, 2 to 3 months after the signing of the EO). That's how messy the implemention of the MRP is.

And that is why even BFAD people are possibly horrified of the new tasks that will be assigned to them by the President and the DOH, to check ALL those bottles and tablet packs that are under MRP in ALL drugstores nationwide, on a sustained and regular basis. Then receive all attacks and flak by the legislators in the oversight committee should there be loopholes and inefficiencies in their implementation.

And that is why even PCPI leaders, the owners of Filipino-owned, non-MNC pharma companies, are also not in favor of drastically issuing the MRP, partly because of that logistical nightmare.

Dr. So added that "what is crucial is enforcement on the part of the DOH. Otherwise, if the DOH cannot fully enforce the MRP effectively, then the affected pharma companies can just find ways to go around the entire procedure, DOH efforts will be wasted."

So I wonder who now has the more realistic view -- the DOH and BFAD that will implement the EO and will receive all flaks and congressional criticisms if the EO is not fully enforced, or the groups and individuals who want MRP signed and implemented veeeerrrryy soon, if not today.

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