Tuesday, September 22, 2009

Patients' vested interest: more choices.

A friend, Winthrop, made a comment to the article by Cito Beltran. Wyn argued
that the "mandatory" car for medical representatives ("med reps") is a perk that he feels can be done away with, along with various incentives to physicians/dispensers. And that the current "live rep push-marketing and (effectively) payola incentive schemes cost more."

Middle of last month, there was a social dialogue between civil society groups (including those under CHAT) and the Pharmaceutical and Healthcare Association of the Philippines (PHAP). Officials of PHAP explained their "Code of Ethics" that apply -- with penalties and sanctions to violators -- to their member-companies. Even PRRM chief and former Sen. Bobby Tanada, former DAR Sec. Obet Pagdanganan, were surprised to hear about the strict code being imosed to member-companies. If companies are not happy with the Code, they can leave PHAP anytime.

PHAP officials and officials of some MNC pharma who were there were emphatic that for payola-type and other unethical promos by pharmas, "at least 85% probability, they are not PHAP members". Personally, I have heard admissions from some local pharma how they go out of their way to attract physicians. Since they are not MNCs and have no global brand or corporate name, it's difficult for them to get physicians' patronage, unless you are Unilab, the biggest pharma (you combine the sale of top 3 MNCs in RP like pfizer, GSK, another one, Unilab's sale is the same or even bigger).

I guess the use of med reps is inevitable. Unlike t-shirts, shoes, underwear, ballpens, etc., where an ordinary shopper can scrutinize these products in terms of price and quality, medicines are another stuff. Not even the best lawyer or the best solar physicist can analyze the properties and characteristics of what's inside those tablets, capsules and bottles. So physicians are sort of "guided" by the med reps sent by the drug manufacturers, or physicians are invited by the manufacturers to some continuing medical education (CME) to introduce their new products. There are costs to all those activities, so the producers pass on those costs to us, patients. In addition, because of the growing competitive nature of the local pharma industry (thanks to the generics law), manufacturers have to embark on certain ads and marketing, otherwise their competitors will beat them.

When manufacturers give cars to their med reps, maybe this is to also protect the quality of the drugs that those sales people bring. Most medicines require a particular temperature control, say below 25 C always. So an air-con car will help preserve the quality of those drugs. If the med reps wait several minutes under the sun to wait for a taxi or jeepney or tricycle, the quality of those delicate medicines may be affected. So the patient will still not be healed quickly from those sample medicines.

I dont know what else are the factors that manufacturers and distributors consider. It's not my field. Mine -- and ours -- is on public policy. Let the various players over-spend or underspend if they must, it's their business and it's their money that will be lost if they make bad business decisions. Our business as watchers and researchers of government policies, is to expose and fight those regulations that kill competition. As consumers, we have our own vested interest -- more choices. Let there be 200 or 400 different medicines against hypertension, and allow us consumers, our physicians or other health advisers, to decide which of those 200+ medicines will best fit our particular health needsgiven our budget and other health conditions. Government should not bow to the health socialists who want to kill competition via rigid and coercive policies like price control and compulsory licensing.

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