PH Pharmacists 5: PPhA Convention 2012, Day 2

Yesterday afternoon, I attended the 2nd day of the Philippine Pharmacists Association (PPhA) National Convention at the University of Santo Tomas (UST) in Manila. I skipped the morning session because I attended the "Online Onsite" program of interaksyon.com at the Enterprise Center, Ayala Avenue, Makati City. I spoke in an informal setting, about the conflict with China over Scarborough Shoal, the Spratly Islands, at the West Philippine Sea or South China Sea, and the interaksyon guys were tweeting my talk, feeding me questions from twitter and from other guys on the site which I also answered. Here's my presentation there,  http://interaksyon.com/assets/documents/interaksyon_online_onsite.pdfinteraksyon.com

Thus, I was not able to listen to the presentations of four good speakers like Dr. Lagrada of PhilHealth, Joey Ochave of UL, John Ware of WPPF, and Ms. Marilyn Tiu of the Board of Pharmacy.

I was not able to leave Makati early, I wanted to hear Dr. Midha's presentation about bioequivalence and related subjects. I came late, poor me. But I was able to hear the presentation by a good friend, John Chang, the President of FAPA, then by Leonie Ocampo.

John talked about the evolving roles of pharmacists: Traditionally from compounder (of drug molecules) to medicine selling/dispensing to counselling + information, to patient care and pharmaceutical care. This is a good evolution of roles. Towards the latter part of his talk, John showed a quote something like "There's no future in (medicine) dispensing, it can be done via the internet, by the machine, or hardly-trained personnel".

There is truth to this. Many pharmacies and drugstores -- especially those owned by the government (Botika ng Barangay or BnB, supported by the DOH), or private non-chain drugstores -- are manned by non-pharmacists, some even have zero formal training in pharmacy. They could be any political appointee by the Barangay or Village Chairman.

So it is possible that many pharmacists are over-educated (mind you, they have to pass a board and licensure exam by the government after hurdling 4 years of college education) if their work will just be limited or focused on drug dispensing and selling.

John also discussed about a debate in some countries where physicians complain or charge that "pharmacists act like physicians", and the reverse of the argument, that "physicians act like pharmacists." It's about the division of labor between the two on drug prescription vs. drug dispensing. John said that there should be complementarity of function between the two because the goal is the same -- patient care. Nice point there, John.

I don't have photo of John and Leonie during the convention, but I have one during the CGDA Conference in Taiwan last November. From left: Nancy Tacandong of FDA, John Chang, Leonie Ocampo, me and Joey Ochave.

The presentation by Leonie was good, lots of good data for the Philippines, like the following:

1. In community pharmacy, about 60 percent of the pharmacy business is controlled by the biggest chain with 800+ outlets nationwide. (That's Mercury, who else -- me)

2. About 40 percent of the business by 5,000+ outlets from different companies.
-- 70 percent of this 40 percent are from five chain pharmacies (That's Rose, Watsons, Med Express, The Generics, who's the 5th? -- me).
-- 30 percent of this 40 percent are from single branch pharmacy operations (The BnBs and Botika ng Bayan or BNB are not included in this 40 percent? -- me). The practice of pharmacy here is mainly dispensing, almost nothing else.

3. Hospital pharmacy constitutes 10 percent of the total pharmacy business. And this is dominated by 10 big hospitals (Makati Med, St. Lukes, Medical City, PGH,...)

Then Leonie discussed some unfavorable practices of the profession:

- Poor implementation of the "no prescription, no dispensing" rule;
- Poor storage of medicines practices,
- Medication counselling is not practiced;
- Sale of medicines unsupervised by trained pharmacists in non-traditional outlets (like those walking house to house carrying medicines in hand bags, selling drugs in public markets, etc. -- me)

She noted that "Pharmacists appear overeducated and underutilized". Thus, there is big role by the PPhA being the main (and only) professional association of Filipino pharmacists. PPhA is the umbrella organization of 10 affiliate organizations and 82 local and provincial chapters.

The various initiatives, projects and networking by PPhA were discussed by Leonie. I won't mention them here, I think her presentation will be made available in their website soon.

In relation to the top killer diseases in the Philippines and worldwide, about 2/3 are from non-communicable diseases (NCDs), medicine and lifestyle counselling will be an important role for pharmacists. What good are the most effective drugs made cheaper via drug price control and coercion policy, or even freely available via government of hospitals and assistance to the poor, if the patient will continue their unhealthy lifestyle like over-drinking, over-smoking, over-eating fatty and salty food, over-sitting and sedentary life?

Identification and monitoring of counterfeit and/or substandard drugs is also an important function for pharmacists. We ordinary folks will not be able to detect such, especially if we go to lesser known or even known for notoriety pharmacies, and worse from non-traditional outlets like "sari-sari" or variety stores, those sold on house to house marketing, etc.

Again, it is refreshing to hear that many of public health problems have private solutions, relying little or zero on politics and politicians. Health is mainly personal and parental + civil society responsibility.

* See also  PH Pharmacists 4: PPhA Convention 2012, Day 1, April 27, 2012

PH Pharmacists 4: PPhA Convention 2012, Day 1

Upon the invitation of the President of the Philippine Pharmacists Association (PPhA), Ms. Leonila "Leonie" Ocampo, I attended yesterday the afternoon activity, also the formal opening ceremony, of the PPhA National Convention 2012, held at the University of Santo Tomas (UST) in Manila. There was a poster and product exhibit in the morning at the conference venue.

I was amazed at the big crowd, more than 2,000 pharmacists from around the country came, the biggest turnout so far. I will post photos later.

Here is the program for the Opening Ceremony.

I was able to see the procession, then heard the opening message of Leonie and the keynote speech of Dr. Kamal Midha, the presentation of plaque, then I left. I will come later today, afternoon session as I have a talk in the morning on the Spratly/Scarborough Shoal, or the dispute in the West Philippine Sea or South China Sea, depending on which country you are standing on.

The welcome reception yesterday was sponsored by the United Laboratories (Unilab or UL) and its VP, Mr. Chito Sta. Maria, would give the message. UL is a giant pharma company here. Although it is a generic manufacturer, its annual sales is larger than the combined sales of #s 2 to 4, all innovator companies (GSK, Pfizer and #4 Wyeth, I think), it has lots of resources to give food, prizes, entertainment and other perks to the convention participants and organizers.

Dr. Midha's talk focused on rational use of medicines (RUM), the characteristics of medicines that should reach the public, and the importance of bioequivalence testing especially for generic drugs. He used the WHO definition of RUM -- right needs of a patient, right dosage, right time, and at affordable price.

There are six characteristics of medicines for the public, he said: Safe (adverse effect is avoided), Effective, Patient-centered, Timely, Efficient and Equitable. In particular, Quality, Safety, Efficacy and Affordability are all required characteristics.

He also discussed the problem of counterfeit medicines and how the public, with the assistance of pharmacists and other health professionals, can detect and avoid them. He said that Council of Europe has certain guidelines to help along this line, like all medicines should have 13 digits barcode.

Bioequivalence is important -- pharmaceutical equivalence, bioavailabilities after administration of the same molar dose under the same condition would show essentially the same effect as the innovator drugs.

I was actually expecting that Dr. Midha would give a technical presentation, like what are the strict processes required before bioequivalence can be declared or stamped on generic drugs that are newly introduced. Or the problem of antimicrobial resistance (AMR) that are related to irrational use of medicines. But nonetheless, his presentation was clear.

I was happy to see again yesterday two friends whom I have met during the Taiwan conference last November, the President of the Federation of Asian Pharmaceutical Associations (FAPA), Mr. John Chang from Malaysia, and FAPA Past President, Dr. Soo Ja Nam from S. Korea. PPhA Past President Normita Leyesa was also there of course.

What I find impressive in the PPhA Convention is the absence of high government officials -- say the DOH Secretary, or WHO Regional Director or Representative, or PhilHealth President -- as speakers, something that is so common in many private sector- or NGO-organized events like this one. Instead, key leaders of the profession, especially the Presidents (and past President) of the three international organizations (FIP, FAPA and WPPF) were given prominent roles to speak in the convention.

This is the way to strengthen and professionalize civil society organizations (CSOs) like the PPhA. To stand on their own, discuss matters among themselves, and rely less on certain political favors that high government officials would give them.

More stories and photos later...
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See also:
PH Pharmacists 1: Convention in Naga, April 06, 2011
PH Pharmacists 2: Patient Rights and Responsibilities, April 08, 2011
PH Pharmacists 3: Public Health and PPhA 2012 National Convention, April 16, 2012