MeTA 19: National Forum 2015, Empowerment of Patients

The two-days annual national forum of the Medicines Transparency Alliance (MeTA) Philippines started today. I attended the afternoon session only because I attended the w FNF event at The Mind Museum, Fort Bonifacio.

Here is the program.

Daty 1, February 17

SESSION 1:  OPENING OF THE 2015 FORUM

ACCESS AND EQUITY: MAKING HEALTHCARE A REALITY FOR ALL

1. Invocation, Ms. Precy Declaro-Deluria,

Executive Director, Philippine Cerebral Palsy, Inc.

2. Overview of the Forum, Ms. Cecilia C. Sison, Country Coordinator, MeTA Philippines

Opening Message, Mr. Roberto M. Pagdanganan, Chairman of MeTA Philippines

3. Remarks from the International MeTA Secretariat

Ms. Deirdre Dimancesco, Technical Officer - Department of Essential Medicines, World Health Organization (WHO)

Dr. Tim Reed, Executive Director, Health Action International (HAI)

4. Message of the Department of Health (DOH)

Atty. Nicolas B. Lutero III, OIC, FDA; Director, Legal Services, DOH

5. Keynote Speech, Dr. Julie Lyn Hall, MBE, WHO Representative to the Philippines

SESSION 2: EMPOWERMENT, ENGAGING PATIENTS IN THE DIALOGUE ON HEALTH

6. Stakeholder Mapping and Development of a Framework for the Engagement and Empowerment of Patient Organizations in the Philippines

Mr. Wadel S. Cabrera III, WHO / MeTA Project Consultant

7. Panel Discussion

Moderator: Dr. Noel R. Juban, Professor, UP College of Medicine

(a) Ms. Deirdre Dimancesco, Technical Officer - Department of Essential Medicines, WHO

(b) Dr. Maria Minerva P. Calimag, President, Philippine Medical Association (PMA)

(c) Mr. Teodoro B. Padilla, Executive Director, Pharmaceutical and Healthcare Association of the Philippines (PHAP)

(d) Engr. Emer Rojas, President, New Vois Association of the Philippines

(e) Dr. Benjamin Bernardino, Secretary General, Life Haven Independent Living Center

(f) Ms. Salvacion Basiano, President, Center for Empowerment and Development of the Elderly and Seniors

(photo below, during the MeTA national forum 2014, held at Bayanihan Center, Unilab Complex, Pasig City)

SESSION 3: MULTISTAKEHOLDER COLLABORATION, HEALTH AND MEDICINES FOR THE FILIPINO PATIENT

8. Panel Discussion – Part 1 (Access to Medicines)

Moderator: Mr. Tomas Marcelo Luke G. Agana III,  Adviser, Philippine Chamber of  the Pharmaceutical Industry (PCPI)

(a) Drug Price Watch / Electronic Drug Price Monitoring System (EDPMS) / Drug Price Reference Index (DPRI)
by Mark Haasis, National Center for Pharmaceutical Access and Management (NCPAM), DOH

(b) Rational Use of Medicines (RUM) Framework / Antimicrobial Resistance (AMR) Policy,

by Dr. Anna Melissa S. Guerrero, Program Manager, NCPAM, DOH

(c) Combating SSFFC (substandard, spurious, falselylabeled, falsified, counterfeit) medical products / Coalition for Safe Medicines, 

by Ms. Maria Lourdes C. Santiago, RPh (invited), Director, Center for Drug Regulation and Research, Food and Drug Administration (FDA)

(d) Pharmaceutical Transparency Through Technology (PTTT) / LUNAS mobile app, 

by Dr. Bryan Albert Lim, Founding Partner, Health Sector Catalyst

(e) Tamang Serbisyo para sa Kalusugan ng Pamilya (TSeKaP) / Z Benefits 

by Dr. Rizza Majella L. Herrera,  Head, PCB/TSeKaP Team, Philippine Health Insurance Corporation (PhilHealth)

(f) Local government initiatives to address medicine needs of its constituents and the community 

by Hon. Gerardo V. Calderon (invited), Mayor, Municipality of Angono, Rizal

(g) Training Modules on Supply Chain Management (SCM) / Philippine Practical Standards for Pharmacists (PhilPSP)

by Mr. Roderick L. Salenga, NPO (EDM), WHO Country Office

Day 2, February 18

SESSION 4:  STAKEHOLDER PERSPECTIVES

10. Stakeholder Workshops

Moderator: Ms. Cecilia C. Sison,  Country Coordinator,  MeTA Philippines

Group Facilitators:

 Mr. Ralph Emerson P. Degollacion

 Dr. Irene F. Farinas

 Mr. Manuel Alexander Haasis

 Dr. Elenita Loida A. Pedrosa

 Ms. Karen A. Villanueva

SESSION 5:  SHARING STAKEHOLDER INSIGHTS

Invocation Ms. Maria Zenaida J. Averilla, Founder / CEO, Scleroderma Society of the Philippines

Reports on the Day 1 Stakeholder Workshops

11. SESSION 6: ACCOUNTABILITY,  FOLLOWING THE MONEY SPENT ON KEY HEALTH PROGRAMS

(a) Medicines Watch, by Dr. Elmer S. Soriano, MeTA / CHAT Project Consultant, Civika Institute

(b) Philhealth Watch, by Mr. Rene R. Raya, MeTA / CHAT Project Consultant, Action for Economic Reform

(c) Sin Tax Monitoring Tool, by Ms. Marian Theresia R. Valera, Consultant, HealthJustice Philippines

12. Lunch / Civil Society Meeting with the IMS

Panel Discussion

Moderator: Mr. Roderick L. Salenga,  NPO (EMD),  WHO Country Office

(a) Asst. Sec. Elmer G. Punzalan, MD (invited), Head, Office for Health Regulation, DOH

(b) Ruben John A. Basa, Senior Vice President, Health Finance Policy Group, PhilHealth

(c) Ms. Teofila E. Remotigue, CEO, National Pharmaceutical Foundation, Inc., Coalition for Health Advocacy and Transparency

SESSION 7:  SUSTAINABILITY, BUILDING ON THE GAINS AND MOVING FORWARD

13. Response of The Filipino Patient 

Mr. Josefino de Guzman, President, Psoriasis Philippines;

Ms. Maria Fatima G. Lorenzo, President, Philippine Alliance of Patient Organizations

Synthesis and Closing Remarks 

Mr. Roberto M. Pagdanganan, Chairman, MeTA Philippines

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See also:
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014 

MeTA 16: Day 1 of Conference 2014, February 11, 2014 

MeTA 17: CHAT General Assembly, March 2014, March 31, 2014 

MeTA 18: More Financial Independence, More Stakeholders Participation, December 11, 2014

ETHIKOS 2: Pharma Companies and Patients, April 01, 2014

MeTA 18: More Financial Independence, More Stakeholders Participation

The Medicines Transparency Alliance (MeTA) Philippines will be conducting meetings and fora next year related to health transparency and its own financial sustainability. It is a UK Department for International Development (DFID) funded project conducted in seven developing countries including the Philippines. Thus, while MeTA is classified as a non-government organization (NGO), technically it is a government-funded organization (GFO).

Despite this fact, MeTA-PH is providing the regular venue for multistakeholder discussions on medicines and healthcare in general in the Philippines. Below, in one of the big meetings of MeTA held in Makati, early July 2014.

The Department of Health (DOH) Advisory Council for the implementation of RA 9502 (Cheaper Medicines Act of 2008) seems to be dead, at least temporarily. Zero meeting this year.  There should have been about two meetings, like the  one in mid-July 2014, but in both cases, they were cancelled. And no reason/s is/are given why the meetings are cancelled. I suspected that  the July meeting was cancelled because the  DOH got busy with the Disbursement Acceleration Program (DAP) controversy where the DOH got P3+ billion of extra funding from that program. When DOH Under Secretary Mads Valera was still there, the agreement was a quarterly meeting. When she left the DOH, the meetings were also gone.

I think there is also zero meeting by the Congressional  Oversight Committee on RA 9502 this year, the legislators (House and Senate) perhaps just divided among  themselves the P10 M/year average budget of Congressional Oversight Committees. Another fiesta time for Congress.

  

So if DOH cannot provide the regular consultation and dialogue process, MeTA should fill that vacuum. And Yes, MeTA should go for a real civil society and NGO status, not largely GFO. The annual dues for all members, corporate, institutional and professional affiliates, individuals, should proceed and not sidelined. Government/multilateral money (UK-DFID, WHO, etc.) can help finance the overhead expenses but the regular fora and conferences should be internally generated. Many local pharma companies, innovator and generics, can co-sponsor certain events. Participants can also pay minimal registration fees, and so on.

Below, another MeTA meeting held in February 2014. Both photos I got from MeTA facebook page.

Past President of the Philippine Pharmaceutical Association (PPhA) Leonie Ocampo noted that medicines are not given due attention in protecting their integrity in the supply chain  Rather, quality (transport, storage, dispensation, etc.) is sometimes sacrifice because medicines are  used as a political tool. Thus, the need for a multistakeholder involvement to prevent their wastes, advance rational and responsible use of drugs. And the need for better system in the procurement, warehousing, distribution, and use of medicines.

Tonight over dinner, I talked to a friend whose wife is a cancer survivor. He shared that his wife's doctor told him that until about 10 years ago, the survival rate of his wife's cancer at stage 4 was only about four percent (ie, around 96 percent mortality). Now with new treatments, survival is more than 50 percent. Wow, in just 10 years! But her anti-cancer medicnes are expensive, something like P70,000 every three weeks for about one year. Good that they are both rich, they can afford it and recoup that money once the wife goes back to full time work. I think that in 10 years time, that P70k (DOF/BIR gets at least P8K of it in VAT alone) can go down significantly. This chart is true.

A stronger and more financially sustainable MeTA-PH is a good springboard for dynamic multi-sectoral discussions and dialogue for more stakeholders participation, if not consensus building. I am not hopeful of the Advisory Council now to continue big multi-stakeholder participation given the recent and on-going politics at the DOH.

In our book, “minimal government = maximum civil  society”. That is why civil society organizations (CSOs) should be as independent of government as much as possible. Civil society is about volunteerism while government is about coercion. One can  say that government is the “uncivil society” :-) Note that in government, things are  done by coercion, with fines, penalties and even  imprisonment for  violations, Thus, the drug price control  policy, the mandatory and forced discounts for all senior citizens including the rich and super-rich ones, are bad policies but they remain in force until now. And even if people are not happy with the 32 percent (max rate) mandatory withholding tax for fixed income earners, they are forced and coerced to send 1/3 of their monthly or annual  income to the government.

Dynamic and independent CSOs can point out certain mistakes of more government interventions and unnecessary regulations.

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See also:
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014 

MeTA 16: Day 1 of Conference 2014, February 11, 2014 

MeTA 17: CHAT General Assembly, March 2014, March 31, 2014

ETHIKOS 1: MeTA-PH, PCPI, PHAP and FDA on launching, March 30, 2014

ETHIKOS 2: Pharma Companies and Patients, April 01, 2014

Drug Price Control 40: CWF Wants Price Dictatorship for Lipitor

Last Wednesday, an email from James Auste (below), founder and Executive Director of Cancer Warriors Foundation (CWF) was forwarded by email by the Secretary General MeTA Philippines, Ms. Cecile Sison, to members of the Medicines Transparency Alliance (MeTA) PH, Coalition for Health Advocacy and Transparency (CHAT), ETHIKOS and Alternative Budget Initiative (ABI) Health cluster. I am a member of MeTA PH and CHAT so I saw it.

The email therefore was widely circulated to many stakeholders in the PH health sector – government, industry players, NGOs, academe. James is asking for  another round  of drug price dictatorship aka price control. Price dictatorship is the  subject  of my book in 2011, Health Choices and Responsibilities, and it is a policy that I will  always oppose.

James addressed his letter to the President/CEO of Pfizer, but it was distributed to various network in the  health sector, so  it is implicit that he also addressed it to us, hoping that other stakeholders in the health sector will support his call for a new round of drug price control, but targeted to only one medicine, Lipitor.

I posted these comments by email to members of CHAT and MeTA PH early today. Reposting it here.

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James  wrote,

(1) “SABI NG MGA BATA,HINDI KAMI HUMIHINGI NG AMING GAMOT PERO PARA SA AMING MGA LOLO AT LOLANA GUMAGAMIT NG LIPITOR!”

O, this  is new. The children cancer patients are now lobbying part time not to get cheaper cancer medicines for themselves,, but to get cheaper Lipitor for their grandparents. And soon maybe, they will also lobby for cheaper Norvasc for their parents, cheaper Augmentin for their older siblings and relatives?

(2) ANG ANNUAL SALES NG LI[PITOR AY 750MILLION PESOS! NUMBER 1 IN THE MARKET! AT NUMBER 1 PA ATA SA BUONG MUNDO!

Good data, but Pfizer themselves gave this data to James? Or IMS did, or someone who dislikes Pfizer and has access to industry data did?

(3) “PARA general health and well-being of every Filipino ( NA CORE VALUE RIN NG PFIZER) IBABA NATIN SA 14 PESOS ANG 10MG AT 17 PESOS ANG 2OMG!”

O, part 2 of price control. Part 1 was made in August 2009 under the administration of former President Arroyo.  Price control  is price dictatorship. Government regulators – the DOH and DTI in particular, backed up by the Office of the President, Congress, LGUs, etc. – would act as the price dictators. Those who will not obey the dictated price will be harassed and penalized.

Btway, it was former DOH Secretary Duque and DTI Secretary Favila who coined the Gloria Macapagal Arroyo Price (GMAP), aka Government-Mediated Access Price, an illegal term (not in RA 9502, not in the IRR) which until now  is being used, four years after GMA’s term has ended.

I am not exactly a great fan of Pfizer. I am more a fan of “boycott medicines”, innovator or generic, whenever possible and have healthy lifestyle instead. But I will  always be an enemy of government  dictatorship including price control, wage control, fare  control, rent  control, income control (via high income taxes).

The call for another round of drug price control or price dictatorship  is lousy James. Better focus your energy on lobbying for cheaper childhood cancer medicines. You are more effective there.

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DEAR SIR/MAM PRESIDENT/CEO OF PFIZER!

HI AT MABUHAY! I AM JAMES AUSTE A BRAIN CANCER WARRIOR! PATIENT ADVOCATE! FOUNDER! EXECUTIVE DIRECTOR OF THE CANCER WARRIORS FOUNDATION! SINCE JUNE 2000 WE HAVE SUPPORTED AT LEAST 1000 KIDS WITH  CANCER AND THEIR FAMILIES IN THEIR BATTLE FOR LIFE! RIGHT NOW WE HAVE 400 SCHOLARS UNDER OUR CARE FROM PAMPANGA TO DAVAO!

SABI NG MGA BATA,HINDI KAMI HUMIHINGI NG AMING GAMOT PERO PARA SA AMING MGA LOLO AT LOLANA GUMAGAMIT NG LIPITOR!

SABI RAW NI LOLA AT LOLA NIYA 34 PESOS ATA SA MERCURY! ANG 10MG! 39PESOS ANG 20MG! DAHIL SA MDRP(MAXIMUM DRUG RETAIL PROGRAM) NUNG 2009! ANG DATA NATIN  NA NAHANAP NAKITA AT NABASA NG ATING SENIOR WARRIORS

 ANG ANNUAL SALES NG LI[PITOR AY 750MILLION PESOS! NUMBER 1 IN THE MARKET! AT NUMBER 1 PA ATA SA BUONG MUNDO!

MAM SIR BAKA PASOK NA SA ATING CORE VALUE NA MAXIMIZE REVENUES AND MANAGE COSTS! ANG REVENUE NA ITO

PARA general health and well-being of every Filipino ( NA CORE VALUE RIN NG PFIZER) IBABA NATIN SA 14 PESOS ANG 10MG AT 17 PESOS ANG 2OMG!

BAKIT GANUN KABABA DAHIL SA MASIGASIG NA PANANALIKSIK NG ATING SENIOR WARRIORS MAY BAGO RAW TAYONG GAMOT NA TAWAG AY Rhea GALING DAW SA AMERIKA!

PERO SAME DRUGSTORE MAGBEBENTA--MERCURY DRUG STORE-NUMBER 1 SA PINAS

SAME MANUFACTURER--PFIZER

SAME ADDRESS--KM 1.9 ROAD 689, VEGA BAJA, PUERTO RICO USA

SAME PACKER-PFIZER MANUFACTURING DEUTSCHLAND GMBH, BETRIEBSSATTE, FREIBURG MOOSWALDALLEE1, FREIBURG, GERMANY

SAME IMPORTER-PFIZER,INC- 23RD FL, AYALA LIFE-FGU CENTER, 6811 AYALA AVENUE, MAKATI CITY

SAME SA SUKAT, KULAY, AT PAREHO PA ANG MARKING NA PO156

PAREHO LAHAT PERO ANG PANG PINAG KAIBA AY 20 PESOS SA 10MG! 60% CHEAPER NG LIPITOR! ANG 20MG 55% CHEAPER!

MALIIT SA INYO PERO MALAKI SA MGA MAY SAKIT NG PUSO NA ARAW ARAW ANG GAMIT NG GAMOT NA ITO

MALIIT SA INYO PERO MARAMING MATUTULONG SA ATING SENIORS AT MAY PANG JEEP PEDICAB, O MRT PAPUNTA SA MERCURY!

MALIIT SA INYO PERO MARAMING MABUBUHAY SA BENTE PESOS

SABI NG ATING SENIOR WARRIORS LIPITOR ANG GUSTO NAMIN KESA RHEA KASI BAKA

IBA ANG TAMA SA AMING MGA PUSO

IBA ANG  TAMA SA AMING MGA KATAWAN

IBA ANG AMING PATUTUTUNGUHAN

KAYA ANG AMING PANAWAGAN  SA PAMAHALAAN SIR MAM SANA I SUPPORT NIYO AY PAG ARALAN ANG SECTION 5 EO821 ".... MEDICINES,,, SHALL BE REVIEWED AFTER 3 -6 MONTHS BY THE DOH"KASI 5 YEARS NA PALA ANG MDRP! AT WALANG PANG NAG RE REQUEST NG REVIEW!

PANAHON NA PARA BIGYAN NG PANSIN ANG  ISA PANG HINAING(BUKOD SA CHILDHOOD CANCER) SA ATING LIPUNAN NA WALA PANG PUMAPANSIN ANG HINAING NG ATING MGA LOLO AT LOLA! NA KAILANGAN NG LIPITORFOR LIFE!

                                           KONTING SAKRIPISYO MARAMING MAGBEBENIPISYO!

THANK YOU FOR YOUR TIME!  WILL BE HOPING AND PRAYING FOR A POSITIVE RESPONSE!

INGAT GODBLESS!

JAMES AUSTE

BRAIN CANCER WARRIOR

PATIENT ADVOCATE

FOUNDER ONLY MEMBER OF CANCER WARRIORS SENIORS TEAM!SAMA NA!

**THIS WILL BE THE FIRST PROJECT OF THE CWF SENIORS TEAM!

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See also: 

Drug Price Control 36: Advisory Council, James Auste and China, July 12, 2013 

Drug Price Control 37: Four Years of the Policy, August 16, 2013 

Drug Price Control 38: Presentation at USC, Cebu, March 2010, March 01, 2014 

Drug Price Control 39: Presentation at USC, Cebu, March 2014, March 25, 2014

ETHIKOS 2: Pharma Companies and Patients, April 01, 2014

UHC 24: Corruption in Government Purchase of Medicines, April 02, 2014

UHC 24: Corruption in Government Purchase of Medicines

An old article by Rappler got circulated by some friends in fb. Portions of the paper said,

…Sharing his experience with Rappler, the 26-year-old doctor said he was shocked by the steep prices of purchased medicines and medical supply. He had requested for the drugs for his RHU some time in December 2012.

"Even test tube brushes, which cost around P10-P20 perhaps, cost P350! Gloves which cost P120-P150 pesos are priced P550 in that receipt. Amoxicillin syrup which costs P15-P20 is priced P115," he said in an interview. The receipt was dated Jan 13, 2013.

The system is simple, based on what the doctor deduced from his experience: the supplier and mayor "agree on a certain jacked-up price" where both get to have their share from the extra amount added on top of the medicine's real price.

"If I did the purchase myself and not thru the Bids and Awards Committee, the amount would just have been around P60,000-P80,000," he said, adding that it could have saved the municipality some P320,000….

The same doctor sees around 20 patients a day. As in Casuga's case, medicines are dispensed to residents at the Office of the Mayor and not at the rural health unit (RHU).

"All patients who need medicines as per my prescription have to go to his (mayor's) office to get the medicines themselves... Even this much jacked-up medicines are used as political tools," he said.

Casuga said this set-up affects the "continuity of care" delivered to the town residents.

I hope I can also see they are getting the right medicines. Those who dispense the drugs are waiters of the mayor with no health background..

Casuga narrated an instance when a patient came back to him with the wrong medicine and said “that's what they gave upstairs [in the mayor's office.]"

A mother with her 5-year-old suffering from pneumonia was also hesitant to go to the mayor's office to ask for the prescribed medicine, as she was not a voter….

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Another case of local government corruption. This largely explains why medicines constitute a big portion of government health spending, both national and local agencies. What could be a P2 million medicines procurement can become P5 million or P10 million or even higher. Then some sectors complain why "medicine prices are high... and thus government should intervene more in pricing." Very often we are talking about government failure and blame or call it as market failure.

In one MeTA-Philippines forum at the AIM in Makati last year, the DOH showed some tables, procurement of medicines by some government hospitals, DOH and LGUs owned. Same medicines from the same supplier, PharmaWealth (owned by former Cong. Ferjenel Biron) have different prices, the price range sometimes 10x among government hospitals.

Transparency, DOH itself is hiding this and other data. NCPAM presented it before MeTA, they said they will verify the numbers further, and that was the last news I or we heard from them. I have several friends at NCPAM, I think they are not allowed to release such data without clearance from the DOH Secretary or Undersecretary.

I remember also a few years back, the WB-funded survey done by ANSA-EAP, or of Ateneo School of Government, of medicines procurement by different government hospitals, from UP-PGH to AFP Medical Center to some DOH and LGU hospitals. Same medicines and prices range up to nearly 100x, with the AFP hospital having the highest procurement prices. The WB itself hide that data, then WB talks about transparency and "good governance". Double talk can happen anywhere.

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See also: 

UHC 16: Dialogue on UHC and Medicine Access, AIM July 25-26, July 24, 2013

UHC 20: Health Equality Will Never Happen, September 20, 2013 

UHC 21: The PGH, Manila City Government and Civil Society, December 10, 2013 

UHC 22: Shortage of Doctors in the Philippines, February 10, 2014 

UHC 23: Orthopedic Hospital Corporatization, Not Privatization, February 21, 2014 

Drug Price Control 35: DOH Procurement Price and Lobbying for Another Price Coercion, July 29, 2013 

Drug Price Control 39: Presentation at USC, Cebu, March 2014, March 25, 2014

MeTA 17: CHAT General Assembly, March 2014

Last March 14, 2014, the Coalition for Health Advocacy and Transparency (CHAT) held its General Assembly this year at Dolce Latte Restaurant, Quezon City. Minimal Government Thinkers is among the original charter members of CHAT when a Civil Society Mapping was held in January 2009 at Diamond Hotel in Manila, two days before the 3-days MeTA National Forum, same venue.

CHAT is an alliance of health-focused civil society organizations (CSOs), people's organizations and public policy research organizations or think tanks (including IBON Foundation and MG Thinkers) that works with the Medicines Transparency Alliance (MeTA) Philippines as its civil society partner. It is a big coalition as some member organizations are themselves alliances or coalitions of their own. Like AGAP (Ayos na Gamot sa Abot-kayang Presyo) and 3CPNet (Cut the Cost, Cut the Pain Network).

The first speaker was Dr. Virgie Ala, former DOH-NCPAM Director, and she gave a health situationer of the country. I came late that day and was lucky to catch perhaps the second half of her presentation. Second speaker was Atty. Paula "Pau" Tanqueing of AGAP and she discussed various activities that  CHAT and its member organizations have undertaken, 

Ms. Cecile Sison of Philippine HealthWatch Initiatives, also of MeTA Philippines, discussed the covenant of CHAT. Then nice lunch. 

It was a working lunch, participants were paired and we discussed and suggested steps the alliance can take to re-engage and strengthen its role and advocacies, facilitated by Dr. Elmer Soriano. I did not speak during the open foru, and I did not stay long, after lunch I headed to the airport to catch my flight for Cebu City. I was going to give a talk at the University of San Carlos (USC) the next day about government price control and mandatory discounts for medicines policies. See Drug Price Control 39: Presentation at USC, Cebu, March 2014.

Despite some disagreement on certain health policies with some key members of CHAT, I like the coalition. I am the "odd-man out" in most cases for advocating less government (but not zero government) intervention in many health policies, while majority of member-NGOs support more government involvement. Still, members learn to tolerate such divergence in ideas.

Photo credit: Ian Nuevo of MeTA Philippines Secretariat.

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See also:
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014 

MeTA 16: Day 1 of Conference 2014, February 11, 2014 

Drug Price Control 35: DOH Procurement Price and Lobbying for Another Price Coercion, June 29, 2013 

UHC 19: Health is a Right, Health is a Responsibility, September 19, 2013

ETHIKOS 1: MeTA-PH, PCPI, PHAP and FDA on launching

(Note: This is an expanded version of the paper that I wrote last Friday.)

Last Thursday night, the ETHIKOS (Ethics in Healthcare) Movement was launched at C3 Events Place in Greenhills, San Juan, Metro Manila. Many participants from different groups and sectors. Some quotes from some speakers that night.

All photos I got from the MeTA Philippines facebook page. Thanks Ian Nuevo.

1. Former Gov. Roberto “Obet” Pagdanganan, MeTA Philippines Chairman

Gov. Obet thanked the participants, particularly the organizations that formed movement – the Medicines Transparency Alliance (MeTA) Philippines, the Coalition for Health Advocacy and Transparency (CHAT), and the British Embassy’s Foreign and Commonwealth Office (FCO).

Then he introduced the Convenor Group of the ETHIKOS Movement: (1) Princess Nemenzo of WomanHealth, (2) Celia Carlos of the Drugstores Association of the Philippines (DSAP), (3) Girlie Lorenzo of Kythe Foundation, also of the Philippine alliance for Patient Organizations (PAPO); Tony Leachon of the Philippine College of Physicians (PCP), and himself.

He discussed what ETHIKOS is – a movement to encourage ethics in delivering healthcare to the patients, ethics in dealing with healthcare professionals  and other private players in the sector, ethics in government.

2. Atty. Dave Escalona, Philippine Chamber of Pharmaceutical Industry (PCPI) and United Laboratories

Dave said that the local pharma industry is supporting the Mexico City Principles (MCP) for voluntary codes of business ethics in the biopharmaceutical sector. He introduced a similar term, “Manila Principles” where the basis of such code of ethics are the Generics Act of 1998 and the Cheaper Medicines Law of 2008 (RA 9502), and the object of such ethics is the welfare of the patients.

Thus, the Manila Principles should consider TRIPS flexibilities as contained in RA 9502, avoid whenever possible prolonged data exclusivity, disallow frivolous patents, allow early working of soon-expiring patents of innovator drugs. He lamented that many local pharma companies are small and lesser known compared to big multinational pharma.

3. Teodoro “Ted” Padilla, Pharmaceutical and Healthcare Association of the Philippines (PHAP) Executive Director.

Ted narrated that in 1993, the association introduced and adopted a code of ethics called the PHAP Code of Practice. He quoted the late Doc Alberto “Quasi” Romualdez (a former DOH Secretary, founding chairman of MeTA PH) who said that “The most important achievement of PHAP now is that they have made ethical behaviour an import part of their commitment…”

He emphasized that no amount of health reform will be truly universal if people and players ignore the consequences of unethical behaviour. He also expressed support for the FDA to implement the MCP. Then he mentioned the important role of the innovator companies for endlessly producing new medicines which help save lives and improve the quality of life of Filipinos.

4. Kenneth “Ken” Hartigan Go, Food and Drug Administration (FDA) Director-General.

Doc Ken discussed certain FDA guidelines regarding senior government officials (SGOs) who make follow up calls at FDA. There are four possibilities where SGOs:

(a)     to inquire on behalf of his/her private sector associates, or determine the status of a rival company

(b)     to request earlier facilitationof application (expediting or jumping the queue

(c)     to demand aprovals even if the license or product registration is to be denied, or to demand a denial against a rival company, and

(d)     to reverse a regulatory decision.

My comments to some of these points in my next article about ETHIKOS..

MeTA 16: Day 1 of Conference 2014

The 2014 Medicines Transparency Alliance (MeTA) Philippines forum 2014 started today, here at the Bayanihan Center of Unilab Complex, Pasig City, Metro Manila. Attendance is big, 100+ people attending. I see many new faces here compared to past MeTA PH fora.

Below, they key speakers, from left: Former Bulacan Gov. Roberto "Obet" Pagdanganan, MeTA Philippines Chairman, gave the Opening Remarks. Dr. Tim Reed, Health Action International (HAI, Amsterdam, the International MeTA Secretariat). Dr. Deirdre Dimancesco of WHO in Geneva, and Dr. Francisco Tranquilino of the UP College of Medicine, also Chairman of the Ethics Committee, Philippine College of Physicians (PCP). He gave the Keynote Speech. 

In his brief speech, Dr. Tim Reed noted that "Multistakeholder engagement is clearly achieved in this forum" as the participants come from different sectors and agencies -- government, corporate and industry players, and civil society organization. 

Dr. Art Catli of the Pharmaceutical and Healthcare Association of the Philippines (PHAP) introduced Dr. Tranquilino. Said that the latter is a very popular, well-sought speaker, giving countless speeches here and abroad; that he is a "terror" teacher at UP; a workshorse, a researcher who has published dozens of academic articles, an ambassador of good will. 

Dr. Tranquilino disclosed his past and present engagement in the pharma industry, most of which were with the innovator companies. He started discussing "striking a balance" between innovation and government regulations. 

Medicines save lives, but developing new medicines now take 11-15 years out of 20 years total patent period. Many compounds that were originally discovered and were patented do NOT become medicines, if they do not pass the various clinical trials for safety, efficacy and other criteria. In the last decade, there was dying of pipelines of new revolutionary drugs, resulting in more mergers and consolidation of big pharma companies.  

The Mexico City Principles (MCP) for voluntary codes of ethics of businesses especially in biopharmaceutical sector was adopted by APEC member countries to help reduce corruption, bribery, and at the same time protect public health. 

The next session was on “Multistakeholder advocacy for adherence to the MCP”. The speakers were, from left: Tomas Marcelo "Beau" Agana, Past President of the Philippine Chamber of Pharmaceutical Industry (PCPI), the federation of domestic or national pharma manufacturers and drugstores; Teodoro "Ted" Padilla, Executive Director of PHAP; Atty. Florina Agtarap of the Department of Justice (DOJ) Office of Competition; Dr. C. Diza of the Food and Drugs Administration (FDA); and Dr. Melissa Guerrero of DOH National Center for Pharmaceutical Access and Management (NCPAM). Moderator was Yolanda Ibarle, MeTA Project Director.

Dr. Guerrero said that there are ethical issues in government processes, they have to address those upfront. She hopes that MeTA Philippines and its multi-stakeholder partners can help the DOH urge the local government units (LGUs) abide by DOH rules on the selection of suppliers, truthful procurement of medicines.

Dr. Diza said that FDA will hopefully develop guidelines or an Administrative Order (AO) specifying what needs to be followed from the MCP.

Beau Agana of PCPI talked about their draft Code of Ethics, an APEC workshop for voluntary code of ethics in 2012. Relationship building becomes problematic in pharmaceutical marketing under information asymmetry condition, he said. Code of Ethics will temper maximizing personal interest of doctors and other 3rd party decision makers, and prioritize patients' interests. He added that  patients have started to turn to pharmacists, not their doctors, in their medicines purchase. 

Ted Padilla of PHAP said that they have their Code of Ethics early, that penalties are imposed on  violating member firms and personel. Monetary sanction, a fine, is more effective in tightening behavior. Transparency is essential, there is no substitute to being transparent and honest, and medical decisions must always be made with the best interest of the patients, he added.

During the open forum, some concerns were raised regarding the procurement process and practices of LGUs, not only of medicines but also medical supplies, equipment and facilities.

My main concern in being involved in topics like this is how civil society and voluntary organizations will have greater role in promoting transparency and competition in the economy. Very often, self-regulation by industry players themselves are better than government regulations, restrictions and politics. Manufacturers, wholesalers and retailers who sell only good quality products because they have concern for their customers, or because they are scared that they will be scandalized if their products are discovered to be unsafe and/or ineffective. 

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See also:
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013 
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014

MeTA 15: Forum 2014 on Healthcare Ethics and Transparency

The Medicines Transparency Alliance (MeTA) Philippines will hold its annual forum this year with a timely theme, Transparency and Ethics in Healthcare. Things that are expected of various players and professionals in the health sector -- pharma companies, drugstores and pharmacies, hospitals and clinics, doctors and pharmacists, etc. And patients and the public too, we should have our own "code of ethics".

Here is the provisional program as of January 25. I removed the time slots to focus on topics and speakers. Lunch time is indicated, so readers can see which ones are morning and afternoon sessions.

The Mexico City Principles (MCP) is a set of ethical conduct adopted by APEC member countries for the pharmaceutical sub-sector several years ago, held in Mexico City. As shown in the program above, there will be a high-level multistakeholder panel discussion on the adoption of MCP in the Philippines and a call for voluntary codes of business ethics from different sectors and players. 

Day 2 morning, there will be foreign speakers who will talk about global developments in regulating medicines promotion (Tim Reed, Executive Director, HAI Global), regional trends in ensuring transparency in pharmaceuticals policy (Klara Tisocki, Team Leader-Essential Medicines and Health Technology, WPRO), and the way forward for the Good Governance for Medicines (GGM) Program (Deirdre Dimancesco, WHO Geneva). 

In the afternoon, two special topics that have great impact on healthcare in the Philippines - health promotion and sustainable funding, will be discussed by speakers from  HealthJustice  and the AIM.

Participants will come from various sectors and represent all stakeholders in the dialogue about health, medicines and transparency.  They will have opportunities throughout the forum to participate in open forums, ask questions and articulate their positions and perspectives through the stakeholder workshop.

They will be given links to all forum documents, including studies and researches cited in the presentations, as well as reference materials on transparency, ethics in health, addressing corruption in health and related topics.

Meanwhile, I have changed the title of this thread from "Health Transprency" to simply "MeTA" as this thread is mainly about MeTA fora and activities.
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See also:
Health Transparency 11: MeTA Philippines and Multistakeholder Process, September 19, 2012 
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013 
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 

Drug Price Control 36: Advisory Council, James Auste and China, July 12, 2013 
FDA 6: Business and Modernization Plan, July 17, 2013

FDA 6: Business and Modernization Plan

The Food and Drugs Administration is technically a very powerful government agency because it can say Yes or No to the introduction of new medicines and vaccines, innovator or generic; new food supplements and drinks; new skin whiteners, boobs enlargers, soap and shampoo, toothpaste and lotions, medicines and vitamins for animals and fishes, medical and dental devices, and many other things.

So a vigilant and technically capable FDA can block the introduction of those “magic” tea/coffee or herbal drinks that can “prevent or cure all types of cancer, all types of cardiovascular diseases…” and penalize violators, those who introduced those “magical, cure all” products without FDA permission and make big money fooling the public and putting the health of some patients in danger .

Yesterday, I attended a presentation by the FDA headed by its Director, Dr. Kenneth Hartigan-Go, held at the Asian Institute of Management (AIM) in Makati. The event was sponsored by the Medicines Transparency Alliance (MeTA) Philippines, in coordination with the Stephen Zuellig Center for Asian Business Transformation.

He presented this paper, but in powerpoint form. This blog post by the way, is 7 pages long including photos and illustrations, so enjoy.

This paper is straightforward and frank. For one, it explicitly admits that the old FDA set was corrupt and fomented corruption. Hats off to the new FDA guys, led by Dr. Ken, for this admission. Undesirable acts can be corrected if the mistake is explicitly recognized in the first place. The paper said,

Why did the old FDA setup foment corruption? The old FDA is a web of misinformation, dead-ends and inconsistency. Companies who seek to be authorized encounter an ill-defined and dated body of regulations. With a bureaucratic process and indefinite deadlines, application turnaround times are known to exceed two years from lodging in of application to release of authorization. This alone translates to losses for companies who cannot operate and are forced to deal with overhead costs without revenues. In their efforts to avoid dealing with the FDA, middlemen (i.e. freelance regulation consultants) have risen to exploit the market of frustrated industry people taking advantage of the lack of transparency, inconsistency with regards to requirements and evaluation process, and the plain distance of the FDA from company offices in central NCR. While not all middlemen are unscrupulous, the agency’s tarnished reputation has been used as an excuse for the middlemen’s own shortcomings. Unfortunately, the old FDA cannot refute the allegations for it is all true – the process is corrupt, the system is sclerotic and the leadership wanting.

These are the four core reforms that the FDA is banking on. And each major heading has many parts or action items.

On (1) Improving the evaluation process, I was very happy to see those “paperless application”, “electronic payment”, “online application guidelines”, “automated renewal of licenses”. Yes, show the paper trails, remove or minimize the face to face interaction between the regulator and those regulated. Transparency alone reduces the itch for corruption and actual commission of corrupt practices.

On (2) Enhancing regulatory inspection, FDA is getting serious on having rule of law, it is one big good news. Make the inspectors more technologically sophisticated and accountable, more bold, prepared and even armed, and have a strong legal team, prosecute violators.

In a brief open forum after Doc Ken’s presentation, I spoke and lauded this new move. FDA is saying to potential violators that “Go ahead, sell and distribute fake or substandard medicines, adulterated foods, etc. and face our lawyers.” The threat of being legally prosecuted when found violating the rules is a stronger deterrence than pre-business inspections.

Health Transparency 14: IMS-CHAT Meeting

The Coalition for Health Advocacy and Transparency (CHAT) is the umbrella organization of health and research NGOs and think tanks that gathered during the Medicines Transparency Alliance (MeTA)-sponsored CSOs Mapping in January 2009. Many of the health NGOs there are coalition themselves of other community and sectoral organizations. CHAT is affiliated with MeTA Philippines and is considered the civil society arm or partner of the latter.

Last week, April 12, 2013, the International MeTA Secretariat (IMS) had a half day meeting with NGO leaders that composed CHAT. About one-half of the organizations within CHAT were represented, good attendance. The IMS were composed of Tim Reed, Executive Director of Health Action International (HAI), Ms. Renee Vasbiner, Administrative Coordinator of MeTA Secretariat, also of HAI, and Ms. Deirdre Dimancesco. Technical Officer of Medicines, Access and Rational Use, Department of Essential Medicines and Health Products, WHO Geneva HQ. 

CHAT was led by former Bulacan Gov. Roberto "Obet" Pagdanganan and Cecile Sison of HealthWatch. Gov. Obet and Cecile are also the Chairman and Secretary General of MeTA Philippines, respectively. The big coalitions within CHAT are the Ayos na Gamot sa Abot-kayang Presyo (AGAP, or good medicines at affordable price), Cut the Cost Cut the Pain Network (3CPNet) and Medical Action Group (MAG), Woman Health, Health Action Information Network (HAIN) and COPAP, the organization of senior citizens. Everyone was given the floor to introduce themselves and the NGOs that they represent, what they do and who are their main constituency.

I introduced Minimal Government Thinkers, Inc. as an independent think tank advocating free market, less government, personal responsibility and rule of law. Our constituency are individuals and groups here and abroad, who read about any free market reforms in the country and in this case, in healthcare policies.

So we have some big NGOs and coalition of NGOs themselves that played very active roles in the enactment of the Cheaper Medicines Law of 2008 or RA 9502, groups and individuals that supported major amendments to the Intellectual Property Code (IPC) of the Philippines like institutionalizing compulsory licensing (CL) of certain patented medicines. And MG Thinkers that advocate respecting IPR as much as possible. So CHAT is a loose coalition and members recognize that.

One advantage, members say, is that there is wide range of discourse and policy options to choose when we discuss certain issues, so they benefit from such diversity of opinions and observations. But one disadvantage is that it is difficult to come up with a consensus stand or statement on some issues, like I advocate less government while many want more government involvement in healthcare. Or possible disagreement in the possible TRIPS Plus provision in the soon to be negotiated EU-Philippines Free Trade Agreement (FTA).

At this point, I spoke. I said that MG Thinkers' involvement in CHAT was a bit interesting. Many if not all of the groups that attended the CSO Mapping workshop were known groups in the IPR debate before RA 9502 was enacted into law. And I was not with them as I was writing many articles defending IPR and my articles were published in many countries like the US, UK, India, Malaysia, Singapore, Philippines, and even in some Arab countries, published in Arabic, courtesy of MG's international free market network.

That when Ms. Klara Tisocki, then of the EU and now with WHO Western Pacific Regional Office (WPRO) invited me to attend the CSO Mapping workshop in January 2009, she has read my name and my articles, and she must have wanted diversity, not monotony, of ideas among CSOs. Klara played a key role in the MeTA formation in the Philippines. And so CHAT was designed to have diversity, to allow some looseness in the umbrella organization. 

On the issue of IPR and medicines, Tim Reed of HAI showed a youtube video produced by HAI Global, about the "EU zoombies" as a result of EU insistence that stronger IPR protection on patented medicines be adopted in various EU negotiations for FTA with different countries.

Then some organization matters were discussed, like key activities for CHAT.

Last April 08, Monday or four days before the meeting with IMS, CHAT also held an internal meeting about issues to discuss. We devise a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis of CHAT. The matrix was shown and discussed by Atty. Paula "Pau" Tanguieng of AGAP. Good presentation, Pau.

It was a good meeting with the IMS, food was nice too.

I keep writing about these meetings and events as many CHAT and MeTA members tell me that although they may not agree with many of my ideas, they still look forward to my analysis, stories and photos. Just one proof that diversity is preferable to monotony. :-)

Cheers guys.
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See also:
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012
Health Transparency 11: MeTA Philippines and Multistakeholder Process, September 19, 2012 
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013