Lifestyle Diseases 21: NCDs Alarmism vs. Rising Lifespan

From the WHO website, this update on NCDs is shown:

Noncommunicable diseases

Fact sheet
Updated March 2013

Key facts

•  Noncommunicable diseases (NCDs) kill more than 36 million people each year.
•  Nearly 80% of NCD deaths - 29 million - occur in low- and middle-income countries.
•  More than nine million of all deaths attributed to NCDs occur before the age of 60; 90% of these "premature" deaths occurred in low- and middle-income countries.
•  Cardiovascular diseases account for most NCD deaths, or 17.3 million people annually, followed by cancers (7.6 million), respiratory diseases (4.2 million), and diabetes (1.3 million¹).
• These four groups of diseases account for around 80% of all NCD deaths.
• They share four risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.

The alarm bells about NCDs have been sounded by the WHO for several years now. The message is something like "Let us reduce deaths from NCDs, pour more public money into the problem."

So the Department of Health (DOH), PhilHealth and local governments have been pouring more money on reducing or preventing diseases and death from NCDs. PhilHealth for instance reported of Rising Claims for NCD. If PhilHealth will raise further spending for NCDs, the reserve fund can  evaporate soon, or PhilHealth will ask for higher monthly premium from members, especially those employed in the formal sector. Why?

People with NCDs are sort of "patients forever". Unlike treating infectious diseases like dengue or malaria, once the disease inside a patient's body is killed, the patient gets well and will not need medication or hospitalization for the next few years or ever decades. For patients with NCDs though, they have to visit a physician monthly or even more frequently. For instance, a hypertension patient, according to a physician or pharmacist who spoke during the MeTA forum at the AIM last April said will need a combination of 2-3 medicines per day.

The WHO I think is pulling health alarmism here, the same way they alarmed the world with the dangers of HIV/AIDS in the 90s. It turned out that the warning was exaggerated because if their projections were true, the population of Africa by now should be less than its population in the 90s, but this did not happen.

If an average Filipino dies of stroke or cancer or hypertension or other NCDs at age 75 or 80 or older, is it a problem?

WHO and DOH say Yes, because about 2/3 of deaths in the Philippines and worldwide now are due to NCDs.

For me it is not a problem. We will all die. If not of NCDs, we can die of infectious diseases or accidents or some crime.

The average lifespan of Filipinos now is 70 years old; 67 for men, 73 for women, so average of 70. If a person dies at 75 or older due to NCDs, there should be NO cause for alarm except alarmism itself. Ala "man-made warming" alarmism.

Even if death from NCDs rise from 66 to 80 percent, or even 90 percent of all deaths, but life expectancy has increased from 70 to 80 or 90 years old, then it is not a problem.

Perhaps the WHO and various government health agencies want people to die at 100 or 200 years old on average, so they play God to keep prolonging average life span? Which means governments will tax-tax-tax the rest of us further so it will have more money to play and act like a God.

I think governments should focus more on reducing morbidity and mortality from infectious and communicable diseases. Give more vaccines to children for instance to limit deaths from preventable diseases.

For adult NCDs, governments should step back and allow people to buy private health insurance, to augment existing government health insurance programs. As the WHO pointed out above, NCDs are closely related with unhealthy lifestyle, like people who over-eat, over-sit, over-drink and over-smoke. I know of some people who are fat and irritable, they don't even want to admit that they are fat, and yet all they want to do is sit down and eat, rest and sleep or watch TV for hours.

It will be a criminal act of the government to over-tax people who take care of their body more responsibly, so that government will have more money to subsidize the deteriorating health of this type of people. NCDs are essentially lifestyle related, with a minor factor due to genetics.

Meanwhile, Reiner Gloor of PHAP made a good discussion about NCDs in his article last week, below.
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http://www.bworldonline.com/weekender/content.php?id=70310

Posted on 05:16 PM, May 16, 2013

Medicine Cabinet -- Reiner W. Gloor

The global burden of NCDs

(First of a series)

EACH DAY, about 100,000 people around the world die from major non-communicable diseases (NCDs) namely cardiovascular disease, diabetes, asthma, chronic respiratory infections and cancers.

An estimated 36 million people succumb to these diseases each year, or some two out of three deaths globally. About nine million of these were people under the age of 60.

Many of the losses occur in low and middle-income nations to include the Philippines which had cardiovascular diseases as the number one cause of death among Filipinos, according to the Department of Health (DoH). With the sheer number of lives lost, major NCDs are no doubt the world’s biggest killer diseases.

NCDs place a heavy burden on individuals, families, and communities and public health systems that often rely on out-of-pocket payments.

The World Health Organization (WHO) said that out-of-pocket payments could cause households to incur catastrophic expenditures, which in turn push them into poverty. A WHO technical report, "Designing Health Financing Systems to Reduce Catastrophic Diseases," said that when people have to pay fees or co-payments for health care, the amount can be so high in relation to income that it results in "financial catastrophe" for the individual or the household.

Drug Innovation 12: H7N9, SARS, Bird Flu and Vaccines

Today, I read three stories of the SARS-like virus that has affected Saudi Arabia, and bird flu virus in  China.

Some 15 people have already died in Saudi Arabia alone, from SARS-like coronavirus. There are some panic especially in the eastern part of the country. See the news here.

A follow up article, also today, New SARS-like virus can probably pass person-to-person. In one family alone in Eastern Saudi Arabia, the father died and the three children got sick too with similar symptoms, two are in the ICU already. 

Then the news in China with 35 deaths already from a strain of H7N9 bird flu virus, out of 130 reported cases. News story here. All these three stories are from interaksyon.com.

Diseases indeed mutate. They are not dead or static, they are living and evolving micro organisms that want to expand themselves as fast as possible and claim more victims.

And that is why medical treatment, medicines and other aspects of healthcare must continue to evolve too. And some government policies that can discourage such continued innovation should be discouraged instead.

Reiner Gloor of PHAP has two articles last month on vaccines and preventive healthcare, especially in protecting children. Posting them below.

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http://www.bworldonline.com/content.php?section=Weekender&title=R&D-supports-Decade-of-Vaccines&id=68873

Posted on April 18, 2013 05:51:09 PM

Medicine Cabinet -- Reiner W. Gloor

R&D supports Decade of Vaccines

PREVENTING diseases remains the most important health strategy that eliminates the burden of social and financial risks associated with curative or palliative care. Vaccination has saved about 2.5 million lives each year, making it one of the most important and cost-effective public health innovations.

The 65th World Health Assembly (WHA) acknowledged, “vaccination is, and should be recognized as, a core component of the human right to health and an individual, community and governmental responsibility.” The WHA added that as an integral part of a comprehensive package for disease prevention and control, vaccines and immunization are investment in the future of a country.

In the Philippines, President Benigno Aquino himself recognized immunization as part of his priority universal health care agenda. He said that to win the war on poverty, the country must also turn its attention to public health.

“And, as we focus on the health of our country, economy, government, the overall health of all Filipinos also remains a top priority. We want our people to be empowered individuals capable of standing on their own two feet -- strong, healthy, and skilled men and women who can take advantage of the opportunities that life affords them,” he said during the launch of the an immunization program targeting 700,000 poor children.

Introduced at the World Economic Forum in Davos, Switzerland in January 2010, the global health community made a call for a Decade of Vaccines (DoV) which vision is a world in which all individuals enjoy lives free from vaccine-preventable diseases. The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are, or where they live.

The Bill & Melinda Gates Foundation pledged $10 billion for the research, development and delivery of vaccines for the world’s poorest countries. The Foundation projected that about 7.6 million children under five will be saved from life-threatening diseases by increasing vaccines coverage in poor countries by 90%.

Drug Innovation 10: Cancer, H7N9 and Government

Various types of cancer is among the leading causes of mortality (death) and morbidity (sickness) in the Philippines and around the world. It is a non-infectious or non-communicable disease (NCD) that is caused more by genetics and/or lifestyle. For instance, tobacco-related lung cancer, and alcohol-related liver cancer, are the top two killers among cancer for men in the Philippines, according to the article by Reiner Gloor of PHAP below.

A friend in the free market movement here, Joshua Lipana, died this week at a young age of 21, due to a rare and aggressive cancer (T-Cell Lymphoblastic Lymphoma). I mentioned a few times here that my own elder brother died of prostate cancer, and his wife (my sis in law) died of colon cancer, several years ago.

As medical science improves, discovery of more rare diseases that used to be lumped or identified with other diseases is becoming easier. But treating them is another matter and will not be easy. Reiner however, says "researchers are working on more than 800 innovative medicines that are either undergoing clinical trials or regulatory review. Due to these developments, cancer can now be better managed and even beaten."

Then early this month or late last month, we read a new strain of bird flu, the A(H7N9) that the WHO called as "one of the most lethal so far". Not as lethal perhaps as the A(H1N1) strain that killed more than 300 people middle of the last decade.

These H1 and H7 strains, unlike cancer or hypertension, are infectious or communicable diseases. Infection usually starts from chicken and other birds, to humans. So the immediate action is isolation of the patient from the rest of population to prevent further infection, while treating the patient.

Government has an important role in controlling infectious diseases, like detecting and isolating infected people who travel from one country to another through airport medical screening. But government, I believe, has little role in controlling NCDs as these are usually difficult, complicated and expensive to treat diseases, requiring more personal responsibility (remind people that over-eating, over-drinking, over-smoking is not good for their health). If government will put more resources on controlling NCDs, it will further worsen already high public indebtedness, which will have negative effect on other public spending over the long term, like spending to maintain peace and order and ensure a credible justice system.

And of course, governments should not make the business and scientific environment antagonistic to drug innovation. They should not politicize innovation and reward rent-seeking via IPR-busting policies.

Below are two articles by Reiner of PHAP, about cancer and H7N9.. Reposting from BusinessWorld. Enjoy.
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http://www.bworldonline.com/weekender/content.php?id=46080

Posted on 06:05 PM, February 02, 2012 

Medicine Cabinet -- By Reiner W. Gloor

Beating cancer

Major non-communicable diseases were among the important health issues that gained the attention of world leaders in 2010. In a United Nations summit, political leaders agreed to a plan of action that sought to address alarming trends involving four major non-communicable diseases (NCD) that have developed to become the world’s biggest killers.


The four major NCDs are cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers that have altogether prematurely claimed the lives of 38 million people, representing about 63% of the total global deaths in 2008. Studies indicate that the major NCDs are affecting the developing world and lower-income populations hardest.

This is particularly true for cancer, which accounted for about 7.6 million global deaths in 2008. By 2030, cancer deaths are also expected to soar to 11 million worldwide. The World Health Organization (WHO) also disclosed that about 70% of all cancer deaths occur in low- and middle-income countries.

Cancer can affect any part of the body. A defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis which is the major cause of death from cancer, the WHO said.

Locally, the Department of Health recently led the observance of the National Cancer Awareness Week in a campaign to boost public consciousness on the disease. Such an awareness drive is important specifically for the Philippine Society of Medical Oncology (PSMO), which considers information as a keystone to preventing and treating cancer.

The need to raise awareness on cancer has become more evident with the GLOBOCAN Project report, which estimated that there had been more than 51,000 cancer deaths in the Philippines in 2010.

The GLOBOCAN Project, which provides global incidence of, mortality and prevalence from major types of cancer, reported that leading new cancer deaths among Filipinos in 2010 include those involving the lung, liver, breast, colon/rectum, leukemia stomach, cervix uteri, brain, prostate and pharynx.

Among Filipino men, lung and liver cancer comprise 43% of all new cancer deaths. These top two killer cancers affected more than 12,000 Filipino men.

Drug Innovation 9: Treating Lympho Leukemia and HIV/AIDS

I like this story from the NYT although this was published half year ago. A dedicated scientist at Washington University studying human gnome and lympoblastic leukemia has developed the same cancer that he is personally studying. and subsequently weakened him, awaiting death. His colleagues in the research team set aside many things they were doing and focused only on one thing -- find out what is that disease, how it developed, and how it can be killed. Below is portion of that news report.

http://www.nytimes.com/2012/07/08/health/in-gene-sequencing-treatment-for-leukemia-glimpses-of-the-future.html?_r=0

...Dr. Ley’s team tried a type of analysis that they had never done before. They fully sequenced the genes of both his cancer cells and healthy cells for comparison, and at the same time analyzed his RNA, a close chemical cousin to DNA, for clues to what his genes were doing.

The researchers on the project put other work aside for weeks, running one of the university’s 26 sequencing machines and supercomputer around the clock. And they found a culprit — a normal gene that was in overdrive, churning out huge amounts of a protein that appeared to be spurring the cancer’s growth.

Even better, there was a promising new drug that might shut down the malfunctioning gene — a drug that had been tested and approved only for advanced kidney cancer. Dr. Wartman became the first person ever to take it for leukemia.

And now, against all odds, his cancer is in remission and has been since last fall.

While no one can say that Dr. Wartman is cured, after facing certain death last fall, he is alive and doing well. Dr. Wartman is a pioneer in a new approach to stopping cancer. What is important, medical researchers say, is the genes that drive a cancer, not the tissue or organ — liver or brain, bone marrow, blood or colon — where the cancer originates.

One woman’s breast cancer may have different genetic drivers from another woman’s and, in fact, may have more in common with prostate cancer in a man or another patient’s lung cancer. 
Under this new approach, researchers expect that treatment will be tailored to an individual tumor’s mutations, with drugs, eventually, that hit several key aberrant genes at once. The cocktails of medicines would be analogous to H.I.V. treatment, which uses several different drugs at once to strike the virus in a number of critical areas....
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A combination of genetics science and pharmaceutical science is key to treating certain diseases, especially new or emerging ones. Which brings us to the importance of more medicine innovation and how it can be encouraged, or at least how now to impede it via more politics and more government intervention, like dishonoring intellectual property rights (IPR) like drug patents.

Below is another story on medicine innovation to treat HIV/AIDS. The good news is that more and more medicines and vaccines from more drug manufacturers are coming on stream. Since they are different from each other, both off patent and still patented, patients and health professionals can expect competition among them, both in efficacy and prices. Generic producers can help tighten the competition once newly invented drugs and vaccines have become off patent. The important thing is that someone or some firms must invent those new drugs first, assume all the risks and high cost of R&D. Once they are proven to be useful and safe, generic producers can come in later to produce new brands of the same useful molecules against HIV/AIDS.

More science, more innovation, and less politics. Public health and life expectancy are expected to be improving through time.
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http://www.bworldonline.com/content.php?section=14&title=R&D-to-combat-HIV/AIDS&id=62556

R&D to combat HIV/AIDS

Posted on December 06, 2012 06:44:33 PM

Medicine Cabinet -- Reiner Gloor

“GETTING TO ZERO” new HIV infections and zero deaths from AIDS-related illnesses may sound difficult to achieve but significant progress in the prevention and treatment of HIV/AIDS is providing hope for patients and their families.

In time for World AIDS Day on Dec. 1, biopharmaceutical companies announced that around 73 medicines and vaccines are in the pipeline for the treatment and prevention of HIV.

The Pharmaceutical Research Manufacturers and Associations (PhRMA) reported that these are centered on improving treatment regimens, more effective therapies and promising new preventative vaccines.

Between 2011-2015, the World AIDS Days will have the theme of “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS related deaths.” This highlights the need for greater access to treatment for all.

Nearly 40 medicines have been approved to treat HIV/AIDS in the past 30 years. There have also been advances in the diagnosis of the disease, allowing for earlier treatment and care.

The World Health Organization (WHO) attributed many of the gains to life-saving antiretrovirals that reduce the amount of virus in the blood so that patients has increased chances of staying healthy and have less risk of passing the virus on to others.

HIV can be suppressed by combination antiretroviral therapy (ART) consisting of three or more antiretroviral (ARV) drugs. While ART does not cure HIV infection, it controls viral replication and allows an individual’s immune system to strengthen and regain the capacity to fight off infections (www.who.int).

Even with the progress, there remain great opportunities to intensify research for better treatment and prevention of the disease. Until now, there is no cure for HIV/AIDS.

The WHO said that HIV has claimed more than 25 million lives in the past three decades. Globally, about 34 million people are living with HIV in 2011.

In the Philippines, there were 295 new HIV positive individuals confirmed by the STD/AIDS Cooperative Central Laboratory in October this year, or 48% higher compared to the same period last year. In January to October this year, there were 892 more new HIV cases, 48% more compared to the same period in 2011. The significant increase was observed starting July 2011 onwards, mostly breaching 200 or even 300 new cases per month.

The Department of Health-National Epidemiology Center (DoH-NEC) reported 2,761 HIV cases, of which 148 were reported AIDS cases, from January to October this year. Around 748 young people (15 to 24), and four children below 15 were part of this total national figure.

It added that from 1984 to 2012, there were 11,125 HIV cases in the Philippines with 1,130 AIDS cases. More than 350 people in the country have died from AIDS since 1984.

In support of the Millennium Development Goal 6 to stop or reverse the incidence of HIV/AIDS by 2015, the government through PhilHealth, has rolled out an outpatient package to increase patient access to treatment and education. First implemented in 2010, the Out-Patient HIV/AIDS Treatment (OHAT) Package aims to provide patients access to ART and the benefit was later expanded to include treatment for tuberculosis.

In the battle against HIV/AIDS, PhRMA reported that medicines in development include a gene therapy that uses genetic material to remove disease-causing aspects of the virus; a transdermal vaccine that helps suppress virus replication and destroys HIV-infected cells; and a first-in-class medicine intended to prevent the HIV virus from breaking through the cell membrane.

Many of the medicines are in Phase I and II of the long, expensive and complex drug discovery process. Phase I of the clinical trial involves a small group of people, usually between 20 and 80 healthy adult volunteers, to evaluate a drug’s initial safety and tolerability profile, determine a safe dosage range, and identify potential side effects. Phase II is the stage in which the drug is given to volunteer patients, usually between 100 and 300, to see if it is effective, identify an optimal dose, and to further evaluate its short-term safety.

When a candidate drug reaches Phase III, it is given to a larger, more diverse patient population, often between 1,000 and 3,000 patients or more, to generate statistically significant evidence to confirm its safety and effectiveness. They are the longest studies, and usually take place in multiple sites around the world (For the full report, go to www.phrma.org).

Biopharmaceutical companies have expressed commitment to continue research to prevent or treat HIV/AIDS. Policies and collaborations that encourage innovation and healthcare access are critical to this mission

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See also: 

Drug Innovation 5: The US PCAST Report on Propelling Drug Discovery, October 20, 2012

Drug Innovation 6: Dealing with Drug-Resistant TB, November 30, 2012
Drug Innovation 7: IFPMA, Superbugs and Tropical Diseases, December 04, 2012
Drug Innovation 8: Treating Men's Cancer, December 20, 2012

Drug Innovation 8: Treating Men's Cancer

My elder brother died of prostate C a few years ago, then my mother's first cousin in Cebu. Nationwide, prostate C I think is among the killer diseases for men. My HMO or private health insurance told me once to undergo a test of prostate C as it might be hereditary in our family but I have done it yet. 

Today, there is a news report from interaksyon.com on men's cancer, that by 2027, the Cancer Research UK foresees that one-half of our gender worldwide will have one form of cancer developing in our body. Not a scary thought for me actually because I will be in the mid 60s by that time. But then any cancer cell can multiply anytime in one's body as one ages and as one's immune system gets weaker.

Here's portion of that news report:

LONDON - A man's lifetime risk of developing cancer is set to reach one in two by 2027, according to new figures released by the Cancer Research UK on Wednesday.

This prediction means that within 15 years 50 men out of every 100 are likely to be diagnosed with cancer at some point in their lifetime as opposed to 44 out of every 100 in 2010.

The research body predicted that women's lifetime cancer risk is also increasing and is predicted to rise from 40 to 44 out of every 100 women by 2027.

But it is still optimistic about cancer surviving thanks to better techniques.

"Cancer survival has doubled in the last 40 years thanks to research developing better techniques to detect the disease and improved treatments to increase survival," it said.

"So while the risk of being diagnosed with cancer is rising, the overall chance of surviving it is improving."

It held that age is the biggest risk factor for cancer and the increase in risk is largely due to more people living longer. As our lifespan increases more people will reach an age when they are more likely to be diagnosed with cancer....

Thanks to modern medicine and the life sciences. Human understanding of various diseases keeps improving. Understanding of a disease, how it starts and how it expands, is a prerequisite to developing a treatment, both in lifestyle change and in medication.

In an article this year in BusinessWorld, Medicines in Development for Cancer, Reiner Gloor of PHAP wrote,

Meanwhile, more than 30% of cancer could be prevented through healthy lifestyle, which includes non-tobacco use, a healthy diet, being physically active and moderate use of alcohol. Furthermore, the chances of beating cancer become higher each day with early detection, vaccination and a steady stream of innovative medicines.

The solid commitment to patients and the advancement of science are at the core of the sustained progress in the fight against cancer. Biopharmaceutical researchers are now developing 981 medicines for all cancer types. Many are high-tech weapons to fight the disease, while some involve innovative research into using existing medicines in new ways, announced the Pharmaceutical Research Manufacturers of America (PhRMA).

In its 2012 Report on Medicines in Development for Cancer, PhRMA revealed that several cutting-edge approaches are being employed in search for better treatments for cancer.

The report said that medicines in the pipeline include a drug that interferes with the metabolism of cancer cells by depriving them of the energy provided by glucose. Also in development is a medicine for acute myeloid leukemia (AML) that inhibits cancer cells with a mutation found in about a third of AML sufferers. The list likewise includes a therapy that uses nanotechnology to target the delivery of medicines to cancer cells, potentially overcoming some limitations of existing treatments, said the report.

In a bid to address major types of cancer, the report said that there are 121 medicines in development for lung, lymphoma (117), breast (111), colorectal (66), ovarian (63), and stomach (23) cancers among others. In addition, there are 94 medicines and vaccines in the pipeline for prostate cancer. Meanwhile, "orphan drugs" are being developed for rare cancer types that affect less than 200,000 people.

Researchers are also working on treatments for cancer types that affect children. There are medicines in development for brain cancer affecting the young for neuroblastoma, glioma, and glioblastoma.

Many of these candidate drugs have entered clinical trial, or the phase in research and development (R&D) that perform human testing involving up to 5,000 individuals to establish the safety and efficacy of the medicines.

Meanwhile, some medicines in development for leukemia have been granted fast track status or are considered orphan drugs.

Healthy lifestyle like avoiding excessive use of alcohol, tobacco, fatty food and drinks, having a more active rather than sedentary life, is still the best and cheapest defence in preventive healthcare. But should cancer cells or other diseases come in, the use of modern medicines should be tapped whenever possible. 

It is important that public policies and government regulations that tend to inhibit or discourage more medicine innovation, more innovative healthcare schemes under a competitive environment, should be avoided. There is money in healthcare, the same way that there is money in education and housing, in food manufacturing, hotels and restaurants, IT and telecomms, and there is even huge money in politics and excessive government spending. Different players in the pharmaceutical, biotechnology, molecular biology and other life sciences will come in when their risk-taking and health innovation will be properly rewarded, not demonized by politics and heavy government regulations like IPR busting and price control.

CSOs and State 16: The Integrity Initiative

Government is force and coercion. It is an institution created by men and women mainly to protect themselves, their families and friends, their properties, from bullies among the population. It was a good "social contract" where people surrender a portion of their individual freedom to the government, like the "freedom to revenge" and physically attack those who committed physical aggression against them and their properties. Government and its courts, justice and police system is supposed to do that job, to penalize those who disrespect other people's right to peaceful living.

But governments since then have been expanding and getting larger to monster institutions. Rule of law was supplanted by rule of men, and some bullies, thieves and other criminals have captured government power so they can become bigger bullies protected by the government itself and its armed forces. Corruption and plunder is among the byproducts of this situation. Another is large-scale human rights violations, imprisonment if not murder of those who protest dictatorial and despotic governments.

In order to minimize or avoid this situation, government itself created certain offices and mechanisms for self-policing and self-regulation. Thus, the separation of power among the Executive, Legislative and Judiciary branches of government, fiscal and oversight function of opposition political parties, and creation of anti-corruption Commissions, Bureaus or Task Forces within the government. But these offices did not do their function in many countries like the Philippines and thus, corruption has become the norm rather than the exception in many countries and governments. 

Non-government mechanisms and initiatives have sprang up recently in many countries like the Philippines, to help fight government corruption. The approach is different than the usual anti-corruption campaigns. Instead of pressuring government to limit corruption from within, the move is to pressure private enterprises and individuals to stop bribery with government offices and even to report corrupt and extortion practices by certain government officials.

This is the thrust of a new group called the Integrity Initiative (II). I have attended a talk by II Chairman, Ramon del Rosario of the Phinma Group of Companies last month. It was held at the Asian Institute of Management (AIM) in Makati and was mainly sponsored by the Pharmaceutical and Healthcare Association of the Philippines (PHAP) and its partner companies, NGOs and government offices like the DOH.. I liked his talk, short (15 minutes or less), extemporaneous and direct. He said that from an initial 100 company-signatories in 2010, II has grown to more than 1,500 signatory companies. They are now piloting two procedures. One is an Integrity Assessment where companies self-declare certain practices to avoid or minimize corruption with government, and two, an Integrity Validation to be done by a third party and check if those self declaration by a signatory company are correct or not.

During the open forum, I spoke and praised this initiative as truly civil society. It's a unilateral action by the private enterprises and groups themselves to start cleaning up their own ranks first, then demand that government should clean its ranks too. This will be a good branding for company-signatories and have obeyed the processes of II. Thus, II-affiliated companies can "brag" or openly declare that they are doing their businesses in transparent manner and comply with certain government regulations. This can be considered as a trademark by which other companies (suppliers and buyers) and ordinary consumers can hold on and expect that what those companies say are indeed true. A pressure from the outside by a united group of companies from different sectors or fields of business can exert substantial change in government.

I also suggested that while there are industry associations in each sector or industry, some of those associations do not have their own code of ethics and self-regulation mechanisms to avoid unethical marketing and advertising of their products and services and hence, cheat on their consumers. So II can possibly create committees to represent the different sectors and industries that can exert if not impose a code of ethics for member companies in each committee. 

I cited a story of an anesthesiologist friend who complained that they caught one local pharma who sold a counterfeit or substandard anesthesia to one hospital. An anesthesia, if in good standard and effective, is supposed to take effect within minutes to a patient. So for a patient to undergo surgery, he is supposed to feel numbed and be asleep within minutes before the knife will slice his/her tummy or other body parts. But the patient was wide awake, did not get numbed, and it is impossible to do the surgery otherwise the patient will be shouting in deep pain. So the surgeons and anesthesiologists have to scamper for a new set of anesthesia before the surgery can proceed. Surgery done. After that, they reported the incident to the FDA through a very confidential letter, and the pharma company later knew of such letter complaint, meaning they have a "mole" within the FDA and threatened to sue the complaining physicians. 

There were other comments from the audience like those from Leonie Ocampo of the Philippine Pharmacists Association (PPhA). Later, Doc Virgie Ala, the director of DOH-NCPAM, came to represent DOH Assistant Secretary Madz Valera who was supposed to give a talk too in that event, but was not able to come due to a sudden Senate Committee meeting that she has to attend. Doc Virgie expressed support for such civil society initiative like the II, as it would be easier for government offices to reduce corruption if there is such initiative from the private sector.

Civil society organizations (CSOs) and State, not just market and state, is a good initiative to limit government power and coercion. CSOs should be independent of government whenever possible, and not just extension of government like what many NGOs, media and academic people are doing. CSOs should be independent of government funding too, in order to ensure such organizational and philosophical independent from the state.

Meanwhile, PHAP Executive Director Reiner Gloor wrote about that event, I just saw it recently, paper elow. Photos here, he's rightmost. Doc Virgie Ala is to my left. Cecile Sison and former Gov. Obet Pagdanganan of MeTA Philippines, Leonie Ocampo to my right. Lower photos, Mon del Rosario of II and Phinma, and Doc Virgie Ala of DOH-NCPAM.

http://www.bworldonline.com/weekender/content.php?id=62191

The Integrity Pledge

Posted on 05:40 PM, November 29, 2012

Medicine Cabinet -- Reiner W. Gloor

IN 2003, world leaders adopted the United Nations Convention Against Corruption and designated Dec. 9 of each year as International Anti-Corruption Day in a bid to promote a culture that values ethical behavior.

Believing that corruption undermines social progress and results in inequality, the Aquino Administration adopted a platform of government that embraces integrity in public leadership. Early this month, President Benigno S. C. Aquino III. issued Proclamation 506 declaring Dec. 9 as National Anti-Corruption Day. In the proclamation he signed, the President said that corruption undermines the institutions and values of democracy and ethical values as well as jeopardizes sustainable development and the rule of law.

The drive to promote integrity has also been undertaken by the private sector recognizing that the government cannot do it alone. In response to the government’s campaign on good governance, the Makati Business Club (MBC), together with several other organizations, launched the Integrity Initiative (II), a multi-sectoral campaign that seeks to ultimately eradicate the corruption that has worsened poverty and stunted “the development of a competitive business environment that operates on a level playing field.”

Drug Innovation 7: IFPMA, Superbugs and Tropical Diseases

People's lifestyle and communities evolve and continuously change. Their expectations, patience or impatience for more modern lifestyle, including more modern treatment in case they get sick, also evolve and changes. That is how modern medical science, pharmaceutical R&D, diagnostic tests and other aspects of the healthcare industry evolve.

I am reposting below three nice articles by the Executive Director of the Pharmaceutical and Healthcare Association of the Philippines (PHAP), Mr. Reiner Gloor. These are about the role of drug innovation and how to better encourage it, not demonize it. These appeared in his weekly column in BusinessWorld.

Protecting intellectual property rights (IPR) like drug patents is an important policy measure by governments to encourage innovation. Policy reversals like promoting compulsory licensing (CL) and other variants of IPR confiscation can only discourage innovation. After spending 10 to 14 years in various clinical trials and drugs R&D, and some $1 B or more per candidate drug molecule, it is not wise for governments to simply coerce the innovator companies to give away those efforts to other companies which did not spend equal amount of time and money to develop more revolutionary and more disease-killer medicines.

I have argued it over and over in this blog and other papers, that the main function of government is to promulgate the rule of law, protect private property rights, and the citizens' liberty, freedom of expression and freedom from aggression by bullies. Protecting IPR is consistent with this government role.

The three papers are entitled "Impact of innovation", "Protecting innovation", and "Encouraging innovation". Enjoy reading.

(1) Impact of innovation

Posted on 05:03 PM, November 08, 2012

Medicine Cabinet -- Reiner W. Gloor

http://www.bworldonline.com/weekender/content.php?id=61108

THERE was a time when infectious diseases such as pneumonia, typhoid fever and tuberculosis ravaged people around the world with no medicines available to treat or prevent them.

Alexander Fleming’s discovery of penicillin and subsequent research yielded new antibiotics that continue to protect the people from simple to complex infections. Since the 1920s, scientists also had their eyes on prevention, management and even cure for non-communicable diseases. Now, thousands of medicines have been produced to treat or prevent diseases, thanks to pharmaceutical innovation.

During the biennial conference of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) in Geneva last week, the global research-based medicines industry called for a shared commitment to promote global health through the promotion of further innovation.

These medical innovations, along with other health interventions, have, after all, helped in beating polio on a global scale, and prevented measles, mumps, rubella and other ailments.

IFPMA President Dr. John Lechleiter said that in the past decade alone, vaccines for measles, polio, and diphtheria-tentanus-pertusis have saved the lives of an estimated 21.2 million children under the age of five each year.

He added that between 2000 and 2006, immunization campaigns reduced the number of deaths caused by measles by 68% worldwide and 91% in Africa. Furthermore, immunizations provided to nearly 300 million children in 72 developing countries have saved over five million lives. Reports also showed that global infant mortality fell from 77 deaths per 1,000 births to 62 or a reduction of 20% between 2000 and 2009.

Innovations in medicine have also helped increase cancer survival rates, and dramatically reduce deaths due to HIV/AIDS.

Biopharmaceutical research is likewise being focused on non-communicable diseases such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers that have grown to become the world’s biggest killers.

The biopharmaceutical sector has similarly invested heavily on understanding so-called rare diseases or those which affect fewer than 200,000 people. A deeper look at an individual’s genetic make-up is putting personalized medicine in the forefront of today’s innovation so that detection, treatment and prevention of the disease will be more tailored to the needs of each patient (For more information on personalized medicine, go to www.innovation.org.)

People are also living longer due to medical innovations. In illustrating this, a child born in 1955 had an average life expectancy at birth of only 48 years. In 2000, a child could expect to live 66 years. Life expectancy will increase to 73 years in 2025, it is said. Dr. Lechleiter commented that developing countries are seeing the most rapid gains.

Professor Frank Lichtenberg of Columbia University disclosed “new medicines accounted for 40% of the increase in life expectancy during the 1980s and 1990s in 52 developed and developing countries.”

Apart from the impact to life and health, biopharmaceutical innovations also resulted in economic gains by way of years of productive work, economic value added, consumer spending, and taxes paid.

No less than the World Health Organization (WHO) said that a nation needs a healthy population to achieve economic development. In fact, the 2001 report by the WHO Commission on Macroeconomics and Health stated that “health is a creator and pre-requisite of development.” It emphasized that increasing the coverage of health services and a small number of critical interventions to include the world’s poor could “save millions of lives, reduce poverty, spur economic development, and promote global security.”

The IFPMA Assembly also pointed out that there is strong evidence that innovative medicines are the most cost-effective part of health care. In another study, Mr. Lichtenberg found that for every $1 spent on new medicines for cardiovascular diseases in Organization for Economic Cooperation and Development (OECD) countries, close to $4 were saved in hospitalization and other healthcare costs.

More than economic gains are the social impact of medical innovations on patients who may be our children, siblings, parents and friends.

These days, a diagnosis of a disease does not necessarily mean an end to ties with families and friends.

These gains and the processes that these innovations go through must not be taken for granted. As Mr. Lechleiter said, we must build upon and not rest upon the contributions of the past. For despite our tremendous progress, much more remains to be done.

Socialized Healthcare 10: Peru Doctors' Strike, Health Financing

Last week, thousands of doctors in Peru decided to end their more than one month strike, aside from tens of thousands of public school teachers, all demanding higher wages from the government. Here are two stories, 

http://www.bbc.co.uk/news/world-latin-america-20000475

Peru hospital managers' 'mass walkout' over medics' strike

http://www.bbc.co.uk/news/world-latin-america-20019983

Peru doctors 'to suspend strike over pay'

The shows the big problem if healthcare is heavily nationalized or monopolized by the government. When this happens, even if the strike is only for one day -- five weeks in the recent case of Peru -- the most affected are the poor, not the rich, not the government officials, not the politicians and legislators.

The healthcare model in the Philippines is different. There are:

1. DOH doctors (ie, under the DOH-attached hospitals)

2. other national government doctors (eg UP PGH, AFP hospital, Veterans hospital, PNP hospital, etc)

3. local government doctors (Ospital ng Makati, Ospital ng Manila, Ospital ng Muntinlupa, Ospital ng Pasig, etc.)

4. private doctors in private hospitals

5. semi-private hospitals;
6. doctors in each clinic in big companies, offices, schools and universities 
7. Others.

So If the DOH hospitals will have problem with their financial condition, the other hospitals and their doctors are not directly affected and hence, patients can go to these alternative hospitals.

It is universal healthcare (UHC) -- not government monopolization of HC, not drug price control -- that will provide health insurance to the poor. And UHC need not mean government monopolization or nationalization of HC. The important thing is that EVERYONE should have a health insurance card, whether via PhilHealth or LGUs or HMOs or NGOs/charities.

We need more diversity in HC providers, not less. Hence, not monopolization or nationalization of HC.

Meanwhile, here's a related article from Reiner Gloor of PHAP in his weekly column in BusinessWorld. It covers some old and new proposals how to expand  "Health Financing" in the Philippines, like making PhilHealth contribution be based on income and not a fixed amount.

Personally, I am not in favor of this proposal. First, it will further expand PhilHealth towards monopolization and nationalization of HC. Second, those who have large income but do not declare such -- many businessmen, professionals, criminals (both public and private), etc., will contribute little or nothing, and we fixed income earners will subsidize them?

Then there are the personnel and consultants of foreign aid, multilateral and bilateral agencies (UN, WB, IMF, ADB, USAID, JICA, EC, etc.) who are not covered by the mandatory withholding tax on their monthly personal income. Many of them do not declare their income, or declare at highly understated amount.  We fixed income earners from the private sector will subsidize them as well, even if their average salaries are several times larger than ours, tax-free?

http://www.bworldonline.com/content.php?section=Weekender&title=Health-financing&id=60249

Health financing

Posted on October 18, 2012 06:01:50 PM

Medicine Cabinet -- Reiner Gloor

EVEN WITH the robust economic growth in the Asia Pacific region, the World Health Organization (WHO) observed that people suffer financial catastrophe and are pushed to impoverishment because they have to pay for their own health care. In-fact, out-of-pocket payments push 100 million people into poverty worldwide every year because they have to pay for health services directly.

The Philippine health care system is not exempt from high out-of-pocket expenditure and its impact on health and economic outcomes.

The Family Income and Expenditure Survey disclosed that of the P100 spent for healthcare, P54 is paid directly out of the pocket of a Filipino patient. In relation to this, a Social Weather Stations Survey in 2010 revealed that respondents would pay using his own money, would solicit funds or even borrow money just to pay for health services.

But for the poor, they forgo health services to give way to other household priorities. They are the poor who have been identified by the National Housing Targeting System as belonging to the 5.2 million families who live below the poverty line. They are also those who spend two thirds of their income on food alone followed by shelter and transportation.

Dr. Ramon Paterno of the National Institutes of Health at the University of the Philippines, raises the point that people should not go bankrupt just because they are sick. He calls to attention the high proportion of health expenses that patients spend “out of their own pockets” -- amounting to 54% when the recommended rate is 20% to 30%.

The WHO said that the difficult health decision of either getting sick or getting poorer reflects “insufficient health spending by many countries in the region, limited prepayment mechanisms and safety nets, and an overreliance on out-of-pocket expenditures to finance the costs of health care.”

Developing financing strategies to help fund health and achieve universal coverage where people will have equal access to health services is one of the objectives of the government’s universal health care or Kalusugan Pangkalahatan (KP) agenda.

The WHO said that “health financing is concerned with how financial resources are generated, allocated and used in health systems.” Health financing focuses on how to move closer to universal coverage by raising sufficient funds for health; overcoming financial barriers that exclude many poor from accessing health services; or providing an equitable and efficient mix of health services.

As part of the Department of Health-led Secretary’s Cup, issues about health financing are being brought to light this month. The importance of this discourse is underscored by the health outcomes in the Philippines that continue to show gaps in health care between the rich and the poor.

One of the issues to be discussed is the proposal for PhilHealth premiums to be based on capacity to pay. One of the principles of social health insurance system is solidarity where one’s contribution is based on his ability to pay. In this scheme, the rich contributes more, while the poorest of the poor are subsidized completely.

In the present system, members with incomes of P30,000 and up pay a maximum of P750 monthly contribution. If the salary cap would be removed, those earning more will pay more than the current P750 monthly contribution.

Another proposal for consideration is that all Filipinos should be considered covered by PhilHealth by virtue of citizenship. If we shift to a tax-based system, people born before and after the policy is implemented must be covered. It could likewise extend to long-term residents who may be contributing premiums and paying taxes.

The primary goal of universal health care is to provide universal coverage to all Filipinos. On the other hand, discussions are needed if membership to PhilHealth would be made automatic. Some say that the move would encourage non-compliance with payments. Others argue on the basis of fairness in relation to formal employees who will then have to shoulder the costs of health care even for those who choose not to contribute.

Another issue for discussion is PhilHealth’s allocation for mass-based health prevention interventions. Health is seen as a continuum from promotive, preventive, curative, and rehabilitative care. There have been calls to move beyond the “curative” framework of health and include all four in a comprehensive health care plan. If this is so, should PhilHealth use its capital on preventive and promotive care? On the other hand, some cite concerns that PhilHealth may overextend itself.

Other questions correspond to the three dimensions of universal health care coverage such as “Who gets covered?” “What proportion of costs get covered?” and “Which services are covered?” Answering these questions means weighing the costs and benefits, identifying what the country really needs, and examining whether the population is truly “covered.”

For more information, log on to www.phap.org.ph, www.phapcares.org.ph, or joingwww.facebook.com/people/Pharma-Phap/. E-mail the author at reiner.gloor@gmail.com.
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See also:

Socialized Healthcare 5: Alterrnative Views on Universal Healthcare, May 23, 2012

Socialized Healthcare 6: Student Debates, Charity Beds and UHC, August 22, 2012

Socialized Healthcare 7: Degnan and Wagner on ICIUM and UHC, September 04, 2012

Socialized Healthcare 8: Anita Wagner on UHC and Medicines, September 05, 2012

Socialized Healthcare 9: Grassroots Consultation, Insurance for Catastrophic Diseases, October 15, 2012