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

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

Health Transparency 13: MeTA International Visit to Manila

Last Wednesday, April 10, 2013, the International MeTA Secretariat (IMS) visited Manila to meet up with Medicines Transparency Alliance (MeTA) Philippines Council officers and members, and attend the MeTA Discussion Series on PhilHealth's primary care benefit (PCB) new packages. I am one of the members, that's why I was there.

The three visitors from IMS were Dr. Tim Reed, Executive Director, Health Action International (HAI), Ms. Renee Vasbiner, Administrative Coordinator - MeTA Secretariat, HAI, and Ms. Deirdre Dimancesco. Technical Officer, Medicines, Access and Rational Use, Department of Essential Medicines and Health Products, WHO HQ. 

Tim Reed here speaking during the meeting with MeTA Philippines members, headed by Chairman Roberto "Obet" Pagdanganan (former Bulacan Governor, former PITC President) and Ms. Cecile Sison, MeTA Secretary General. 

The morning meeting was mainly on internal matters, like updates on both the international and Philippines offices of MeTA. There was a brief discussion though on pharmacovigilance, presented by Dr. Mariano Lopez. It is a joint project by the Philippine College of Physicians (PCP), MeTA Philippines, and the Rotary Club of Manila, in coordination with the FDA. Gov. Obet is also the club President this rotary year 2012-13.

The plan is to conduct random drug tests from selected drugstores and hospital pharmacies in terms of drug quality and safety. Any anomaly that will be detected, FDA can quickly act. The results of the FDA laboratory test will be (1) shared among the hospital therapeutics committees to improve drug procurement on the basis of good quality drugs and/or; (2)announced to the general public with considerations for possible litigations and/or; (3)left to FDA’s discretion and regulation.

For me this is a good initiative. Civil society organizations like PCP, MeTA and some Rotary Clubs can and should initiate this kind of projects to further protect patients. One participant narrated that they conducted a similar pharmacovigilance survey in the past, and they encountered difficulty getting the support and cooperation of some government hospitals, especially those run by the LGUs. For instance, they discovered that in a provincial hospital in Bohol, an IV supplied to the hospital was improperly packaged in a mineral water bottle (!).