Stem Cell 2: Comments from My Physician Friends

After posting in my facebook status the PhilStar article re DOH Sec. Ona’s proposal that PhilHealth will soon cover stem cell treatment (SCT), several physician friends commented, below. The images I got from the web, I just added them here.

(1) From Doc Ethel:

It infuriates me Nonoy. Patients should not be made to undergo treatment that has not been proven to be safe and effective. And to pay for that is nothing less than unethical, bordering on malpractice. –

(2) From Doc Tony:

Soon every doctor will buy ADI stem machine with rebates and referral system will be in place creating a huge pyramid scam - medical tourism type concept. Why would past PMA leaders band together and risk their image ( ???$? ) and engage the doh secretary. This is to lend credibility to the PSSCM grand plan. FDA has been used too.

Philhealth will be used here. After August 31 deadline, SCT will go big time. With skin regeneration given FDA approval based on FDA new set of guidelines, our kasam Bahay s have plans of having SCT ahead of us.

Philhealth money will be squandered for SCT rather than for building hospitals in the country side , salaries of healthcare professionals, research, PGH renovation, improvement of Fabella hospital, Jose Reyes Hosp, renovation of the dilapidated FDA office in Alabang the only eye sore in posh Alabang area. The stem cell centers in manila will be magnet for more tourists - it's fun in the Philippines. Great plan.

(3) From Doc Jed:

Noy, it seems that the article merely shows that the Secretary is friendly to local stem cell therapy practitioners and that specific supplier of stem cell activator equipment.

Having stem cell therapy covered by Philhealth cannot be done unless it is of proven efficacy for treatment. Our present coverage at thus time is even focused on therapeutic and not on preventive healthcare.

(4) From Doc Donn:

Sec Ona did not say na standard of care ang stem cell. he said that sct is innovative therapy. kaya ung about philhealth, it will happen decades from now when sct is already accepted as standard of care. Until that happens, philhealth will not cover it. the sct issue is being muddled by bogus claims but we must also recognize that there are scts that show promise for certain indications. Still, scts are innovative therapies rather than standard of care. 

(5) From Doc Tony:

Donm. I have respect for sec Ike. But kindly advise him to extricate from PSSCM. He's being used and people will never stop speculating about the motive. I am getting frustrated seeing sin tax gains for Philhealth will go to unproven treatment. I have gone around the country and I have been receiving a lot gory stories about stem cell practice. We don't want this to happen to our healthcare.

(6) From Doc Jed:

Nonoy, I think the preventive aspects would better be addressed by other agencies of the national and local governments. PHILHEALTH being an insurance organization merely provides a form of health care financing. It bases it's health related expenses on statistics and claims management experiences.

I agree that scientific collaborative effort is necessary and such is undertaken in the private sector. Sadly, more often than not, there are always, though subtle, commercial undertones. Not that the commerce aspect is evil in itself, but to cite a quote, "temper their greed".

(7) From Doc Meo:

This is what happens when a clinician with limited administrative and executive experience becomes DOH secretary. It seems to me that Dr. Ona is still having a hard time dissociating himself from his practice. I fully understand his excitement over the progress in stem cell research. I myself am also very enthusiastic about its possibilities. However, Sec. Ona should refrain from making irresponsible statements. He must always keep in mind that he represents a national office. As such, he must be clear if a statement is his personal opinion or an official stand. For example, in the statement, "“Our dream is that when this type of therapy already has a standard of care, its cost will definitely go down. By then, hopefully, (PhilHealth) can offer it already” who exactly was he referring to with the pronoun "OUR"?

Stem Cell 1: PhilHealth to Cover SCT?

I was following the stem cell treatment (SCT) controversy in the Philippines recently.  The Philippine Medical Association (PMA) and the Philippine Society of Stem Cell Medicine (PSSCM), both headed by Dr. Leo Olarte, vs the 21 other specialized medical societies. The former group says stem cell treatment can cure many diseases, the latter camp says it is not true, that stem cell is proven only for bone marrow transplant and blood-related cancer, I think, and that stem cell in other diseases are still under clinical trials.

But one problem came up when DOH Secretary Enrique Ona has generally sided with the PMA-PSSCM camp and even castigated the 21 medical societies for questioning the latter. Sec. Ona is an Honorary Chairman of PSSCM.

Today, I posted this news story from the Philppine Star and posted in the MeTA Philippines email loop. The images I got from the web, I just added them here.

http://m.philstar.com/314191/show/9e9e9bca3e86ccb9a19ca1f3e38608c9/

By Mayen Jaymalin
 MANILA, Philippines - Ordinary people may eventually have the chance to undergo expensive stem cell therapy.  

Health Secretary Enrique Ona said the Department of Heath (DOH) is looking at the possibility of including stem cell therapy in the benefit packages of the Philippine Health Insurance Corp. (PhilHealth) if the medical sector accepted it as a standard care.  

“Our dream is that when this type of therapy already has a standard of care, its cost will definitely go down. By then, hopefully, (PhilHealth) can offer it already,” Ona said.            

He expressed belief that stem cell therapy has the potential to cure diseases such as cancer, autism, diabetes, stroke, liver disease, spinal cord injury, Alzheimer’s disease and Parkinson’s disease....

Stem cell treatment soon to be covered by PhilHealth? Even if it's still under clinical trials for many diseases? And such treatment is not cheap, many practitioners there charging 6 digits, even 7 digits for their rich patients.

If this will push through, ubusan ng pera yan. What's next, PhilHealth will raise the annual premium of members because funds are running out fast? 

If we want UHC, government, the DOH and LGUs in particular, should focus on primary healthcare, in fighting communicable and infectious diseases, and childhood diseases. If people want stem cell treatment and risk their lives and money for the promise of miracle, let them spend their own money, why drag along pooled fund, especially that people are forced, coerced and arm-twisted to contribute to that fund by law?

A lot of distortions in healthcare and other social issues are often initiated by the government itself.

I just hope that such PhilHealth plan will be junked. Or they want another public clamor against it, ala anti-pork barrel robbery movement?

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Three members of the Council commented:

(a) From Leonie Ocampo of PPhA:

How sad of our DOH to be supporting an initiative and/or treatment not proven by clinical trails yet, more so planning to even put this into the Philhealth benefit package. 

Philippines with its limited resources must FOCUS in the MUST DOs in health care delivery. A lot of problems from procurement, handling and storage, distribution, prescribing, dispensing, administration and monitoring of patients are still into a lot of problems and need government attention to manage and control with the right structure and processes; then here is the department tasks to put all of these in place going to something not proven yet . . wow, I could imagine how much of the people's money will be wasted again. 

Yes, I agree with you Noy, FOCUS should also be given first and foremost on primary health care . . . right structure, right processes, right people and the right resources identified and provided. Let's stop talk, talk and talk but let us start to act in the right direction, sa tuwid na daan. You know what I mean.

(b) From Doc K

Dear all, Doh did not say at anytime that phic will cover stem cell.  Sec Ona has not sided with any groups. Pls do not believe all newspaper reports. Ask why these misleading news are surfacing over the last month.

(c) From Doc Delen:

Dear Nonoy,

Very well said!!!  I totally agree with you!  Really, the priorities of this government is something that we should question.  They are not looking at the needs of the vast majority of the Filipino which can be easily addressed if we put our money on public health and primary health services.  Primary health care is an approach that is not being espoused by the DOH when in fact PHC continues to be the backbone of good health strategies.  Secretary Ona, whose experience is very hospital based, prioritizes tertiary care and hospital centered care which is more expensive.  Certainly, if the government's budget for health is directly given to primary care services, improving the local health center facilities and making health care, including medicines, more available and accessible, then we do not have to have Philhealth that still screens what can be supported or not.  People will now patronize the health centers and exercise their right to health.  This will improve their health seeking behavior and  know that they can avail of services immediately.  They need not wait for their condition to worsen, which is what is currently happening, necessitating a tertiary care consult.  Then, eventually, we can have more healthy people who can now be more productive and contribute more to the economy of the country (but of course there should also be concomitant changes in the economic and political spheres as in providing decent and justly paid jobs, humane housing conditions, good nutrition, good education, etc).

It is appalling that Secretary Ona can think of stem cell therapy first to be included in a Philhealth package before he thinks of improving our basic health care services.  Stem cell therapy is very new and still under study and we should not deceive the people and worse, make money from them as indeed this is a very expensive intervention.  And to use our people's money for this is truly something we should not allow!

Thanks Nonoy for your very good insights on this issue.

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See also:

UHC 18: DOH Budget, Healthcare Deregulation and PharmaWealth, August 08, 2013 

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

Rule of Law 21: Fake Stem Cell Therapy and Fake Drugs

* This is my article today in thelobbyist.biz.
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The recent stem cell scandal in the Philippines is another proof that many government agencies are getting busy with so many functions and expectations, spreading their resources thinly, and become distracted if not blinded in implementing what should be their primary mandate.

The Department of Health (DOH) and the Food and Drugs Administration (FDA) are busy with various concerns including those that are better left to the private sector and civil society. And that is how fake – or at least unlicensed and unregistered -- health professionals and medical practices, fake or substandard medicines, untruthful ads on other health products and food supplements, are able to proliferate.

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These are products and services that can be fatal to patients, and both the DOH and FDA seem to be weak on this. Concerns like monitoring and implementing politics-driven policies like drug price control, penalizing small drugstores that cannot upload the electronic drug price monitoring system (EDPMS), can distract them from more important function of going after those fakes.

The old controversy on stem cell therapy was once again highlighted when the Chairman of the Dangerous Drugs Board (DDB), Antonio “Bebot” Villar, went public to complain that after undergoing the treatment to improve his condition – weak body, pain in the bones – the opposite happened. He suffered more difficulty in walking after such treatment.

The stem cell "therapy" was (a) done by foreign physicians (German and Thai) assisted by two Thai nurses, and (b) venue was not a health facility but a hotel, Edsa Shangrila Hotel, done last June 9, 2012. He paid Euros 16,000 for that treatment that produced nothing or even worsened his condition.

Foreign physicians – and many other professionals – cannot practice in the Philippines because of the ban provided in the Philippine constitution. This is one ugly aspect of our charter that needs to be amended and removed. That is why those foreign or non-accredited physicians are doing their practices inside hotels or mountain resorts or spas, where they can hardly be noticed by some government regulatory agencies.

I attended the media briefing by the Philippine Medical Assocaition (PMA) at Rembrandt Hotel last Thursday morning, hosted by the Liga ng mga Brodkasters ng Pilipinas Inc. (LBPI). PMA President, Dr. Leo Olarte said that such  treatment is generally safe if (a) done by accredited physicians, and (b) stem cells should come only from humans, from the patient him/herself especially, and NOT from animals, plants, fetus or embryos of dead babies. He suggested that perhaps what those foreign physicians may have given DDB Chairman Villar was just dextrose or ordinary water.

Mr.  Villar put himself in public ridicule because he dealt with those two abnormal circumstances. But  his act of coming out to warn the public against fake stem cell treatment is good and commendable.

There are crooks and opportunists everywhere, poor and rich countries alike. That is why it is important that the main function of the government is to promulgate the rule of law. Strictly implement laws against stealing, murder, abduction, counterfeiting, etc. When government moves into the function of endless redistribution of income and assets, the primary function is often neglected. And that is where criminals strike, they know that government is busy somewhere else.

Like when our policemen are busy flagging down motorcycle drivers without helmets, or their helmets do not bear DTI sticker; or flagging down color-coding cars, or "colorum"vans that transport office workers to their residential areas. When policemen are busy with these shallow and often extortionary concerns, the real criminals -- thieves, pickpockets, murderers, carnappers, kidnappers, etc. -- are relatively free to do their work.

In one report in rappler, it said, "The Philippine Medical Association earlier said 3 government officials died of complications from stem cell treatments done in the country by non-licensed practitioners." The report could be referring to former Congressmen Pedro Romualdo of Camiguin and Aumentado of Bohol, others.

It is not clear if those government officials died because of the stem cell therapy itself, or their old disease has further advanced to more serious stages and the stem cell therapy was either ineffective or unable to arrest the deterioration of the old disease.

Nonetheless, fake physicians or fake medical practices, fake medicines, they can kill. Or at least they can worsen a patient's condition and hence, make healthcare even more messy and more costly. The DOH and FDA are sometimes clueless that these things are happening more commonly. The DOH for instance issued an order about stem cell treatment only last month, even if these things have been going on for many months or even years.

Government should focus on the rule of law, not on functions that are better left to the private sector and civil society. Drug price monitoring and comparison for instance, is NOT a primary function of the DOH. Even ordinary people themselves can do that -- compare the prices of Mercury vs Watsons vs The Generics vs Rose vs other drugstores. But ordinary people cannot easily detect which medicines are real or fake, which ones can cure and which ones can kill. This function will require laboratory testing, will require lab and medical technologists. That is where the government can ffocus its resources.

Many NGOs, media, politicians and other pressure groups are part of the problem because among their focus is how to demonize the multinational pharma companies. Thus, there are policies like drug price control, EDPMS, IPR and patent tweaking, and so on.  The issue of fake drugs, fake ads in various health products and food supplements, pharmacovigilance and fake medical practitioners often take a back seat.

If existing laws against such fakes are not properly controlled, then more fake stem cell treatment and other illegal medical practices, fake medicines, will happen or proliferate in the country.Bottom of Form

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See also:
Rule of Law 17: Justice Without Discrimination, October 18, 2012
Rule of Law 18: Damaso and Carlos Celdran Conviction, February 04, 2013 
Rule of Law 19: How to Strengthen RoL?, March 25, 2013 
Rule of Law 20: PNP and Rule of Men, April 21, 2013