Sunday, December 16, 2007

Cheaper Medicines Bill

Cheaper Medicines Bill

For lack of quorum in the waning weeks of the House, 13th Congress, the Cheaper Medicines legislation was killed. Retrieving the Bill, its successor the 14th Congress is attempting to pass the legislation before the 2007 Christmas break, raising some anxiety and stress to the eagerly awaiting ill and hypochondriac pill-poppers. The obstacles delaying passage are the debates, lobbying of all-powerful Big Pharma and even from the medical community
Debate on cheaper meds
Philippine College of Physicians (PCP) expressed, in a full-page advertisement, their unqualified support for the efforts to bring down the cost of medicines. (Inquirer, 11/25/07) but fears about the effects of a Cheaper Medicine law on therapeutic efficacy and safety. PCP’s argument—that making medicines affordable would undermine drug safety and efficacy, and avers the bill promotes practice-of-medicine-at-the-drugstore-counter.
Medical Action Group Inc. (MAG) disputes the PCP claims. They allege the World Health Organization (WHO) has been actively campaigning for the use of generic equivalent to medical treatment, even encouraging physicians to issue prescriptions using generic names only. The Cheaper Medicine bill seeks to address the lack of affordable medicines for Filipinos, not replace the physicians’ authority and responsibility in determining the appropriate and safe treatment for their patients. The fact is that one of the reasons why most Filipinos have not followed prescribed treatment is because of their incapacity to buy prescribed medicines. Statistical data show that in 2006, a meager 2.9 percent is being spent on medical care by a Filipino family.
Don’t count your chicks yet, folks. The bill may not be potent enough to neutralize the deviousness of Big Pharma and its cohorts in the medical community. Are there other means to maintain public health? You bet!
Chronic (non-communicable) diseases and practice of prevention is preferable to the current paradigm of ‘popping pills’, the modern conventional medicine. It’s much cheaper and less stressful. Medical science knows that 80% of chronic non-communicable disease (heart disease, strokes, diabetes, high blood pressure and cholesterol) and 30% of cancer can be prevented with proper diet, physical activity and avoidance of tobacco.
Pending the promulgation of the provisions of the so-called Cheaper Medicines Bill it is premature to comment on its merits. But one contentious item in the debates that is disturbing is the setting up of a Drug Price Regulatory Board for its potential to boost corruption. An editorial speculating on the acrimonious debates foresees a watered down version. This would be a pity, a waste of valuable resource. Water is too precious to waste for watering down feeble and ineffective bills purporting to boost public healthcare. Public health policy must focus on protecting the health of the teeming healthy public and preventing disease, both the infectious and the chronic non-communicable type (yes, they are preventable). Suggestion: ensure sustained supplies of clean water and safe food (restrain junk and unhealthy food); use water to wash hands and food to avoid diarrhea and obviate the need to buy medicine.
Chronic (non-communicable) diseases—including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes—are leading causes of death and disability but are neglected elements of the global-health agenda, and, not surprisingly, this includes the Philippines. WHO has proposed a global goal for the prevention and control of chronic diseases to complement the Millennium Development Goals. A British medical journal, the Lancet, published a five part series in pursuing the goal. “Achievement of the global goal would avert 36 million deaths by 2015. Furthermore, because most of the averted deaths would be in low-income and middle-income countries and about half would be in people younger than 70 years, it would have major economic benefits, including extension of productive life and reduction in the need for expensive care.”
Joining the chorus, several of the world's most eminent health scientists and organizations have published, in their study featured in Nature magazine, a landmark global consensus on the 20 foremost measures needed to curb humanity's most fatal diseases, Known as chronic, non-communicable diseases, they are reaching world epidemic proportions and include cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.
In their paper for Nature, the 19 authors say chronic non-communicable diseases:

  • Cause the greatest share of death and disability worldwide;

  • Account for over 60% of deaths worldwide, four-fifths of those fatalities being citizens of low and middle income countries;

  • Cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, maternal and pre-natal conditions, and nutritional deficiencies.

CNCDs, defined by the WHO as cardio-vascular disease, type 2 diabetes, chronic respiratory diseases and certain cancers, are largely preventable. It's estimated that eliminating key risk factors (poor diet, physical inactivity, smoking) would prevent 80% of heart disease, strokes and type 2 diabetes, and over 40% of cancer cases.

The initiative's leaders say their goals are "to galvanize the health, science and public policy communities into action on this epidemic," and to foster global debate, support and funding.

The Grand Challenges are grouped under six broad goals: (The Lancet proposal is essentially similar)

  • Reorient health systems (e.g. Grand Challenge: "Allocate resources within health systems based on burden of disease");

  • Mitigate health impacts of poverty and urbanization (e.g.: "Study and assess how poverty increases risk factors");

  • Engage businesses and community (e.g.: "Make business a key partner in promoting health and preventing disease; Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries");

  • Modify risk factors (e.g.: "Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO framework Convention on Tobacco Control");

  • Enhance economic, legal and environmental policies (e.g. "Study and address the impacts of poor health on economic output and productivity"); and

  • Raise public and political awareness (e.g.: "Promote healthy lifestyle and consumption choices through effective education and public engagement").

While these challenges are applicable to all countries, different nations should identify local priorities from among those identified here for immediate attention, depending on resources and disease Inaction is costing millions of premature deaths throughout the world offsetting the gains from a decreasing burden of infectious diseases. “In developing countries, many beset by infectious diseases, authorities have not resourced or thought through the policy implications of addressing these silent killers. But that's like putting out one fire in a house burning from both ends," says one scientist.

Lifestyle Changes

An American health journal summarizes the lifestyle choices you should do to help prevent chronic diseases, such as diabetes, heart disease, stroke respiratory and certain types of cancer. If you have such disease or are at high risk to develop it, you should do the following:

  • Eat plenty of vegetables and fruits while avoiding trans fats and saturated fats.

  • Keep blood pressure in the normal range, ideally with a systolic blood pressure of less than 120 millimeters of mercury (mm Hg).

  • Don't smoke.

  • Strive to keep your blood sugar levels normal.

  • Manage stress.

  • Become more physically active, and make daily exercise a priority at an intensity level recommended by your doctor.

High LDL cholesterol is one of the major risk factors for heart disease, and the risk increases as the bad cholesterol level rises. Other major risk factors are smoking, high blood pressure and diabetes. Your cholesterol level is determined by your genetic makeup and the amount of saturated fat and cholesterol in the foods you eat. The liver manufactures cholesterol, so even if you never eat cholesterol, your body can make all it needs.

Several factors contribute to high blood cholesterol:

Diet: Reduce your blood LDL cholesterol level by eating less fat, particularly saturated fat (as found in whole milk, cheese and meat). Low cholesterol foods are important, too. Studies have shown that your total cholesterol and your bad cholesterol levels may begin to drop two to three weeks after you begin your lower you intake of fat, calories and cholesterol.

A healthy diet:

  • Contains healthy fats. Once you've cut way back on saturated fats and trans fats (the unhealthy fats), you can start adding healthy fats to your diet. Healthy fats are polyunsaturated and monounsaturated.

  • Contains healthy sources of carbohydrates. Eat more whole grains — foods like whole-wheat bread, brown rice and oatmeal — to help lower cholesterol, improve blood sugar and insulin levels, control weight, protect the heart, guard against diabetes and keep your digestive system healthy.

  • Relies on healthy sources of protein. For a healthier heart, cut back on red meat and switch to fish. The good fats in many types of fish help protect the heart against erratic rhythms and may prevent blood clots. Wild-range fish are preferable to farmed fish. The American Heart Association recommends that people eat fish (especially fatty fish) at least two times per week. Beans, nuts and seeds are also excellent sources of protein.

  • Includes plenty of fruits, vegetables and whole grains. These foods have more powerful effects on your health than most pills.

  • Tastes great. If it doesn't, you probably won't stick with it for long.

Weight control: Obesity increases triglyceride and total blood cholesterol levels, blood pressure and the risk of developing diabetes.

Exercise: Regular exercise or continuous physical activity may help a person control weight, lower blood pressure and increase the level of high-density lipoprotein, or HDL (good), cholesterol.

Genetic factors: Understand that lowering your LDL cholesterol levels through diet often is not enough to reach your goal. Many people are genetically programmed to produce cholesterol in the liver no matter how strictly they follow a diet.

Sex/age: Coronary heart disease is the leading cause of death and disability for both men and women in the United States. Traditionally, coronary heart disease has been associated much more with older men than women. However, today, the importance of lifestyle changes is recognized for both sexes at all ages.

Alcohol: In some people, modest amounts of alcohol can increase the amount of good cholesterol (HDL). Modest intake means two or fewer drinks per day for men and one drink per day for women. There is good evidence that moderate alcohol intake lowers the risk of coronary artery disease, whether or not the protection is due to increasing HDL levels. However, alcohol provides "empty calories" that can add to your weight, and because drinking can have serious adverse effects, present guidelines do not recommend drinking alcohol as a way to prevent heart disease.

Smoking: Smoking damages the heart by raising blood pressure, damaging blood vessels, promoting the buildup of fatty plaque in arteries, lowering levels of "good" cholesterol, making the blood more likely to clot and depriving the heart of oxygen. Quitting smoking is the best thing you can do to prevent a heart attack.

Stress: Stress can increase chemicals within the body that may increase the risk of a heart attack. These fight-or-flight stress hormones, such as cortisol and epinephrine, excite the heart and make it work overtime.

The Lancet provides evidence that this goal is not only possible but also realistic. The major drawback is that it requires the cooperation and coordination of many sectors of society, unprecedented in contemporary Philippine milieu. But a city in the U.S., unaware of the Lancet agenda, is actually undertaking an experiment with the similar goal of preventing chronic disease

Heart-disease prevention target of Baltimore plan

Churches, barbershops and other unlikely allies would take part in a communitywide assault on heart disease proposed by the Baltimore City and Baltimore County health officers. The plan focus will be on simple measures known to prevent the disease or lessen its impact. These include smoking cessation, low-salt diets, exercise and taking medications as prescribed and recommending lifestyle changes to make better food choices on a daily basis The proposal, which is a set of principles and suggestions, has been under development for about a year and is the product of meetings with public health experts. The health officers have posted the proposal on the Internet and are inviting people to submit ideas. Public hearings are scheduled.

Elements of the proposal were borrowed from other cities and countries. Some represent programs that had brief stints in Baltimore. The Johns Hopkins School of Medicine ran a program called Heart, Body and Soul between 1998 and 2002 that involved churches in the promotion of healthy lifestyles. The proposal calls for the recruitment of churches and other faith-based institutions to sponsor health screenings and prevention programs. It also calls for the training of laypeople to become "community health workers" who could accompany patients to medical appointments, refer them to social services and administer blood pressure tests. It also envisions an expansion of the number of barbershops and beauty parlors involved in blood-pressure screening.

The proposal calls for the formation of a task force that would consider ways to get restaurants, grocers and food manufacturers to reduce their use of salt. Several countries, including England, Ireland, New Zealand, Australia and Finland, have reduced dietary salt through voluntary measures or labeling requirements.

The plan keeps an open option as to whether to seek voluntary salt reductions or impose rules on restaurants and food manufacturers. This year, New York prohibited restaurants from cooking with anything more than minute amounts of trans fats, substances implicated in heart disease. A Hopkins professor of medicine and public health who ran the Heart Body and Soul program, said prevention programs inevitably compete with a fast-food industry that propagandizes people to eat unhealthy foods.


Back to the progress of the Bill, Congress has only a few more days before their X’Mas vacation and tensions are building up. Congressman Pablo Garcia is unrelenting in blocking passage to a law he asserts is under lobby by Big Pharma, is a farcical placebo. MalacaƱan is cornered into a quandary, what move to take: support or veto a law that mandates lower prices for placebos?

1 comment:

Lester Cavestany said...

I hope this gets passed into law soon. Tess Termulo also wrote an interesting post on this issue. She found out that Congressman Pablo Garcia is (or used to be) heavily connected with pharmaceutical companies. Here's the link to her post:

And let's make the public aware that there will be more people who will insist that generic drugs are not as effective as branded drugs - this is a myth that has been disspelled by scientific research.