Cheaper Medicines Bill

Cheaper Medicines Bill

For lack of quorum in the waning weeks of the House, 13^th Congress, the Cheaper Medicines legislation was killed. Retrieving the Bill, its successor the 14^th 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.

Filibuster

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. Malacañan is cornered into a quandary, what move to take: support or veto a law that mandates lower prices for placebos?

OFWs

The press calls it a “brain drain” when alarms sounded about hospitals closing down due to deserting doctors emigrating for better paying jobs abroad, a looming medical crisis. By this time, thousands of nurses had embarked on the rampant exodus for employment in the U.S. and U.K. Yet they are only the latest overseas Filipino workers (OFWs) joining the 8 million or so working overseas that remit the dollars home, the group of Pinoys praised as heroes for helping to keep the nation from going down the drain of economic disaster.
These intrepid jobseekers in alien shores have not always been appreciated. The ubiquitous Pinoy nannies in Hong Kong and housemaids in Europe were a source of embarassment for Filipino globetrotting glitterati. The majority of OFWs works in menial jobs but gets paid many times more than similar jobs locally. Work abroad means he or she must endure not just the travails of the job but also the loneliness of separation from family, disrupted social life, strange language and alien customs
The OFW influence on Philippine society has profound implications beyond their economic clout. The average Filipino family consists of the two parents and three children, a family of five. Thus the 8 million OFWs represent half of the country’s population of 80 million. These Pinoys are learning the mores and rules of their host nation, and adapt to them or risk losing their job, their freedom, a hand or even a head. Repatriating OFWs return from a developed country with a higher respect and appreciation of law and order, so their potential to enhance and enrich Philippine culture is enormous. This enlightened class just might become the reformed Pinoy middleclass that will spearhead the renaissance of Philippine society, with the hope and promise of banished corruption, dismantled political dynasties, and laundered dirty politics
The first recorded migration of Filipinos was made by a group of sakadas (plantation workers), who arrived in Hawaii in December 1906, to work in sugarcane fields. This wave may have originated the OFW trend. My maternal grandfather was one of them, but returned to start a family in Luna, a remote town in La Union, (otherwise I wouldn’t be writing this now.) Of the eight million overseas Filipinos it is estimated that 2.3 million have settled in the United States as permanent residents. To mark the centennial of these pioneering Filipino migrants, Senate Majority Floor Leader Francis Pangilinan filed Senate Resolution 389 recently to commemorate the event. "It is only fitting for the nation to honor this momentous event because the country owes a lot to our kababayans [countrymen] in Hawaii. They have tremendously helped the Philippine economy remain resilient and stable with their remittances and investments in the country," Pangilinan said.
I was once an OFW, of sorts, having worked for an international food company in East Africa for over a decade. I was one of the team of four (3 Pinoys and an American) sent from DelMonte’s Mindanao facility to pioneer an expansion at a site located in Thika, famed for its flame trees, Kenya. Personal experience taught me that the most challenging phase of work in a foreign land is adjusting to the local people rather than them to us.
But going back to the fear of a looming medical disaster, will there be a crisis in the healthcare system? I don’t think so. Before the so-called exodus up to the present, Filipinos perceive community health as the availability of medical workers -- the surgeons, dentists, nurses, medical specialists and even alternative practitioners such as acupuncturists, iridologists, and physical therapists. Health is also equated with affordable medicines (chemicals that alleviate symptoms but do not remove the cause). But, in reality, most individuals enjoy a healthy life and think of medical assistance only when they are ill. The ailments are usually minor, not life threatening and are healed by time, the vast majority being colds, flu, LBM, stomach upset and hangover (the last two caused by over indulgence). In such cases, there is no mad dash to the doctor, except perhaps the hypochondriac, in which case the doc usually prescribes an OTC (over the counter) non-prescription pill and plenty of bed rest. So, why is the exodus a cause of worry?
Perhaps general anxiety would disappear if the public was better informed, and government adopted and fostered a policy of preventive medicine, rather than the traditional curative mindset favored by doctors and Pharma firms. Prevention is economical because it consists of three components that are entirely under the control of each individual family (with a bit of government assist): Hygiene (basically washing of hands), sanitation (cleaning domicile and surroundings) and nutrition (eating a healthy diet). This means that if one must eat with one’s hands, wash them first, particularly after defecating, shaking hands or handling money. Sanitation means keeping disease carrying vermin and pests (rats, flies and mosquitos) away from the house by good housekeeping and proper garbage disposal. Nutrition means that if we have to eat anyway, choosing healthful foods. Even the cheap foods can be nourishing and enjoyable.
Okay, those three methods zap the bad bugs that cause infections which include such nasties as HIV, TB, dengue, malaria, meningitis, cholera, dysentery But how about the chronic diseases such as diabetes, heart disease, stroke, hypertension, cholesterol, arthritis, asthma, and cancer? Against chronic diseases, at least 80% of heart disease, stroke, and type 2 diabetes, and 40% of cancer could be avoided through healthy diet, regular physical activity, and avoidance of tobacco use.
. The concept is fundamental, easy to understand and apply, and best of all, cheap.
Note that in both infectious and chronic disease nutrition plays a vital role in prevention of disease. This is because food contains the chemicals that the body metabolizes to sustain the immune system that combats the development of disease. Medical science, particularly the pharmaceutical companies, synthesize chemicals from plants and formulate these into medicines that doctors prescribe (in appropriate dosage to avoid harm since all medicines are poison.) In comparison, Nature, over the millenia has been packaging edible plants into foods in dosages that can be dealt with by the human body.Begrudging the loss of doctors and nurses won’t stanch the outflow. Looking after ones health personally would be more productive, the DIY (do it yourself) principle.