TWENTY-seven-year-old Raoul Bermejo III recently obtained his Doctor of Medicine degree from the University of the Philippines. He is currently taking up review classes for the medical board examinations this August. Like many idealist young adults, he says he thinks of engaging in public-health work once he hurdles the exams either with a nongovernmental organization or the provincial health office in his hometown of Capiz.

While he may be ecstatic over his personal future as a physician, Raoul cannot help but also worry about this healthcare subculture associated with pharmaceutical companies — the way they market drugs by lavishing doctors with a lot of perks. He finds the practice unethical but wonders if he and the 153 members of his graduating class can make a difference, even as they just allowed a drug company to host their class graduation party.

These are his thoughts:

No free lunch

I just received the degree of Doctor of Medicine and these days a new physician has many things to be bothered about — an eroding public image of the doctor, the crisis of health worker migration, and the lack of access of many Filipinos to health care. But while these issues have been often talked about, I would like to raise another that, because it is ingrained in our health care subculture, is often tolerated.

I am bothered by the fact that our class graduation party was largely paid by a drug company. They footed the bill of 150,000 pesos for dinner. Just to be clear about it. It was a party. It was not a scientific meeting. It was not a course of continuing medical education. People went there to eat, drink and be merry.

I am bothered that our class allowed it. It is patently a marketing scheme from the drug company and our class fell for it. Many feel that they are above the issue thinking that they can personally resist being swayed by all these marketing schemes. I think that is being quite na├»ve. Drug companies utilize these schemes because they work. Clear evidence has shown that physicians’ behavior in prescribing medication is affected by these enticing efforts of drug companies.

And even if a doctor really can resist being swayed by these marketing schemes, where is the marketing money of drug companies coming from? Do you really think that it is out of the goodness of their heart? Or their fondness of physicians? Marketing costs are passed on to the consumers and thus are shouldered by patients. Costs from maintaining an army of cute and dapper medical representatives, and costs from cups of coffee, rounds of golf, lunches, tours, and various freebies that physicians accept contribute to the high prices of medications in the country. All these enjoyable freebies come from the pockets of patients, many of them poor and could hardly afford the complete course of medications their doctors prescribe.

Drug prices in the country are as much as it is in Western Europe, the U.S. and Canada. Our country, having no real pharmaceutical industry of its own, is one of the favorite playgrounds of the three big pharmaceutical firms. They are now challenging even the band-aid effort of our government to make essential drugs accessible to poor Filipinos though parallel drug importation. Expensive marketing schemes compound the problem of unjust drug pricing.

Will making a stand now against an unethical practice really change the situation? Our small daily choices may seem minute to make a dent on what is a much-ingrained practice. But how do we expect the situation to change? Who will make that stand if not us? Our collective stand will matter and will make that change.

There is no such thing as a free lunch. Or a free graduation party.
You can email Raoul your comments.

8 Responses to No free lunch…or graduation party

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Juan Makabayan

May 31st, 2006 at 7:52 pm

These pharmaceutical companies are vultures. They have co-opted our healthcare system, both public and private.

Conscience-striken medicine grad/practitioners like Raoul Bermejo III are encouraged to reddiscover traditional medicine and other non-pharma dependent modality.

I hope for an advocacy for an Asian Trad Med Center/Institute to bring together Filipino indigenous, Indian Ayurvedic and Chinese medicine. I believe this is the best way to go for the development of a truly beneficial (not exploitative) health-care system.

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naykika

May 31st, 2006 at 11:39 pm

My Advise to Raoul and all his co-graduates is to remember that Hippocratic Oath they made. It was the same advised I gave to my baby sister and to her husband and you can not go wrong which ever part of the world you do your practice and whatever field of medicine you specialized in. Good luck..

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Ambuot Saimo

June 1st, 2006 at 12:20 am

Raoul,
I salute your being a principled and courageous young man to advocate for a change to this anomalous doctors-pharmaceutical companies marketing scheme the end result of which further saddled the poor majority. I hope you are not alone. Doctors are supposed to save lives and in rare cases to terminate it when necessary in order to avoid further agony such as when a person is in a coma. However, the effect of the present system some doctors are practicing is just the opposite- they are not saving lives and it prolongs the patient’s suffering because of their inability to continue a prescribed regimen or medication due to high cost of drugs or medicines and die just the same. I hope you will continue your crusade and don’t be swallowed by these “giants” or give up to the adage “if you can’t beat them, join them”.
As I was reading your lines, I cannot help but reflect on what happened to myself more about two decades ago.
As a working student then, I cannot afford to go to better colleges/universities in Metro Manila and ended up enrolling in a college primarily offering criminolgy. You will not believe but professors/instructors usually tell the class not to be discouraged about policemen’s low salary. They insinuate or indoctrinate these young would-be-police officers not to mind the salary because it’s actually your “salary + Metro Manila”. Great emphasis is given to “PLUS METRO MANILA” and that if you are allegedly the Chief of WPD there would be a one million pesos in your doorstep coming from Chinese Community every December without you asking for it, that if ever you’ll become police officers you should not “forget your superiors” (give their share of the loot)otherwise you will be assigned to “kangkongan” (a place where there’s not much activity”. (A policeman long enough in the service who don’t have cars or queridas are precieved to be weak and the laughing stock in the Department.)
After taking credits enough to qualify for the National Police Comission (NAPOLCOM) Exam I sat and passed the exam and applied to become a police officer. But while at a room awaiting for my turn for the psychological exam at Camp Panopio in Quezon City, I reflected deeply if I really wanted to become a police officer and be a part of the most corrupt and rotten organization. Suddenly, the images of those malalaking tiyan na pulis taking lagays/tongs from drivers, tinderas, libreng pancit, kape, pasahe, sine etc. rewinded in my mind and I almost vomitted. Right then I decided not to be part it and walked out of the room. I finished the course though but I purposely did not join the police to preserve my dignity and took up higher studies instead. But the question was- did I do the right thing by not joining or I should have joined and institute reform from within no matter how trivial it will be? That’s a question that until now I’m still pondering and looking for an answer. Sometimes I feel I did the right thing and justified but at times my conscience bothers me and feel guilty.
The main reason why the culture of corruption pervade in our society is because we incourage or tolerate it. If we have to institute a meaningful reform it must come from the young generation like you. But despite everything, I still believe reform is still attainable. Remember, young and skinny David got rid of giant Goliath by just a single stroke of a slingshot. I know you have the support of a lot of people. Good luck!!!

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fabian

June 1st, 2006 at 1:27 am

The big 3 will charge Western level prices because there are no viable alternatives to them. Bring in alternatives and we can break their market power.

I don’t think Filipino/Indian/Chinese medicine will be viable alternatives in the near future. Is anybody producing these in cheap, mass and quality quantities for the people? If so, good. Otherwise, it’s a plan for the long term.

Short term, parallel importation seems like a good idea. This is all about getting cheap India produced medicines into the country right? If I’m not mistaken the Pharma lobby says that bringing in these medicines will break our Intellectual Property right commitments (India made medicines don’t respect patents, they’ve reverse engineered meds made by these pharma companies? someone just correct me if I’m wrong).

Anyway, there are WTO clauses that say at a state of national medical emergency you can break IPR. We should go ahead and do it. Import a truckload of these medicines (just double checking for quality). Q: Can the big 3 retaliate, hurt the Philippine medical market? They can refuse to sell medicines, but they’d lose money that way too.

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baycas

June 1st, 2006 at 10:35 pm

“doctors under the influence of drugs” is old news and certainly, “doctors under the influence of drug companies” is also not a new phenomenon. go ask your neighborhood doctor when he/she was last treated by a med rep to a posh restaurant while introducing a new drug product lectured on (or actually, endorsed) by a doctor-specialist under the payroll of the pharmaceutical…

and one may think corruption only happens in government…haha!!!

…be wary of doctors who write prescriptions on pads with brand names of drugs printed on them…chances are they have succumbed to easily-agreed-upon sweet deals most diabetics could have a hard-on.

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Marketing and advertising often masquerading as “educational” expenses add enormous costs to medicines and are passed on to the consumers.

…please read on dr. a.g. romualdez, jr.’s Health views, news.

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Rep. Biron underscored that it is the greed of giant multinational pharmaceutical companies and that of the largest drugstore chain in the Philippines that has driven the prices of medicines to uncontrollable and inexplicable proportions. He thereafter revealed to the Body that the existence of a drug cartel is the primary reason why the cost of medicines in the country had escalated to mind-boggling and prejudicial levels.

…one may view here dr. ferjenel g. biron’s privilege speech with interpellations from some members of congress.

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counterfeit or not, people who cannot afford high-priced medicines opt to buy from wholesalers (and also retailers) at juan luna st., binondo, city of manila.

effective or not, cheaper drugs may have some kind of placebo-effect in some for it’s better to to take one rather than have none.

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raoul’s revelation, granting it is true, attests to pharmaceuticals gaining influence at root-level (the newly-grads). who knows how many of them will eventually practice medicine the big pharma way?

of late, cheap medicines are increasingly hard to come by. but worse than that, are cheap doctors increasingly getting drunk from drug companies’ porks and perks…

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Toro

June 5th, 2006 at 9:12 am

Raoul’s apprehensions are very true. From medical school graduation up to the day he retires from the profession he will be hounded by these giant pharmaceuteical corporations to be showered with all kinds of perks and it will be very difficult for him to decline all this because as a doctor there is much to learn especially from the medical seminars that are frequently sponsored by these medical companies. He will be invited to social and sports functions and travel to attend medical conventions in every part of the world that are hosted annually by these corporations, all expenses paid. All this in exchange for endorsing the medical products to his patients. It is inevitable that this will happen because pharmaceuticals spend tremendous funding for medical research and development of new medicines and what better salesman can they find other than the doctor himself. Thus, you see pharmaceutical reps make frequent visits to doctor’s clinic every day giving free samples of new products.

Is the practice immoral? It is not, but the resulting effect on the cost of medicines is unconscionable. Like any commercial enterprise, the production of medicine is big business because everybody gets sick, rich and poor alike. There is a stiff competition going on among pharmaceuticals and they are not alarmed by the mounting costs of producing new medicines because they know money is no object for those who want survive from their illness. It is a perfect business set up because nobody wants to die.

There is no escaping from the grips of these giant pharmaceuticals. Raoul is now an unwilling part of that giant monopoly which conscientious doctors throughout the world will have to contend with, and he cannot fight it alone because there are countless others who’d rather enjoy the perks than fight a losing battle. Bothered by his conscience, the least Raoul can do to help is to endorse generic and herbal medicines. He should join responsible and honest medical practitioners for the development of such medicines and encourage people to use them. Press the govt to provide incentives for the development of such medicines and offer special grants and tax subsidies as well. Wait until medical patents expire and encourage the production of these medicines at a cheaper price. This is how India resolved the problem of high cost of medicines to become a major manufacturer today.

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naykika

June 5th, 2006 at 5:48 pm

One way to fight these so-called Giants is through responsible legislations. Today the Health Ministry of the Ontario Provincial Government will table a bill that will further lower the cost of prescription drugs in the Province. Prescription drugs alone is taking 10 % of the total health care budget at the amount of close to $3 billions a year. It is a fight between Name brands manufacturers and the Generic producers. And in between the Pharmacies which make profits on prescriptions fees and REBATES from Generic Drugs producers. Everyone of them have their say during the preparation of the Bill. Now it’s the Government turn to have its say, because it is paying the bill and most -it is its Obligation. By the Way our Doctors are still the most Trusted of all Professional Practitioners in this country, followed by our Cops. Lawyers and Politicians somewhere at the bottom, but government institutions are still respected, because they are mostly run by professional civil servants effeciently –despite of their political masters..

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baycas

June 6th, 2006 at 8:03 am

no free lunch, yes, but raoul need not be a party to the big pharma way. he only has to master goodman & gilman and katzung, and perhaps melmon & morelli too. conscientious medicine is really knowing the craft by heart…medicines become cheap (or aptly, cost-effective) when given to the right patients with the right ailments.

sometimes, medicines are really not necessary…it’s like saying to a patient that water is still the best mucolytic above all else. applying in practice what a medical graduate has learned is the key…lest he falls prey to the overly-greedy predators.

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as regards the pharmaceuticals’ perks (the representation expenses afforded to lucky doctors)…the pharmas provide the plane tickets and accommodations but not the registration to the conventions (only if the postgraduate course and convention to be held in the Philippines involve international delegations are they allowed to shoulder even the registration fees — possibly because the funding came from the mother company abroad).

but bottomline here is that the beneficiary doctors had delivered or should deliver the goods by prescribing the particular drugs their benefactors sell…and the pharmas have a special way to monitor their doctors. the successful doctors the pharmas loved the most (owing to their numerous patients) oftentimes get perked more (to the point of not personally shelling out costly registration fees, esp. in international conventions where fees amount to hundreds of US$.

as to gurong bayan’s comment…some fellows-in-training get stipends directly from drug companies, i.e., they are externally-funded…meaning that their items are not being paid by UP-PGH. usually, each department of a specialty taps the pharmaceutical-designate for the fellows to be trained. this is but normal occurence even in other government hospitals as well as private medical institutions. this will help ease the burden of escalating costs in training of doctor-specialists.

(information above was provided by a doctor-friend of mine.)

i guess, we’ll just have to leave the morality of the issue to the doctor’s conscience when he graduates and feels he is obligated to patronize his benefactor or be beholden to his benefactor and continues to uphold and perpetuate the latter’s best interests.

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i don’t know if this could be applied here…the unwritten dictum come election time, is to receive the money from the politicians but instead vote wisely by conscience…

woody allen had a movie in 1969, it’s title (not the story’s main theme) may be appropriate…i think it’s really up to the idealist raoul, to either be forever indebted to the graduation party sponsor or just take the money and run

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