Bad beyond pharma

The alleged multi-level marketing practice of a local pharmaceutical company exposed by media is now the talk of the health care community.

Briefly, a local pharmaceutical company “B” built by enterprising doctors/businessmen incorporated multi-level marketing schemes and practices in their sale of the medicines they manufacture or “carry.” Company “B” was so successful that they allegedly sold more meds than the largest local pharmaceutical company in the country, Company “U.”

Doctors were incentivized to prescribe their medicines by giving concert tickets, foreign trips and luxury SUVs. As a result, competitors of Company “B” were boxed out of the Philippine Heart Center. Unfortunately, not even Company “U” dared to complain publicly for fear of being ostracized by doctors.

If the PHC Board and ethics committee want to clear their physicians and their reputation, all they need to do is to review the patients’ files and prescriptions. My doctors are from the PHC and none of my prescriptions are from Company “B.”

Observers say that the older set of physicians, 40 years old and above, generally ignore advances of med reps because they are already well-established in their practice. The newbies or doctors starting out in the profession are more likely to get enticed or tempted with such offers for a variety of reasons.

To begin with, new MDs are trying to build up their career and develop their network of contacts in the field. They are the ones who are more accommodating and tend to try new products. Getting a bundle of samples, invites to scientific seminars are also very attractive for MDs who want to pass on free meds to financially challenged or poor patients. They may be playing nice to aggressive or attractive med reps, but MLM is bad medicine.

Many of these young MDs lease/own and maintain two to three clinics inside hospitals in Metro Manila. For every clinic, they need to hire at least one office manager or share in their services. In some hospitals, some doctors have split the days in the week or between a.m. and p.m. to cut their out-of-pocket costs.

Problem #1 that needs to be investigated is the extremely expensive and commercialized cost of education for doctors. Are schools of medicine following international standards and practices or are students milked for all the cash they can give?

Problem #2. These new MDs are required to “invest” and/or lease office/clinic space in several hospitals. How come no legislator has had the courage and integrity to question or investigate the “real estate” and “investment requirements” of hospitals? Why do interns, even nurses, have to pay the hospital internship fees when they work the floor or pull duty at the ER?

We balk at MLM practices of a local pharma but not the real estate business of hospitals that all add to the cost of consultation and medicine!

Problem #3 is to investigate delayed payments and charges.

Because most patients already have some type of HMO or are paid by PhilHealth, etc. These HMOs have negotiated the prices down to rock bottom, the fees are split between doctor, office manager and the hospital which is the MDs’ landlord.

To make matters worse, payments to MDs are apparently delayed by as much as three to six months. Even PhilHealth is accused of such delays in reimbursements. If hospitals are the ones who collect on behalf of doctors, then you can add on another 30 to 45 days delay. No wonder doctors charge such big professional fees, they have to tack in for inflation and losses on cost of money.

Problem #4 is that there is no law that rigidly governs the ethical conduct of local (Philippine) pharmaceutical companies and there is really no agency with the manpower and funding to cover all issues of concern. Government and the media tend to bundle both local and multinational pharmaceutical companies in one group, but the truth is foreign pharmas are highly regulated while local pharmas are not.

When I was asked to consult for a multi-national company, the first requirement for me was to read, page by page, line by line, the contents of a 3” thick folder containing the entire provision of the “United States Anti-Corrupt Practices Act.” It spelled out how you may or may not engage with the public, what activities and events you were allowed to host, participate or engage with.

It stated how much you could spend for breakfast, lunch, dinner or similar forms of entertainment, gifts, tokens, etc. The binder told me that anything normally done in the Philippines for public relations was considered illegal in their books. I might add that US regulators, both internal and external, were on the ball. I was actually called by two US lawyers checking on issues of concern.

We don’t have any of those here in the Philippines, which is why any local company in any industry can get away with all sorts of gimmicks, promotions, even employing corruption and multi-level marketing just to push their brand or have an advantage. The tendency is to blame the big multinationals who must play by the rules. But who’s watching the dirty players who have no rules?

Problem #5. Government needs to audit practices of drugstore chains in terms of handling charges and pass-on costs to pharma companies. Unbeknownst to many, a number of foreign firms have opted to engage distribution firms to sell their medicines while they pull back or pull out from the Philippines. I was told that three or four are already in process, which means lots of jobs are about to go. We still have a serious problem concerning fake or adulterated medicines as well as doctor/drugstore connivance.

*      *      *

E-mail: [email protected]