Category Archives: health

Virus scare hits Asia

Rising cases of dengue fever, chikungunya, bird flu and ebola viruses were reported in several Asian countries in the past two months. Relax, there are no pandemic threats. Not yet, anyway.

Last month, 4,521 dengue cases and 13 dengue-related deaths were reported in Malaysia. These are alarming numbers. Last year Malaysia recorded 49,335 dengue cases and 112 dengue deaths – the worst in the nation’s history.

Aside from dengue fever, there is another virus that is spreading in several Malaysian states: chikungunya. According to a medical specialist, chikungunya is the latest in a long line of diseases carried by mosquitoes, which include malaria, dengue fever, yellow fever, Japanese encephalitis and West Nile encephalitis. These diseases are causing 1 million deaths worldwide every year.

In Singapore, dengue cases were down last year but chikungunya infections were up. Last month, 160 chikungunya cases were reported. This figure is high since only 11 chikungunya cases were registered in 2008. This was confirmed by the Ministry of Health, which already included chikungunya fever in its weekly infectious disease bulletin.

Chikungunya is expected to become endemic in Singapore soon. The World Health Organization has reported that chikungunya has become endemic in several parts of Southeast Asia.

In China, eight people have contracted the deadly H5N1 bird flu virus this year. Five of them are already dead. China has slaughtered more than 13,000 birds in the far west where the outbreak was reported. Officials said the epidemic has been brought under control.

The last recorded bird flu outbreak in China was only in mid-December last year. More than 300,000 fowl in eastern China were killed when the disease was discovered.

Vietnam confirmed that there are nine bird flu-hit provinces in the country. The virus was discovered in more than 30 communes in 16 districts in the nine provinces of Thanh Hoa, Thai Nguyen, Ca Mau, Soc Trang, Nghe An, Hau Giang, Quang Ninh, Bac Ninh and Quang Tri.

To contain the bird flu, Vietnam slaughtered over 30,000 fowl, including 11,500 chickens and 21,000 ducks which had contracted the disease.

Five persons tested positive for the Ebola-Reston virus last month in the northern Philippines. The five individuals were from pig farms in Bulacan, Pangasinan and Valenzuela City, and a slaughterhouse in Pangasinan.

According to health experts, this is the first time the virus has been found outside monkeys. There are five Ebola virus subtypes: Zaire, Sudan, Cote d’Ivoire, Bundibugyo and Reston. The Ebola-Reston virus was first found in the Philippines in the late 1980s.

Filipino health officials claim there has been no evidence that Reston can cause significant illness in humans. But the transmission of the virus from pigs to humans has worried many experts. People are more exposed to pigs than monkeys. If the virus is not contained, more humans might be infected with the disease.

Dengue, chikungunya, bird flu and ebola viruses – these are “diseases of globalization.” The forces of globalization are also causing the transmission of viruses around the world. As economies become more interdependent and as more people travel, local viruses become globalized strains. Technological advances in transportation and communication have expanded and improved the global flow of people, capital and goods – and also, unfortunately, diseases.

Controlling the spread of these viruses should be a top concern of governments. Inefficiency in governance is partly to blame for some of the reported outbreaks. For example, critics slam the “protracted silence” of Malaysia on the dengue epidemic last year. The WHO questions the quality of China’s system in monitoring bird flu viruses. Vietnam’s veterinary agencies are accused of providing inaccurate data on animal vaccinations.

Referring to the spread of chikungunya, the WHO warns that the “socio-economic factors and public health inadequacies that facilitated the spread of this infection continue to exist.” It recommends the strengthening of “national surveillance and response capacity through multisectoral approach and active participation of the communities to prevent and contain this emerging infectious disease.”

Recently, the Malaysian government has launched a dengue awareness campaign in response to the rising number of dengue cases. One of the aims is to combat ignorance of public cleanliness. Residents are also encouraged to welcome fogging operations in their villages.

The Philippines’ Department of Health has added an information page on its website about the dreaded Ebola-Reston virus. It has instructed the public on proper meat handling and preparation to avoid infections from pigs.

It’s only the second month of the year but several alarming outbreaks have been reported already across Asia. This looks like a very interesting but scary year. 

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Legalizing organ trade in Singapore

Links: 100th year of “Kebangkitan Nasional” in Indonesia. Fuel protests in Jakarta. Vesak Day in Buddhist countries. Island dispute between Malaysia and Singapore.

New pictures in my webshots album. I wrote this policy briefer for the Philippine Legislators Committee on Population and Development a few months ago: Economic Sabotage – The extent and impact of smuggling in the Philippines

There is a raging debate in Singapore today: Should the government legalize the organ trade? Should Singapore endorse transplant tourism? The debate began last month when two young Indonesians were jailed for trying to sell their kidneys to a wealthy businessman in Singapore. The Human Organ Transplant Act of Singapore prohibits the supply of any organ or blood for monetary transaction.

Singapore is fifth highest in the world in terms of incidence of kidney failure. According to a news report, at least 3,500 people in Singapore have kidney failure; 600 are on transplant lists. But they have to wait up to nine years for an organ from a deceased donor. This explains why many Singaporeans are seeking kidney transplants in other countries.

The people are divided on the issue of buying and selling organs. Some are in favor of it in order to save lives. Others oppose it because it involves the exploitation of the poor. The Singapore Medical Association, to the surprise of some doctors, voted against the legalization of the organ trade. The group cited the short-term and long-term medical complications arising from kidney transplants.

As expected, Catholic groups are criticizing the organ trade. They ask: “A donated organ can save a life but at whose expense? Will the organ trade lead to an economic allocation of resources where only those who can pay will stand a better chance of survival in receiving an organ transplant? Will an organ be treated like a commodity?”

One Catholic blogger wrote that the organ trade reflects the widespread commercialization in society and insisted that the relationship between the organ donor and the recipient has no altruistic meaning, but is purely a commercial transaction.

But lawyers Jennifer Yeo and Madan Mohan support the organ trade on the grounds that it can help both the poor and the kidney patient. They wrote:

“Is it fair to criminalize such social relationships where no third party is harmed? When a social relationship is forged which gives a new lease of life to both the stakeholders, then law ought not to step in to criminalize and punish such relationships.

“Organ donation, even if it involves valuable consideration, may make life better for both parties who find no way out of problems of health or poverty. If the state – and the altruists – cannot help the poor in overcoming their problems, it ought not to raise more barriers for them.”

The government of Singapore seems to be in favor of a limited organ trade. The minister of health recently hinted that a certain procedure allowing trade in organs will be tested soon. Singapore is reviewing the practice in Spain and Norway, which allow the use of cadaveric kidneys from persons above 60 years old. Singapore does not accept kidney donations from the elderly.

Iran is often mentioned in the organ trade debate because it is the only country in the world which has legalized the selling of kidneys since 1997. (Iranians call it “organ sharing.”) By 2006, more than 16,000 Iranians had sold a kidney. Singapore officials are now studying the Iranian model.

A live-donor registry is also being proposed in Singapore, which would facilitate the matching of donors to patients. It would also be used to monitor the health and financial conditions of donors after organ transplants. Charity groups would be tapped as well to help in the post-transplant needs of donors and their families.

The proposed live-donor registry, aside from being the first of its kind in the world, would address the common problems encountered by organ donors after transplants. A study published on the World Health Organization Web site enumerates some of these problems: In Egypt, 78 percent of donors reported deterioration in their health status; 78 percent spent the money within five months of their donation; and 73 percent reported a weakened ability to perform labor-intensive jobs. In Iran, 60 percent reported negative effects on their physical activities; and 65 percent reported negative effects on their employment status. Singapore policymakers should be guided by the disturbing results of this study.

The organ trade debate in Singapore is interesting and essential because the issue is being discussed from the point of view of an organ-importing country. In other countries like India and the Philippines, the organ trade issue is often linked to the issue of poverty. Discussions are focused on how to stop rich patients, especially foreigners, from exploiting the poor in these countries.

Singapore can discuss the issue dispassionately. It can take the lead in setting the legal, medical and ethical framework for an organ trade that respects the rights of both the organ donors and recipients. It can set an example by delineating the role of the state in ensuring that a fair, safe and rational system of organ transactions is in place.

Singapore should also not forget that the bigger issue today is not the organ trade but holistic medical care given to the poor. Prevention of kidney failure and other chronic illnesses should be a higher priority. Singapore should re-examine its healthcare budget and investigate if proper medical attention is being given to its citizens, especially the poor. As much as possible, organ transplants should be discouraged. They should be the final option for those who are sick.

Related entries:

Filipino kidneys for sale
Fastfood and Heart Center

Fastfood is good for our hearts

Three fastfood outlets have just opened inside the compound of the Philippine Heart Center in Quezon City. Streamers announcing the opening of these popular food stores were placed at the gate of the hospital. This sends a subtle though dangerous message to the public that eating burgers, fries and softdrinks is good for our hearts.

What a good marketing strategy for the fastfood companies. How irresponsible of hospital officials to allow these stores to open within the Heart Center. Is the Heart Center now endorsing foods which are rich in cholesterol, fatty acid and salt?

Of all public hospitals, the Heart Center should be the most aggressive in promoting a balanced diet among consumers. How could it teach the public to take good care of their hearts when it just allowed fastfood outlets, which are not offering healthy meals, to open inside its premises?

The selling of burgers, fries and softdrinks in front of the Heart Center is like opening a lotto outlet in a church or the selling of cigarettes in the Lung Center. Maybe the Heart Center officials did not intend to instruct the public to eat junk foods but they indirectly promoted these unhealthy meals when they allowed fastfood stores to operate inside the Heart Center. This is not public service.

I believe the Heart Center was forced to lease out a portion of its property since it lacks resources for its operations. Public hospitals and the health sector are not receiving enough subsidies from the national government. Public hospitals are forced to charge higher fees or to commercialize their assets in order to continue giving quality service to poor patients.

The government should increase the funds of the health sector. Lawmakers should allot more of their pork barrel to public hospitals. Another way to generate more resources for social services is to eliminate corruption in government. If contracts are not overpriced and projects are efficiently implemented, there will be more money available for the needs of our hospitals.

The food crisis today is not limited to rising prices and lack of supply. It is also about the quality of food we are eating. Public hospitals should be a reliable partner of government in educating the public about the role of proper diet in maintaining a healthy and productive lifestyle. Sadly, the Heart Center interpreted this duty by indirectly encouraging the public to eat burgers, fries, and softdrinks.

Practical nurses

An article which was published in a major daily two weeks ago mentioned the opposition of the Philippine Nurses Association to the “Practical Nurses” course offering of the Commission on Higher Education. The nursing group wants the higher education body to remove the new program because “it was misleading students into thinking it would qualify them for work in hospitals abroad.”

According to Ched, the “Practical Nursing” program is part of the “ladderized education scheme that aims to bridge the gap between vocational-technical training and a college degree.”

Maybe the nursing group has other reasons why it is opposing the new program. Ched should address these criticisms. But the idea of training and producing practical nurses is commendable. Whether initiated by Ched or other organizations, the country needs to train more practical nurses who have clear grasp of the health needs of our people, especially those living in the barrios.

The country is already suffering from the mass exodus of Filipino doctors, nurses and other health workers. Hospitals are closing down due to lack of qualified health personnel. Urban poor and peasant communities are deprived of basic health services.

We need creative programs to solve the shortage of health workers in the country. We need practical nurses who can deal with the common health problems of Filipinos. We need health workers who are motivated by a genuine concern to serve the dying and the sick.

Recently, the World Bank reported that poor sanitation is costing the Philippines about $1.4 billion in economic losses. More Filipino children are afflicted with acute lower respiratory infection, malaria, as well as increased mortality from other childhood diseases. The Philippines also ranked eighth among 22 countries with high incidence of Tuberculosis says the World Health Organization.

This is another reason why we should give more priority in training practical nurses who can assist the government in educating the people about proper sanitation and other instructions for healthy living.

Unfortunately, nursing schools, whether Ched-administered or privately-owned, are more concerned in training nurses who can pass the standards required by big local hospitals and foreign employers. It seems nursing education has failed to inspire the students about the need to prioritize the health needs of the poor. Higher education in general has been reduced as a technical requirement to clinch employment abroad.

The notion of mass producing practical nurses is not bad at all. Whether they will be called nursing assistants or second rate nurses does not matter as long as they are determined to work in poor communities and help in addressing the health needs of Filipinos.

And why stop with practical nurses? Let’s also produce practical doctors. These are hard and interesting times. Doctors are studying again to become nurses. We need new doctors. We need practical health workers. If we fail to act swiftly, the other more dangerous alternative is to accredit the faith healers as the new health workers of the country.

Related entries:

Burgers, fries, coke, politics
Books for coke
Jollibee kid
Ban junk food
Exporting nurses
Labor export
The doctor is out

Beauty and taxes

New pictures in my webshots album

I remember reading last December an interesting article in The Economist about the possible link of beauty and success. The article mentioned several studies which showed that beautiful persons seem to be more intelligent and successful in life. Beautiful persons have higher salaries, higher IQ and they have higher chances of winning in elections.

Perhaps this explains the expanding profit margins of the global cosmetics industry. People need to look and feel beautiful at all times.

This was partly the same argument used by local cosmetic surgeons three years ago when they opposed the proposal of the House of Representatives to impose a 20 percent excise tax on cosmetic surgeries.

Rep. Abraham Mitra wanted to expand the list of non-essential goods subject to excise tax by including non-essential services such as nose lift, bust lift, breast augmentation, botox and liposuction in the tax base.

As expected, most of the doctors who were invited in the public hearings of Congress rejected Mitra’s proposal. They did not want to classify cosmetic surgery as a luxurious activity.

Among the invited medical specialists, it was only Dr. Alicia Lim of the Jose Reyes Memorial Medical Center who described cosmetic surgery as a “non-essential service” since according to her “it is not therapeutic, not life threatening and it is not medically indicated.” However, she appealed that reconstructive surgeries for cancer patients and for those who suffer deformities due to accidents should be exempted from the excise tax.

The other resource speakers did not agree with her. Dr. Pie Calayan explained that cosmetic surgery was first developed during the 1st World War when the broken bodies and faces of soldiers need to be restored. According to Calayan, cosmetic surgery boosted the morale of soldiers in the battlefields.

Calayan argued that cosmetic surgery is not a vanity and many of their patients do not belong to the super rich. Most of their patients “have bitter need or material necessity to look better to maintain their jobs and support their families.” Calayan pointed out that doctors do not just treat physical injuries but they also heal “emotional pain and broken spirits so that individuals shall have renewed feelings of themselves.”

Dr. Corazon Jose of the Philippine Liposuction Surgery and Philippine Society for Cosmetic Surgery warned that imposing new taxes on cosmetic surgery will lead to the proliferation of pseudo-cosmetic clinics. She noted that many of their patients are Overseas Filipino Workers and entertainers who need to enhance their physical appearances as a requirement for their better paying jobs.

She also testified that part of the high professional fees charged by cosmetic surgeons is spent for their continuous medical education.

Dr. Jose added that liposuction is a surgical procedure for unwanted fats “which uplifts the physical and psychological well-being of patients.” It also improves the level of blood sugar and blood pressure of patients. Rep. Mitra countered this point by citing a study in the New England Journal of Medicine which stated that the diabetes and other diseases of some women did not improve even after undergoing liposuction surgery.

Dr. Benjie Alonzo of the Philippine Academy for Aesthetic Surgery claimed that that tax proposal could hurt the cosmetic surgery industry. Contrary to the common impression, Alonzo clarified that there are only few cosmetic surgeons in the country. He said the industry became well-known because of TV exposure and other forms of advertisement.

Instead of imposing an excise tax on cosmetic procedures, most of the invited medical specialists proposed the promotion of medical tourism in the country in order to increase tax revenues.

In response to the testimonies presented by the resource speakers, Rep. Luis Villafuerte stressed that Congress is supporting reconstructive surgeries such as dental surgery, harelip procedure, hair transplant, organ transplant and other physical deformities. But Villafuerte added that cosmetic surgeries for uplifting self-image should be taxed.

Congress conducted several public consultations regarding the proposed tax measure. During the third public hearing, the cosmetic surgery industry presented a united front. Representatives from the Mendez Medical Group, Belo Medical Group, Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons, Philippine Academy of Aesthetic Society and the Philippine Dermatological Society signed a position paper opposing the passage of the proposed bill.

They also advanced a new argument by citing a provision in the 1987 Constitution. They asserted that “patients who seek consultation for cosmetic and dermatological procedures have valid medical, psychological and emotional needs such that the imposition of a ‘vanity tax’ will be discriminatory as it will only apply to a certain group of patients who under the Constitution, have a right to the pursuit of happiness, a right to life and to the fullness of life.”

Rep. Jacinto Paras agreed with the invited medical specialists. He manifested his opposition to the proposed measure by also citing that the Constitution provides that no person shall be deprived of life, liberty and property and that cosmetic surgery is a form of cure and not vanity.

The bill was not approved. Maybe lawmakers did not pursue this proposal since they prioritized the passage of the E-VAT. But this issue will always be discussed every time the government wants to improve tax revenues. Public debate should continue whether cosmetic surgeries should be considered as non-essential services. The concept of luxury changes over time. A lawmaker declared in 2005 that TV sets and microwave ovens were no longer luxurious items.

A celebrity doctor reminds us that beauty is power. Indeed, beauty is important for many people. But the article in The Economist reminds us that real beauty is hard to fake. Beautiful persons emit “unfakeable signals” which are always detected by people. Perhaps what we should concentrate is the cultivation of real beauty within ourselves.

Related entries:

Urban facelift

E-VAT and riots

Manila as fake capital

Kidneys for sale

The Philippine government claims the number of people living below the poverty level has been decreasing in recent years. However, this is still an imprecise indicator to measure the extent of inequality in Philippine society. This does not measure the distribution of income among the poor.

Some are poorer than others. Some are more undernourished and hungry than the rest of the population. Some have more body parts than others since a large number of desperate poor people have been selling their kidneys to foreign buyers.

The selling of kidneys in the Philippines has already reached an alarming level. The Department of Health avers it has no database on organ donations in the country. But there is a consensus that something must be done to minimize, regulate or even ban the trading of kidneys in the country.

In almost all urban poor communities in the Philippines, scores of young men and women have scars on the side of their bodies. These are indelible proof that they donated one of their two kidneys to local and foreign recipients.

Selling of body organs is against the law but this practice is thriving in the country. Why? Humans need to survive. Persons suffering from end-stage renal diseases need a kidney transplant to become healthy again. The lack of access to renal care and the high cost of dialysis increase the demand for kidney donors. On the other hand, the starving poor need money to buy food, clothing and other basic commodities.

A kidney costs only US$2,000 – $5,000 in the Philippines. Sometimes children of organ donors are given scholarships and other health allowances. But the money is a pittance compared to what the donors lose. Their lifestyles have to change since they cannot function as well as before. If they suffer from renal disease in the future, they may need a transplant too. Most of the time, donors are not properly informed about the negative impact on their bodies if they agree to sell their kidneys.

Kidney recipients are also not assured of becoming healthy again. They risk getting HIV, hepatitis or infection from the donors. The medicines they need to take may increase cardiac risk, hypertension and lipid disorders.

Those who profit from the trading of body organs are the government, hospitals, doctors and kidney brokers. Hospitals benefit from an increase in the number of paying patients. Doctors can practice their skills and enjoy higher compensation without leaving the country. Kidney brokers act as the middlemen who scout potential kidney donors in the slums.

The government has included kidney transplants in its medical tourism program. A senator estimates that the Philippines can expect to earn US$300 million per year if it focuses on improving the business opportunities for medical tourism. At present, there are 25 partner hospitals offering medical tourism services and they expect 175,000 medical tourists each year.

However, a former senator is against the proposal of the health department to double the number of foreigners being given kidney transplants in the Philippines. This was also the sentiment of a member of the House of Representatives who filed a bill seeking to "regulate the living non-related organ donations in the country to protect and promote the right to health of the people and instil health consciousness among them."

The lawmaker pointed out that "the organized practice of organ donation for profit is against ethical standards and is not within the commerce of man."

Even the influential Catholic Church has issued a statement condemning organ sales in the country. A bishop reminded the public that there is a "whale of moral difference" between organ donation and organ sales.

Church officials said "Our body ought not to be treated as a commodity or object of commerce, which would amount to the dispossession or plundering of the human body." They added that human organ sales or trade is morally unacceptable since it is contrary to the dignity of the human person. Instead of kidney selling, the church encourages voluntary organ donation from cadavers and also from living donors.

The former Speaker of the Philippine Congress delivered a privileged speech early this month lamenting the extent of corruption in government. He complained that "everything is for sale in this country." He was right. Even kidneys are sold in hospitals at bargain prices.

It is poverty which has forced more than 8 million Filipinos to work in other countries. The cheap labor cost in the Philippines has enticed foreign investors and employers to hire Filipino workers. Now, Filipinos are selling body parts to foreigners. This is the face of poverty in modern Philippines. The desperate poor may even be tempted to trade their souls if this was only possible.

The government insists the Philippines has registered the highest economic growth in the last 31 years. But it has failed to mention that more people are hungry today, more people are migrating to other countries and more people are living with only one kidney. Is this progress? Is this freedom?

Related entries:

Exporting nurses
The doctor is out
Brain hemorrhage

Filipinos need affordable medicine

Yehey pictures: click here and here.

The cost of medicines in the Philippines is among the highest in the world. A study shows that it would take a full six days of wages for an average worker to purchase basic medicines in the country. There are more than 17,000 registered drugs in the local market, but a majority of the population can barely afford these expensive essential drugs.

Lawmakers are bewildered why Norvasc, a medicine for hypertension, is sold in the Philippines by a multinational pharmaceutical company for 41.41 pesos (US$1) per 5-mg tablet; while in India and Pakistan, the same drug manufactured by the same company is priced at around 5.77 pesos (US$.14).

Plendil, also for hypertension, is priced in the Philippines at 21.82 pesos (US$.54) per tablet while it costs only 2.69 pesos (US$.07) in India. A Ventolin inhaler for asthma patients is sold for 315.00 pesos (nearly US$8) in the local market while in India it costs only 126.78 pesos (US$3).

Other medicines also show the same disparity. Ponstan, a common painkiller, costs only 3.22 pesos (US$.08) in India but costs 24.92 pesos (US$.60) per pill in the Philippines. Bactrim 400, priced at 17.75 pesos (US$.40) per tablet in the Philippines, can be bought for only 1 peso (US$.02) in Pakistan and 0.69 centavos in India (less than US$.01).

Why are medicines so expensive in a poor country like the Philippines?

A few big foreign pharmaceutical companies control the local drug market. More than 70 percent of local drug trading is dominated by transnational corporations. Since there is no competition, drug firms are dictating the prices of medicines for as much as the market can bear. The Intellectual Property Code is used by the dominant pharmaceutical companies to block efforts of local companies and even by the government to manufacture and import patented drugs.

Wholesale drug distribution in the country is dominated by one company. The people are helpless if the company decides to raise drug prices in its more than 600 outlets throughout the country. Government-subsidized drug kiosks are very few and remain inaccessible in most provinces.

The Generics Law of 1988 is a big disappointment. Only 5 percent of drugs sold in the country are generic. Doctors continue to prescribe branded drugs. The Philippine has to study why generics laws have worked so well for other countries in bringing down the cost of medicines.

The local drug industry can only manufacture less than 200 drugs. Most of the raw materials used to produce drugs are imported. There is also no sustained research or government program to develop the medicinal and commercial potential of the country’s herbal products.

The issue of costly medicines has been recognized by the government and steps have been taken to reduce drug prices. The government announced its plan to sell affordable drugs in public universities and health centers. The first legislative proposal filed in Congress last July was the Cheaper Medicines Bill.

Senator Mar Roxas explained the urgency of approving this measure:

"The bill seeks to amend the Intellectual Property Code in order to allow the parallel importation of more affordable medicines from abroad; support the generics industry by adopting the ‘early working’ principle and to disallow the grant of new patents on grounds of ‘new use;’ and give ample muscle to the government through a framework for government use and compulsory licensing. The substitute bill also reiterates the president’s power, patterned after the Price Act, to impose drug price ceilings in times of calamity, public health emergencies, illegal price manipulation and other instances of unreasonable drug price hikes."

Most political parties have vowed to support this bill. The president has also certified it as a priority measure. So far, Congress has not yet approved the final draft of this measure. Is the lobby fund of big drug companies working already?

Perhaps the Cheaper Medicines Bill will finally become law next month. But the two chambers of Congress must first resolve their differences over what regulatory measures to include in the law. There are lawmakers who believe that parallel importation of cheaper drugs cannot substantially lower drug prices in the country. They want to create a drug price regulation board which will be given absolute powers to fix a maximum retail price for medicines. However, senators are worried that a drug price regulation board which is composed of only seven individuals could be influenced by big pharmaceutical companies.

Some activist groups are also not very optimistic that the people will have access to low-cost essential drugs through the Cheaper Medicines Bill. They are frustrated that the proposed bills in Congress do not make any single mention about the need to develop a self-reliant national drug industry that is responsive to the medical and health needs of the people. The Cheaper Medicines Bill is also silent about the control of multinational corporations in the marketing, distribution, and pricing of medicines in the country.

Health advocacy groups are urging the government to tap the medicinal potential of indigenous and herbal plants in the Philippines. They propose that prices of medicines should be regulated based on the production cost and reasonable profit of companies. Tax incentives can be given to local drug manufacturers to ensure production of medicines. A drug price regulatory board is also being proposed; but it should be represented by health stakeholders and the selection process for membership in the board should be independent and transparent.

Many Filipinos are dying because they lack the means to buy the drugs prescribed by doctors. The government is right to prioritize the passage of the Cheaper Medicines Bill. Congress should improve this measure and incorporate the criticisms of various organizations.

Related entries:

Don’t get high on drugs
Expensive medicines in the world
Congress goes back to work

The need to cope with AIDS

I am in Cotabato City today. My batchmate Zaynab Ampatuan invited me to give a series of lectures on the youth situation.

Thank you Marlon for providing the data I used in this article.

"Every minute, a child under 15 dies of an AIDS-related illness. Every minute, another child becomes HIV-positive. Every minute, four young people between the ages of 15 and 24 contract HIV," says the United Nations Children’s Fund.

Human Immunodeficiency Virus or HIV damages the defense system of the body. Acquired Immune Deficiency Syndrome or AIDS is caused by infection with HIV. The infected person develops a number of serious illnesses which eventually leads to death.

Some people develop AIDS shortly after being infected with HIV. Some live with HIV for more than ten years before developing AIDS.

Last year, 4.3 million people around the world were infected with HIV, more than in any previous year. There seems to be a lack of progress in lowering the number of HIV cases.

The first reported HIV case in the Philippines was in 1984. Dolzura Cortez was the first prominent HIV-infected person in the country. After her life story was made into a film in 1992, more people living with AIDS came out into the open and revealed how they were struggling with the disease.

According to the National Epidemiology Center, there were 2,965 HIV Ab seropositive cases reported from January 1984 to September 2007. More than half of the cases were in the 25-39 years age group. Sixty-six percent were males. Sexual intercourse, mainly through heterosexual contact, remained the leading mode of transmission. About 307 have already died due to AIDS-related complications.

The average cumulative annual increase of cases is at 110. But since 2002, an average of 20 cases per month has been reported. This figure may be higher because many persons infected with AIDS are still undocumented or unwilling to report their condition.

According to a study conducted in 2004, the estimated number of people living with HIV in the country may reach 9,000. For every known HIV/AIDS case, there are three to four individuals who are unaware of their condition.

An area is recognized as high-risk to AIDS prevalence if it is a tourist area, highly urbanized, contains a high number of transit points and a high number of registered entertainment establishments. High risk groups include female sex workers, deep-sea fishermen, injecting drug users and overseas Filipino workers.

The high prevalence of sexually transmitted infections is another indicator of high-risk behavior. Young people are also vulnerable because of the high percentage of those engaging in unprotected sex. Condom use has been consistently low in the Philippines. It is also alarming that more than 60 percent of the youth believe there is no chance for them to contract HIV/AIDS and only half of them know the major methods of preventing transmission of HIV.

In 1998, the Philippines passed the AIDS Prevention and Control Act which laid the basis for a comprehensive national HIV/AIDS response. Some local governments also created Local AIDS Councils to strengthen advocacy for AIDS prevention and awareness campaign. There is a need for an independent assessment to validate if the mandates of the law are operational and if the local councils are functioning.

The Fourth AIDS Medium Term Plan (2005-2010) seeks to maintain HIV prevalence in the Philippines below one percent of the general population. Preventive interventions focus on education, condom promotion, STI management, voluntary counseling and testing, harm reduction and stigma reduction. Institutions are asked to integrate HIV/AIDS policies. Schools, work places, communities and mass media are tasked to take the lead in offering programs and services to help reduce AIDS incidences.

Support, treatment and care for those infected with AIDS involve clinical care, home care, palliative care, ante-natal and community support. There should be an increase in the percentage of people with advanced HIV infection receiving anti-retroviral combination therapy.

The government should target more schools with education on HIV/AIDS integrated into the curriculum. The country’s 30 largest companies, 100 medium and 100 small-scale enterprises should have HIV/AIDS education programs. Government spending on health facilities should be increased.

Last June, the government health department included call center workers as among those vulnerable to HIV infection. Public officials, employers and the workers themselves should be aware that risky behavior in call center establishments, like taking drugs to remain awake during the nightshift and unsafe sexual practices, may lead to HIV infection. Preventive education and counseling programs are needed in call center companies.

Stakeholders should exert the best efforts to prevent discrimination against people infected with HIV/AIDS. Positive attitudes should be harnessed in the community to facilitate the integration of AIDS victims. Leadership is important to prevent a rise in the number of AIDS cases and foster respect for the human rights of all HIV-infected persons.

Related entries:

Sex and youth
Usapang gatas

Sex and Filipino youth

The Philippines has a very young population. Adolescence is thought to be the healthiest stage of the life cycle, but in this country statistics defy this common observation.

A study by Dr. Corazon M. Raymundo reveals that at least one-third of the 475,000 abortions in the country are attributed to women aged 15-24 years old. Three out of four maternal deaths are from the adolescent group.

Many of the health problems of adolescents are lifestyle-related. About 13 percent of adolescents have thought of committing suicide. More than half of unsuccessful suicide incidents involved the slashing of wrists. About 11 percent of the youth have tried illegal drug substances. The most commonly used illegal drugs are marijuana, rugby, shabu, ecstasy and cough syrup.

According Dr. Raymundo, reproductive health is an important aspect of adolescent health. Threats to adolescent reproductive health include early and unprotected premarital sexual activity, early pregnancy and childbirth, abortion, rape, violence and sexual harassment.

Premarital sex is increasing in the Philippines. The study shows that 20 percent of premarital sex occurs among high school students. Many first sexual encounters are not planned or wanted. Most sexual experiences are unprotected.

Substantial numbers of young people have reproductive health problems but they are not seeking medical help. Painful menstruation among girls and painful urination among boys are the most commonly reported ailments. Sexually active youth have more such problems. One-third of these boys and girls have experienced sexually transmitted infections.

Dr. Raymundo notes that those who smoke, drink, and use drugs are more likely to have sex. Premarital sex is most strongly linked with drug use. This shows that risky behaviors do not occur in isolation, rather they are interconnected.

It is also alarming that many teenagers think AIDS can be cured and still a large percentage thinks they are not vulnerable to AIDS. The government should also look into persistent rumors that AIDS cases are on the rise among call center workers.

Dr. Raymundo reminds the public that teenage pregnancy is another cause for concern because of the special situation of young women in society. By age 18, about 10 percent of teenagers have been pregnant already. The figure rises to 25 percent by age 20.

There is a higher risk that a teenage pregnancy will lead to miscarriage, premature birth, stillbirth and low birth weight. The baby of a teenage mother is four times more likely to die.

Dr. Raymundo appeals to various stakeholders to help in reducing teenage pregnancy and the negative outcomes of such pregnancy. There is need to create a physical and cultural environment favorable to the promotion of adolescent health. This should lead to a decentralized structure, reduction of mortality and morbidity caused by early sexual activity, sexually transmitted infections, drug use and other risky behaviors.

The government should draft a program on adolescent reproductive health that will integrate sexuality education and fertility awareness in the school curriculum. It should tackle teenage pregnancies and HIV/AIDS, among other issues.

If the government is amenable to including climate change in the curriculum, why does it continue to object to reproductive health education for students? Unwanted pregnancy and other adolescent problems are serious threats to the well-being and future of the people.

Amending the AIDS Law is important too, since it is silent on the rights protection and provisions for children affected by HIV and AIDS. Girl children are the most affected by these diseases. The amendment should incorporate concerns for special treatment of children with HIV.

Stakeholders should motivate the youth, communities, opinion leaders, political and religious authorities to adopt favorable attitudes vis a vis promotion of youth health. Initiatives should promote the idea that sexual development is an inevitable, normal and important part of adolescent development.

Extra effort should be applied in engaging the powerful Catholic Church and other conservative forces in the "pro-life" camp. Many sectors of Philippine society still consider sex and sexuality as taboo issues. Dr. Raymundo is frustrated that healthy adolescent sexuality is still regarded as promiscuity. She also identified the "moral panic" about sexuality especially with regards to sexuality education and homosexuality.

The Catholic hierarchy is the single biggest stumbling block as to why the Philippines has not yet legislated a comprehensive reproductive health program that would greatly benefit women, youth, children and the people in general. Political parties are afraid to antagonize the influential clerics who could instruct the faithful to disobey public officials and even defeat the electoral chances of obstinate politicians.

There is a shortage of condoms and political will in the Philippines. Politicians and civil society groups should reject the fundamentalist position of the Catholic Church by addressing the rights and needs of the people. Government should provide free reproductive health services, improve maternal health care, offer contraceptive choices and promote fertility education. This is the more genuine "pro-life" position with regards to the population issue.

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Dont’ get high on drugs

Bloggers Kapihan: Blogging Beyond the Basics: September 8 Philippine Science High School, 2-5pm. If you want to attend, email me.

In the Philippines, medicines are 3.4 percent to 184 percent higher than the international reference index. For example, a 250 milligram Amoxycillin costs $9 in Indonesia, $8 in Nepal, $5 in Pakistan and $22 in the Philippines. Erythromycin costs $12 in India, $5 in Pakistan and $22 in the Philippines.

Health care expenditure may be low in the country but Filipinos are spending too much on medicines. Prescription drugs alone eat up 40 percent of health spending. Last year, Filipinos bought P47.9 billion of prescription drugs and P17.8 billion of non-prescription medicines.

Why are drug prices abnormally high in this country?

The government is not investing enough on public health. There is high out-of-pocket expenditure and low spending on cost-effective public health interventions. This means individuals are shouldering health expenditures instead of relying on national/local government subsidies or social health insurance. The Philippines is the only country in the region where public financing for medicines is less than 30 percent.

Physical accessibility of medicines outlets or health facilities remains a problem. Only 11.5 percent of low priced generics are available in the public sector outlets (Botika ng Bayan). The distribution on drug consumption is concentrated only in Metro Manila and in the more urbanized sectors of the country.

According to the World Health Organization, “competition is the single most powerful policy instrument for lowering medicine prices.” But there is no healthy competition in the Philippines. Multinational companies control 80 percent of the local drug industry. There is no drug manufacturing firm in the country, only distributors. Selling/retailing of medicines is monopolized by two drugstores cornering 90 percent of the market while the remaining 10 percent is supplied by 10, 000 small drugstores nationwide. Discount on senior citizens is not given tax credit which becomes a burden to small drugstores.

Policymakers should also address other issues which impinge on improving access to medicines. For example, rational use of medicines requires legislation on ethical promotions, education and enforcement of the National Medicines List. As a first step, the Department of Health should be encouraged to pursue its campaign against the unethical promotion of infant formula products.

Generics Law should also be reviewed. After two decades of implementation, generics law has not succeeded. There is poor compliance to Generics Law by health professionals themselves. There is low patronage to generic medicines due to lack of education among the general public. There is also inadequate monitoring and enforcement of quality of drugs. An oversight is needed to probe why the Philippines still has problems with pricing of medicines and why other countries are succeeding.

There are many policy options to achieve equity pricing aside from promoting generic drugs. Government can implement differential pricing and drug price monitoring, Intellectual Property Code flexibilities like parallel importation and compulsory licensing and improvement of local generic production.

The good news is that Congress has prioritized the passage of the Cheaper Medicines Bill. Even President Gloria Macapagal-Arroyo highlighted the need to lower drug prices during her state of the nation address. The bad news is that big pharmaceutical companies are prepared to allot billions of lobby money to prevent the enactment of a drug pricing regulation measure. The two houses of Congress should also harmonize different versions of the bill and various approaches in lowering drug prices.

More than five bills were filed in the House of Representatives which will amend the the Intellectual Property Code and spur the local industry to undertake development of patented products and encourage the government to conduct parallel importation of cheaper generic drugs to give more affordable choices to consumers, especially the poor. Senator Mar Roxas was the first to propose this measure.

Congressman Ferjenel Biron is proposing the creation of a drug price regulatory board which he described as the “more revolutionary measure.” He believes lowering the price of medicines cannot be accomplished alone through amendment of the Intellectual Property Code since patented products represent only 5 percent of medicines consumed in the country. On the other hand, there is fear that a drug price regulatory board can be used by the dominant multinational drug companies to dictate drug prices.

There may be differences in views on what should be the best national approach to improve access to medicines, and hopefully Congress would resolve these differences quickly, but there is consensus that drug price regulation is a state obligation.

The country is losing its doctors and nurses, medicines are expensive, public health spending is low and Filipinos are dying without receiving medical attention. Could this be the government’s population control policy?

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Random pictures from my photoblog.

MILB*

I’m back as Yehey! news editor.

Last month, four thousand Filipino mothers from 156 different locations in the country set a new world record by simultaneously breastfeeding their children at 10am. This event was meant to encourage more women to recognize the supreme nutritional benefits of a mother’s milk over the much advertised infant formula.

The Department of Health is behind this advocacy since it is also alarmed over the declining number of breastfeeding women in the country. The World Health Organization estimated that 16,000 children below 5 died in the Philippines due to improper feeding practices, including use of infant formula in 2003. According to the Unicef, only 16 percent of Filipino children between 4 and 5 months old are exclusively breastfed while 13 percent of mothers do not breastfeed at all.

This figure is frustrating since so many innocent children are deprived of the nutrients contained in a mother’s milk. A primer of the Food and Nutrition Research Institute-Department of Science and Technology reveals the natural wonders of breastfeeding:

“The initial liquid that flows from the human breast is colostrum, the yellow fluid produced during the first three days after delivery. It is rich in vitamins, antibodies, and immune-system cells that protect the newborn from gastrointestinal disease and other infectious disorder. The colostrum hastens the excretion of meconium, the stool passed by newborn after birth. The colostrum contains Lactobacillus bifidus factor, which encourages the growth of Lactobacillus bifidus, the intestinal friendly bacteria, that hinders the growth of potentially toxic bacteria in the intestine. The human milk is thin and almost watery in appearance and often has a slight bluish tinge. The breast milk protein forms soft, light curd in the infant’s stomach and is easy to digest. The lipids in breast milk are high in linoleic acid and cholesterol needed for brain development. It contains long-chain omega-3 fatty acids, such as docosahexaenoic acid (DHA), used for synthesis of tissue in the brain, nervous system, and eyes.”

According to further studies, children using infant formula are 25 times more likely to die of diarrhea than those who are breastfed. The National Commission on the Role of Filipino Women clarifies that breastfeeding does not cause sagging breasts. Breastfeeding also helps in bringing back a mother’s figure because of the hormones that are secreted during breastfeeding. Health authorities believe breastfeeding can save the nation P21.5 billion in infant formula products which people can use for other basic needs like food, clothing and education.

During the term of President Corazon Aquino, breastfeeding was promoted through the promulgation of Executive Order 51 or otherwise known as the Milk Code. Eventually, Congress approved Republic Act (RA) 7600 known as “The Rooming-In and Breastfeeding Act of 1992” which facilitates breastfeeding to newborn children.

Despite these measures, use of infant formula continues to surge to this day. In fact, infant formula products are among the most imported goods in the country. One reason attributed to the popularity of these goods despite being expensive and vastly inferior to breast milk is the aggressive advertising of milk companies. The public seems mesmerized by milk ads which claim to make children more intelligent, healthy and strong forgetting that infant formula remains a poor substitute to breast milk.

Perhaps noting how these exaggerated ads may have done a great public disservice, the Department of Health imposed a ban on the promotion and advertising of breast milk substitutes last May 2006. This regulation was challenged by milk companies in the Supreme Court arguing that it infringed on freedom of trade and the freedom to inform the public on infant formulas. The Supreme Court sided with the petitioners and granted a temporary restraining order which prevented health authorities to enforce the ban on milk ads. The order is still effective today.

Last weekend, this matter became headline news again when economist Solita Monsod reminded the public how Trade Secretary Peter Favila endorsed the appeal of milk companies regarding the DOH regulation. Apparently, there was pressure from US businessmen to rescind the ban on infant formula ads which they claim will cost them $128 million.

From this moment, the issue is no longer breast milk versus infant formula. It now behooves us to ask whether public health was compromised by acceding to the demands of corporate interest. Is the obsession to create a good business climate to foreign investors necessarily requires the abandonment of public good?

The DOH regulation of infant formula ads is among the concrete measures initiated by the government to improve delivery of health services in the country. We can also cite the Cheaper Medicines Act which Congress failed to approve on time. It seems public health care is held hostage both by powerful corporate lobbyists and irresponsible lawmakers. This will further worsen health situation in the country.

* Mom, I love to breastfeed!

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