Medicine-wise

PINOY KASI


Medicine-wise
By Michael Tan
Inquirer

Last updated 00:12am (Mla time) 02/07/2007

MANILA, Philippines--“CAN I use my senior’s discount card?” asked the woman in front of me in the line, as she was about to pay for the medicines she had just bought.

“Only if it’s accompanied by a prescription,” tersely answered the woman at the cash register.

I could tell the woman was hard up, as she groped through her purse to bring out mostly coins to pay. But my pity gave way to horror when I saw what she was purchasing: one tablet of Trexil and one tablet of Cefalin.

Both are antibiotics and there is no way you can effectively treat any ailment with one tablet of each of the antibiotics. I could only hope the woman was, like many Filipinos, buying medicines "tingi" (in small amounts), and that she’d eventually be able to take enough of a correct dose to have some effect on whatever ailment she had. But, for the life of me, I couldn’t think of what ailment you would treat with the combination of medicines she had bought. (For those with medical background, Trexil is one of the brand names for amoxicillin while Cefalin is a brand name for cephalexin.)

How expensive?

We have the "tingi" buying system because of the high prices of medicines. I’ve lost count of the times when I’ve seen people in drugstores reducing the number of tablets they need, or opting not to buy any at all simply because they didn’t have enough money.

Filipinos have suffered too long from these high prices. The government and NGOs respond from time to time, trying to find ways to reduce the prices. The Generics Act of 1988 was one such attempt. In recent years, the government has tried parallel imports, bringing cheaper versions of brand name drugs from their subsidiaries in other countries. And recently, a bill was filed in Congress to work for cheaper imports. The Inquirer carried a full-page ad the other day from NGOs, like the Coalition for Services to the Elderly (COSE), calling on Congress to pass the bill.

It’s unlikely Congress will, given the politicians’ attention is now focused on the May elections. Besides, I wonder if importation alone will solve the problems. We just haven’t given enough attention to developing a stronger local drug industry to help make drugs more affordable.

The United group of companies has helped to some extent, with generic lines like Rite-Med. They’ve also come up with lower-priced brand name versions that put up some competition with the multinationals’ products, as we saw recently in the battles with a heart medicine.

But even the lower-priced versions are still expensive, relative to what Filipinos can afford and to what the same medicines cost overseas. About two years ago, I wrote about my own experiences with propranolol, a drug for hypertension. I was buying 40 mg of Inderal in the Philippines at P12 each, but in Bangkok, I found I could get another brand name version for P3 each.

The price of Inderal is now P14 each in the Philippines, but the price of the brand name version in Bangkok has remained the same. Not only that, during a recent trip to Vietnam, I found a generic version that cost far less. Not P2, not P1, but P0.85 each.

Market intelligence

The multinationals scare people by saying cheap drugs are probably fake drugs. But many of the cheaper versions of medicines, including the ones being brought in by the government through parallel importation, are produced by the same multinational companies. And the low-price drugs I found in Vietnam come from Apotek, a respected Canadian generic drugs manufacturer.

Filipinos are taking action on their own with “market intelligence,” figuring out where to get good medicines at low cost. I have friends, physicians and nurses, who buy their medicines abroad, whenever they attend conferences and workshops, some even having developed "suki" (regular client) relationships with reliable drugstores. Similarly, people living with HIV/AIDS learned, years ago, to bring in cheaper medicines from Thailand and India, with the help of international NGOs.

But what happens to the millions of Filipinos who don’t travel abroad, or don’t have networks for accessing low-price medicines?

Learn to use the law. The Generics Act requires drugstores to carry price lists to help customers choose from different brand and generic names and I’ve seen many pharmacists and drugstore clerks helping customers with choices.

I’ll give one more personal experience here to make my point. It’s that time of the year when many Filipinos have allergy problems. I use cetirizine and for many years had only one expensive choice: Zyrtec. Now that cetirizine is off patent, there are a few alternatives but you won’t know unless you ask. The larger drugstores are too busy to give you choices, but if you go to a smaller one, like I did, the clerk will give you several choices: Zyrtec at P39.65 each (with a buy 6, get 1 free offer for P217.70), Virlix at 39.65, and Alnix at P25.30. At another drugstore the clerk gave me a choice between Zyrtec, Alnix and Histamed, the last one priced at P25.00 each but they were out of stock.

It may be more time-consuming, but it pays to be medicines-wise. And that might include not taking a medicine unless you really need it. Cetirizine causes drowsiness and I have to finish this article so I’m bearing with the itching before I take my Alnix -- while regretting I didn’t buy my cetirizine in Thailand, where it costs about P3 each.

Karma

I’d like to go back to the woman I mentioned at the beginning of my article. The woman’s purchase was only one example of what happens when the costs of medicines are beyond the reach of people. And frankly, I don’t know what’s worse, not being able to buy the medicine at all, or buying an inadequate amount.

The adverse impact isn’t just on the indigent patient. This "tingi" use of antibiotics is just unacceptable and will, in the long run, affect other people as well in the form of antibiotic resistance in the general population. It’s already happened with many other infectious diseases. For example, we have one of the highest rates of resistance to anti-tuberculosis medicines in the world, mainly because there was so much self-medicating with the medicines, and the use of incorrect doses. People were also stopping treatment even before the infection had come under control. The cost factor was always there, behind what doctors call non-compliance.

There are also super-strains of gonorrhea resistant to several antibiotics, again because Filipino men were taking antibiotics for “prevention.” (For the readers’ general information, taking antibiotics does not prevent gonorrhea, or any other sexually transmitted diseases. Only condoms have been proven effective.)

I don’t know, but the problems we have with antibiotic resistance may be a kind of karma, the result of our not doing enough, as consumers, as government regulatory officers, as educators, to help people get those low-price, good-quality medicines and to use them wisely.