FILIPINO FOCUS
Vol. XVI
No. 2
FEBRUARY 2004
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Far
From Cure
by Henrietta Teresa O. de la Cruz M.D.
WHAT AILS FILIPINOS
THE ASSISTANT PROFESSOR IN THE DEPARTMENT OF BIOLOGY AT ATENEO DE MANILA UNIVERSITY SURVEYS THE AVAILABILITY OF MEDICINES TO THE AVERAGE FILIPINO. THE NEWS IS NOT GOOD.
For many people in far-flung barrios or
villages, anything from the family's canned sardine dinner down to the
baby's antibiotic is available at the neighborhood sari-sari (convenience)
store. The
salesgirl's expert opinion on a drug's efficacy can work wonders in
convincing the local folk – especially when the next alternative to the
store's dusty shelves is miles away, not to mention a day's earnings more
from the local doctor's clinic.
Well-informed?
For many Filipinos, drug information is not difficult to come by.
Direct-to-consumer advertising has a cure for anything from a sore throat,
cough, down to delicate vaginal itching. Promotions have been so effective
that drug consumption patterns have shown that next to antibiotics, cough
and cold preparations and vitamins rank among the highest categories of
drugs sold in the Philippine market between 1998 and 2000.
In a country where the leading causes of morbidity in the same years
(Philippine Statistical Yearbook 2002)???, the mis-prioritization of drug
expenditure may have cost lives. Pneumonia and tuberculosis continues to
rank among the ten leading causes of death in the country.
Limited access
While laymen can be adequately (mis-)guided in the purchase of drugs, the
cost of drugs still limits access for many Filipinos. It has been fifteen
years since the Generics Law, the government's first legislative move to
provide greater access to safe and affordable medicine.
One of the provisions of the law required pharmacies and physicians to support lower-priced, unbranded or generic drugs as a solution to the high cost of branded products. A common analgesic like paracetamol for fever, for example, can be bought for P1.00 (one peso) as a generic product, while its branded counterpart costs as much as P7.00 (seven pesos).
Despite higher prices, branded products continue to be preferred by most Filipinos. Only 10-15 % of the Filipino market purchase the lower-priced unbranded drugs. In comparison, in the U.S., as much as 40 % of the public prefer the same generic drug counterparts.
As many as 64 % of Filipinos rely on self-care in dealing with health problems in the lower income groups. Self-medication is as much a practice in the upper income quartiles, with as much as 50 % reliance on self-care.
Pattern of poverty
Many Filipinos unknowingly shoulder costs for the brighter-colored, fancy
packaging and heavy marketing of labeled drugs. By industry estimates, as
much as 40 to 60 % of the actual chemical drug costs can go into the
advertising and retailing of drug products.
An unfortunate common laborer ekes out the daily minimum wage of P 209.24
(circa $ 3.80) in Manila (already only 44 % of his calculated living costs.)
If he contracts tuberculosis, the cost of the standard triple regimen for
his disease can eat up anywhere from a third to half of his earnings.
For many Filipinos, buying drugs accounts for as much as 40 - 45 % of the
total health expenditures. Such a pattern is not seen in the U.S., where
drug expenditure accounts for a much lower 10 % of the health expenditures.
Tough
opposition
Pharmaceutical industry growth is not reflected in the number of registered
drug manufacturers in the country (only 240 in 1998 versus 222 in 2001). An
ASEAN survey showed, however, that the retail prices of medicine in
Indonesia, Malaysia and Thailand are 40 to 70 % lower than in the
Philippines, according to the Philippine International Trading Corporation.
In a move that could reportedly cut drug prices by half, the Department of
Trade and Industry announced importations from India of at least eight of
the locally most prescribed medicines in 2001. The shipment, worth P 20
million (US $ 362,318.84), included Salbutamol (Ventolin), Beclomethasone (Belcoforte/Becoride),
Atenolol (Tenormin), Cotrimoxazole (Bactrim/Septrin/Septran), Glibenclamide
(Daonil) and Nifedipine (Adalat Retard).
Not surprisingly, the practice of scouring the market for cheaper drugs from
drug subsidiaries has been met with tough opposition. Dr. Michael Tan,
medical anthropologist and former consultant at the Department of Health,
noted that "the multinationals weren't too happy and sued the government"
for such measures.
The cure for many Filipinos is brought farther from their homes when
measures to bring down costs are met with such opposition.
<WM
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