Bloated population results in poverty
BY AMADO P. MACASAET
Transplantation debates
A.G ROMUALDEZ JR., M.D
‘Allowing paid or compensated organ donations in the face of existing grave health inequities is unethical and unjust.’
THERE are times when zealous advocacy overwhelms reason in debates over health policies. Such seems to be the case in the tempest that has been stirred around the "Forum on Incentivized Donation from Living and Deceased Donors" sponsored by transplant advocates at the National Kidney and Transplant Institute.
The featured speakers at the forum were a Minnesota-based transplant surgeon and a psychiatrist from Washington, DC. The visitors are well-known experts who favor allowing the provision of incentives to encourage living individuals or the relatives of the newly deceased to donate organs (particularly kidneys) to patients in the last stages of organ failure whose only chances for survival lie in transplantation. Their arguments have resonated with a number of transplant surgeons as well as some nephrologists who care for patients on hemodialysis and in desperate need of severely limited kidneys available for transplantation.
What especially riles opponents of the proposition to allow payment for organ donations is the participation of Health Secretary Enrique Ona, a noted transplant surgeon and known advocate of more liberal organ donation policies. They are particularly concerned that the Secretary will overturn the restrictions contained in an administrative order signed by his predecessor.
As in any controversial issue however, there are extremists on either side. Those who lobbied hard for the restrictive administrative order and oppose its revision include individuals who will not tolerate any transplantation program at all and would push for a ban on all transplant programs. At the same time, those who support opening up organ donation policies to encourage more donors and improve the supply situation for transplantable organs include radicals who would remove all regulatory barriers to full expression of free market forces.
In the matter of the controversial forum at the Kidney Institute, it appears that those who support restrictions have gone to the extent of restricting even the legitimate exercise of freedom to advocate the opposite view. They are suspicious of any group that would even hint that the existing administrative order would require review and possible revisions from time to time. They are convinced that the present dispensation at the Department of Health is bent on rescinding the order in the shortest possible time. This group had even gone to the extent of attempting to get Malacañang to stop the forum. It appears that some of them would go further and carry their fight to the confirmation process in Congress.
Fortunately, there are the proverbial cooler heads on both sides of the debate. Most moderates believe that Secretary Ona is capable of implementing the Aquino administration’s agenda to introduce meaningful change in the Philippine health system in order to make health services available to the greatest number of Filipinos. For these groups, the transplantation issue is a distraction, albeit an important one, from the broader objective of a more just and equitable health system.
This column fully agrees with opponents of "transplant tourism" that allowing paid or compensated organ donations in the face of existing grave health inequities is unethical and unjust. In fact, this writer favors a review of the existing administrative order with a view to eliminating the loopholes that still allow unscrupulous private individuals and institutions to continue exploiting impoverished communities and families by recruiting them as potential kidney donors.
However, there are those who believe that within a well regulated framework, it is possible to accommodate "incentivized" organ donation. In the interest of a thorough scientific and ethical debate, these voices should not be stifled. For this reason, the forum at the National Kidney and Transplant Institute should be a welcome contribution to the on-going transplantation debate.
The existence of counterfeit medicines is recognized as a serious threat to health all over the world. Traffickers in fake drugs probably do more harm to larger numbers of innocent people than those who deal in conventional dangerous drugs. Fake anti-malarials and ineffective antibiotics are especially cruel because they are inflicted on individuals (many of them young children) and communities who are already marginalized and less protected than others.
Unfortunately, the way forward to combatting drug counterfeiting has been muddled by groups who seem to place commercial gain above public health security in the discussions of anti-counterfeiting measures. This is a point recently made in a news article in one of the world’s most prestigious medical journals, The Lancet.
The article was a report on a "proposed treaty to criminalize the manufacture and trade in counterfeited drugs and other medical products" to be known as "the Council of Europe’s MEDICRIME Convention"’. The treaty is due to be signed by European Ministers of Justice at their meeting in Istanbul on 25 November 2010.
Although the journal and most health observers strongly support the objectives of the proposed treaty, the article points out some serious defects that would render it ineffective and possibly even more injurious to the objectives of ensuring access to safe and effective medicines for all people especially the poor.
"First, the proposed MEDICRIME Convention contains a poison pill that would severely impede new generic drugs." It is likely that this is due to the influence of institutions such as multinational companies that persist in invoking intellectual property protection for their products even to the detriment of access and availability to the poorest of peoples.
"Second, the MEDICRIME Convention proposes to criminalize honest medicine manufacturers for unintentional mistakes." This article penalizes suppliers who can make honest mistakes about the quality assurance of their sources. Again, an overly strict interpretation of counterfeiting may work against those who are trying to be helpful to countries.
"Third, Europe’s medicine policy is distrusted by important developing countries, particularly India and Brazil." This situation became apparent during the discussions on intellectual property rights implications for the global pharmaceutical industry at the World Health Assembly last May.
To avoid these pitfalls, The Lancet supports suggestions from a number of public health advocates that signing of the treaty in its current form be held in abeyance until a more open and transparent process can be organized to correct the enumerated defects. It is further suggested that the process be led by the World Health Organization modeled after the successful negotiations on the "Framework Convention on Tobacco Control" that has now been signed and agreed to by the overwhelming majority of WHO’s Member States.