oday, Christians
throughout the world celebrate the birth of the infant Jesus. By all accounts
the birth did not take place in an ideal setting from the public health
perspective. Christ’s mother was a high-maternal risk teen-aged girl without
benefit of such prenatal preventive interventions as tetanus immunization. She
gave birth in a stable surrounded by farm animals any of which could harbor and
transfer infectious organisms to both mother and child. Except for Joseph, the
human father, there were no other persons, let alone professional health
workers, in attendance.
But then again, this was a very special birth. There was no
need of human intervention to prevent perinatal adverse events from harming
either mother or child. In lieu of birth attendants, shepherds from nearby
fields and angels from the heavens appeared to glorify what turned out to be the
most important baby of all time for the Christian world.
Two thousand years later in this modern day and age, there
are still many women who give birth to children in very high risk situations.
For many, scientific methods of ensuring reproductive health and responsible
parenthood are unavailable because of lack of access to information and services
sue to poverty or governmental neglect.
***
The Philippine Congress has given the Filipino people a
welcome Christmas present in the form of legislation that will help halt the
increasing prices of medicines. Although the Senate had easily passed its
version of the "Affordable Medicines Bill", the House version, labeled the
"Cheaper Medicines Bill" had some stormy moments and barely squeaked through
before the Christmas break.
The bicameral negotiations to reconcile the two versions
promise to be, at the very least, quite interesting. There are several
contentious points marking the differences between them.
The House Bill mandates the creation of a "Drug Price
Regulatory Board" to ensure that prices of essential medicines are not allowed
to exceed maximum limits to be set by government. This notion is anathema to
free market advocates who are fairly well represented in the Senate. A
compromise version of this proposal may well be an appropriate solution to what
could be an impasse that could frustrate cheaper medicine proponents.
While price control may be the most high-profile issue, there
are a number of other differences that may well further delay the law’s passage.
There were a number of attempts in the lower House to dilute some of the
intellectual property provisions of the Senate Bill. For example, there was
strong criticism of the provision that would prevent patent-holding
multinational companies from using minor chemical alterations to extend a drug’s
patent monopoly period (also known as "ever greening"). If any of these
alterations are allowed, the intellectual property revisions would be so badly
flawed as to allow global pharmaceutical giants to maintain hegemony over
vulnerable markets like the Philippines.
One point that may attract dissent from some quarters of the
medical profession is the provision intended to strengthen the Generics Law of
1988. The article prohibits the inclusion of brand names in medical
prescriptions altogether. The more conservative older practitioners have raised
an old argument that emphasizes the notion of physicians’ sole prerogative to
decide what medicines his patients take.
Many younger doctors, trained in the post-Generic era, may
find this notion rather quaint and not in keeping with the times of
patient-centered team approaches to health care. Nevertheless, their more senior
colleagues do have a point when they argue that there may be issues of patient
safety if safeguards at drugstore level are not put in place by government
regulatory bodies. In any case, most advocates of generic drug use believe that
the strengthened provision, if it remains, should be the subject of intensive
stakeholder discussions during the preparation of the implementing rules and
regulations.
***
The General Appropriations Act is another possible bone of
contention in the bicameral discussions between the Philippine Senate and the
House of Representatives. The House proposal includes a major increase in social
expenditures including the budget of the Department of Health. One danger is
that the bulk of these increases will again go to expensive curative fixtures
such as retained hospitals. Of particular public health interest is the proposed
one billion peso budget for tuberculosis control – a critical measure if the
Philippines is to be weaned from donor-dependency in its major public health
programs.
***
The first Rafael M. Salas Golf Cup will be launched on January 17, 2008 at
the Eagle Ridge Golf and Country Club, General Trias Cavite, with former
President Fidel V. Ramos leading some of the nation’s most avid golfers. The
tournament is for the benefit of the advocacy group, the Philippine Forum for
Population and Development.