Saturday, September 29, 2007

Essential Medications for All

I met a young physician yesterday who has his heart set on producing safe and effective generic medications for the 80% of the population who are unable to purchase medications for hypertension, diabetes, asthma, peptic ulcer disease and infectious diseases.

Throughout the campaign, I had advocated for Filipinos producing their own medications. Why resort to importation from other nations when we can produce these drugs in our own country? Most people are not aware that drug prices in the Philippines are more expensive anywhere in Asia except for Japan. This is because we Filipinos have very little say when it comes to multinational drug companies dictating prices. Here in our country, drug companies are reaping great profits essentially because they can get away with it . Our government does not encourage competition and would rather let the majority of our people go without their essential medications rather than tangle with the wealthy and powerful drug industry. In no way is this an indictment of pharmaceutical companies because these entities are simply pursuing their stated business goals which is to manufacture quality products and realize as much profit that is possible. It is a miserable reflection of our weakness that we have always appeared powerless to determine our destiny.

Medications do not have to be as expensive as they are in our country. Even if we still have to import all the raw materials needed to compound these drugs, the actual cost of producing these drugs is relatively negligible, for example:
Celebrex: 100 mg Consumer price (100 tablets): $130.27 Cost of general active ingredients: $ 0.60 Percent markup: 21,712%
Claritin: 1 0 mg Consumer Price (100 tablets): $215.17 Cost of general active ingredients: $0.71 Percent markup: 30,306%
Keflex: 250 mg Consumer Price (100 tablets): $157.39 Cost of general active ingredients: $1.88 Percent markup: 8,372%
Lipitor: 20 mg Consumer Price (100 tablets): $272.37 Cost of general active ingredients: $5.80 Percent markup: 4,696%
Norvasc: < /I>10 mg Cost of general active ingredients: $0.14 Percent markup: 134,493%
Paxil: 20 mg Consumer price (100 tablets): $220.27 Cost of general active ingredients: $7.60 Percent markup: 2,898%
Prevacid: 30 mg Consumer price (100 tablets): $44.77 Cost of general active ingredients: $1.01 Percent markup: 34,136%
Prilosec: 20 mg Consumer price (100 tablets): $360.97 Cost of general active ingredients $0.52 Percent markup: 69,417%
Prozac: 20 mg Consumer price (100 tablets) : $247.47 Cost of general active ingredients: $0.11 Percent markup: 224,973%
Tenormin: 50 mg Consumer price (100 tablets): $104.47 Cost of general active ingredients: $0.13 Percent markup: 80,362%
Vasotec: 10 mg Consumer price (100 tablets): $102.37 Cost of general active ingredients: $0.20 Percent markup: 51,185%
Xanax: 1 mg Consumer price (100 tablets) : $136.79 Cost of general active ingredients: $0.024 Percent markup: 569,958%
Zestril: 20 mg Consumer price (100 tablets) $89.89Cost of general active ingredients $3.20Percent markup: 2,809
Zithromax: 600 mg Consumer price (100 tablets): $1,482.19 Cost of general active ingredients: $18.78 Percent markup: 7,892%
Zocor: /B 40 mg Consumer price (100 tablets): $350.27 Cost of general active ingredients: $8.63 Percent markup: 4,059%
Zoloft: 50 mgConsumer price: $206.87Cost of general active ingredients: $1.75 Percent markup: 11,821%

because once we stop subsidizing enormous marketing expenses (which includes the vast amounts of money spent convincing prescribers to stay with brand names and not give generics the opportunity to prove themselves) and immorally immense profits, we can expect a steep price drop.

This young doctor is the research director of a start-up company that will produce, or more accurately compound raw material originating in Europe to make antihypertensive like amlodipine and losartan; drugs for diabetes like metformin; antibiotics like cefuroxime and even anti-obesity agents like orlsitat. In no way am I endorsing his company. I would like to give him the opportunity however to prove to all of us that a local company can produce effective, safe and affordable medications. They are already very busy warding off several legal challenges and conforming to expensive government regulatory procedures. This is the least we Filipino physicians can do, give these entrepreneurs a chance to profitably capitalize on a perennial problem that will benefit the greater good.

Thursday, September 27, 2007

Will We Ever Get It?

Most people with cable television watched intently the Senate hearings concerning corruption in the highest government offices in the land. There was live blogging and this being the Philippines, there certainly was no shortage of comments or opinions from our national surplus of pundits.

Many people were secretly expecting the government to fall after the former economic planning minister exposed the attempts of the election chief to influence, through brazen bribery the awarding of a broadband contract with a Chinese corporation. It was as if we had never known that official corruption officially existed all along and as if we expected our newly-minted Senators to ferret out the truth. What a joke! The old reliable clowns all acted with reliable predictability. The Diva staged a walkout. Our learned protectors displayed all sorts of legal legerdemain with the sole express purpose of protecting their private playing grounds. And the former economic planning minister punted on his chance to become a hero by simply doing his job and remain true to the Filipino people he swore to serve. Instead he woefully fell short and mumbled a series of excuses averring executive privilege.

These are the times that try my soul. Corruption is so pervasive and lethal yet we are all so wrapped-up with our personal loyalties. There are literally thousands of upper-level government employees who know that corruption is a daily event and while most of them are not active participants, none of them would even consider rocking their sinecures and blowing the whistle on their patrons.

Will we ever get it? The problem appears to be much worse than we thought. We all assumed they were being born at the rate of one a minute. It’s turning out to be a generation-wide pestilence. We have seen the suckers, and they are us.

Sunday, September 23, 2007

The Library

This is our library, the result of years of collecting from bookshops and catalogues. There is a marked bias for books on history and politics. We also have a big poetry section. A decided advantage of small-town living is the amount of time available for reading books at night. Too bad you can't see the speakers artfully concealed from which classical music wafts throughout the evening.

We regularly read the reviews from the New York Times. Popular books with large prints would usually be available at Sam's which would always be cheaper compared to Barnes and Noble. Many bargains can be had through Daedalus and there are special catalogues for out of print tomes.
This is a view of our beloved bar. Check out the wine cooler at the base. The special stain was specifically chosen by my wife. Lately, the drink of choice has been Tanqueray Rangpur with tonic.

Wednesday, September 19, 2007

Welcome to the Clinic

This is a photo to the entrance of the Specialty Clinics of St. Anne, built in 2000, designed by my classmate Noel Gamboa a New York City-based architect. Previous to this, my wife and I had practiced in a mobile home that was parked close to the Memorial Hospital of Texas County.

The signage has changed through the years. We had the Amarillo Heart Group practice in the facility for a year. Dr. Steen Andersen saw his OB patients for about two years. The surgical group based in Liberal, KS also used to come down twice a week.

We've worked hard to keep the plants and the trees healthy. The Catalpa trees were imported from San Angelo, TX. Look how they've grown. We added a pharmacy at the northeast part in 2005.

There are seven examination rooms in the east side of the clinic and there are four on the west side. There is a complete endoscopic suite as well as a laboratory for chemistry analysis and immunological tests. The X-ray facilities are continuously upgraded and the Clinic offers exercise stress and pulmonary function testing.
At the center of the Clinic is a courtyard with a statue of Our Lady. The view is from the breakroom where premium coffee is available all day. I noticed that the hedge which we had painstakingly sculpted to form a cross was being infested by some type of fungus. I hope we can still save it.

Tuesday, September 18, 2007

Our Fearless Leaders

Today we all witnessed the spectacle of a Senate with a shallow bench. Oh, the quality of the questions! It was all about grandstanding and media mileage. Totally unproductive. 10 million dollar bribes here and there no longer surprise us because it has become ingrained, commonplace even in the highest echelons. The one mitigating factor that assuages us all is the fact that all this wheeling and dealing occurred before the husband of GMA had his brush with death. What did we get from all the bluster? Sample question: “how did GMA’s husband talk to you? Remember, I know this waiter who works in the place where you met”.

All the people involved in this deal are from Central Casting. No new names. Election officials, the son of the Speaker, retired military personnel. What do we all know? That the entire country is corrupt. Everyone’s on the take. Nothing gets done. We are all on the know yet we fall into the same trap these traditional politicians spring every single time: we get disgusted, we despair and we resolve never to get involved. We leave governance to them and we trust them to conduct official business with integrity, decency and honesty.

We must become serious with “pulse politics”. Without exception, leadership positions are fixed for a single term with no multiple family memberships. This is the one, best way to put an end to all this nonsense. We have a country with virtually no healthcare infrastructure, poor educational pathways, crumbling roads and bridges and what is the first order of the day? To seek pardon from an unrepentant former president who built mansions for mistresses using public money. What sort of message are we trying to send? We engage in endless expensive inquiries and we are entertained by long-playing trials only to seek at the end the pardon of a member of the ruling class. We need to get real.

Monday, September 10, 2007

I'm Still Here

Ever since the elections, I have been to our clinic in Oklahoma three times. At least 60,000 frequent flier miles. I haven’t posted an entry for some time because I have been covering for one of our physicians here for the past week and it has been busy. It is gratifying to know that patients who stopped coming to the clinic during my absence faithfully return as soon as they know I am back. Guymon, OK is rapidly changing. I was impressed with the brand new Super Wal-Mart that recently opened in our fair town that now provides the community with 24 hour service. A new school was inaugurated to keep up with the burgeoning student population. There are double the number of traffic lights compared to when we first got here 11 years ago and the police department has trebled in size. Rumors are rife regarding the impending construction of another meat packing plant with 3000 employees. There is a lot of progress in the little “medically underserved” town that allowed me to change my visa years ago.

We have kept our house in Guymon. Our books continue to adorn our beloved library and many toys of the children are still stored somewhere. Our yard is being tended by a dear friend and the bar stays fully stocked.

We all try to make the most of our lives and we strive to provide the best opportunities for our children. It just so happened that we were able to build a good life for ourselves here in the US. It required a lot of work and commitment and we had to hurdle many challenges. This is why I am very conscious of the many sacrifices that immigrants have to pull off daily. It would always have been better had the opportunities existed at home and we could be close to family and friends and community but this has never been the case in my lifetime. We Filipinos always had to seek a better life elsewhere. The variety of educational choices, security, technological convenience and compensation were never simply to be found in our country. To the politically unconnected and the unlanded, to those not relying upon a substantial inheritance, the egalitarian benefits of democracy do not exist.

Because our children are in school in Bacolod, I am all alone in our house. After work, the solitude becomes unbearable. This, just after a week. Nothing compared to the years of living alone in inhospitable and intolerant communities.

My patients want me and my family to return to Guymon and it is apparent that I am needed here. What they will never understand though is the striking contrast in the quality of life between the great plains in the US and the great misery found in the majority of the 7100 islands in the Philippines. I can not remain uninvolved in the rescue of my country. So while all these second and third generation scions of political kingpins continue to plot the ruinous course of our nation we just can’t pray for guidance to descend upon them because that’s exactly what we’ve done all along and the consequences have been disastrous.

There is a clear an urgent call for all of us ordinary citizens to become servant-leaders. We must find out how we can best serve our country and help the poor and the weak. All our small contributions pooled together will change our world.