Tulfo, Herbosa argue over pharma-sponsored trips for doctors

Health Secretary Teodora Herbosa and Senator Raffy Tulfo engaged in a heated argument during a Senate hearing on Tuesday over the "junkets" supposedly sponsored by pharmaceutical companies in exchange for physicians' preference to their manufactured medicines.

During a Senate health committee hearing, Tulfo raised this "rampant" practice among doctors as he questioned why public hospitals often use branded medicines for their patients, especially those who were admitted in their facilities, instead of generic medicines that are way cheaper.

Herbosa, a physician himself, explained that while there is an existing executive order on the use of generic drugs in public hospitals, there are cases that the generic medicines are "not clinically effective."

"Not all drugs are created the same. So even if they are generic, it doesn't mean may (they have) potency. Kung minsan, 'yung (sometimes, the) percentage of the available active component is also lower. So 'yun 'yung mga problema po (so that's the problem), sometimes, it's cheaper but the quality is not that good," Herbosa said.

Herbosa also noted that all the procurements in public hospitals undergo public bidding as this was provided under the law, and most of the time suppliers of generic medicines win the bidding due to its price.

The Health secretary, however, explained that generic medicines or even anesthesia were being replaced with branded because of its efficacy.

'Half-truth'

But Tulfo asserted that doctors prefer to prescribe branded medicines due to the trips sponsored by pharmaceutical firms.

"I'm not saying na you're lying pero (but) I am saying na half-truth 'yung mga sinasabi niyo (what you are saying is a half-truth). I'll tell you why bakit pine-prefer 'yung mga branded sa mga ospital, sa mga pharmacy, bakit nireseta. Kasi nga po may tinatawag na junket (doctors in hospitals prefer branded medicine, because of junkets)," Tulfo said.

"'Yung mga doktor ginu-good time ng mga pharmaceutical companies [sa] mga seminar, sa abroad, schooling, free airfare, business class, hotel accommodation, food, entertainment, etcetera, etcetera, and we're talking by the millions of pesos, or even dollars," he added. 

Tulfo pointed out pharmaceutical firms will not sponsor trips if they are not expecting something in return.

"What's in it for us? You scratch my back, I'll scratch yours. Ganon po 'yun. Kaya itong mga doktor, magre-reseta sila ng mga branded kasi 'yun yung nanggu-good time sa kanila. 'Yung generic na hindi nanggu-good time sa kanila, hindi nila irereseta," he said.

(That's how it is. That's why these doctors prescribe branded medicines because these were made by the firms that sponsored the trips. Makers of generic brands don't sponsor trips.)

Tulfo claimed there are trips to the United States, Canada, and Australia for doctors that were already scheduled until the end of the year, adding he can prove this allegation from doctors who have divulged this information to him.

"Kung minsan 'yung isang hotel sa Las Vegas punong puno 'yan ng mga doktor from different countries kasama d'yan ang Pilipinas... Libre pa pati pangsugal sa casino," he said.

(Sometimes a hotel in Las Vegas is occupied by doctors from different countries, including the Philippines... the doctors even receive money to be used in the casinos.)

Mexico Protocol

While Herbosa acknowledged that there were "junkets" before, he said that the Philippines has become a signatory to the Mexico City Principles which provide voluntary codes of business ethics in the biopharmaceutical sector.

"Meron po tayong tinatawag, Mr. chair, na (We have this thing called the) Mexico Protocol, and the Philippines follows this professionally. All professional organizations are supposed to not accept 'yung ganitong (these) gifts from the pharmaceutical industry based on the Mexico Protocol," Herbosa said.

"Tayo po ay signatory and all professionals are expected to do so. Kung meron pong makitaan na ganitong kaalaman, kinakasuhan po 'yung pharmaceutical company at pine-penalize sila. So, meron silang penalty from their own association, the Philippine Association of Pharmaceutical Industry. So nagse-self police sila d'yan among them pagka may nagja-junket," he explained.

(We are all signatory and all professionals are expected to follow it. If something like this happens, pharmaceutical firms are charged and penalized. They are penalized by their own associaton, the Philippine Association of Pharmaceutical Industry. So there is self-policing.)

Still, Tulfo was not convinced.

"Doc, hindi ko na matiis po (I can't take it anymore). Were you born yesterday? This practice violates the code of ethics of the medical profession for doctors because number one, it affects the autonomy in giving the best and most affordable healthcare to the patients. Number two, in a way exploits patients for the doctor's personal gain. Number three, it does not improve access to equitable healthcare," Tulfo asserted.

Herbosa responded to a vividly agitated Tulfo and said that charges can be filed against pharmaceutical companies that give "gifts" to doctors and these gifts should be declared as donations or grants to hospitals and educational institutions.

If the physicians were found to be receiving benefits or gifts from pharmaceutical companies, Herbosa said cases against them should be filed with the Professional Regulation Commission (PRC).

Call to DOH

Tulfo insisted that the Department of Health (DOH) should lead in addressing this matter, noting that there were no cases that were filed against anyone.

"It's your job d'yan sa DOH para to find out bakit nangyayari pa rin ito. At kung nangyayari ito, sampa kayo ng kaso. Meron bang nasampahan ng kaso? Wala," Tulfo said.

(It's your job in the DOH to find out why this is happening. And if it is, to file cases. Has there been anyone charged? None.)

"What I'm trying to point out here, there's regulation, but hindi nare-regulate. There's regulation pero hindi nai-implement. Implementation is important that's why we're here today. That's why you're there as the secretary of Department of Health," he went on.

Herbosa committed to implement the regulations and investigate Tulfo's claims.

"We will investigate this and your claims. We'll be happy to receive any knowledge that your office has and we will conduct the further investigation," he said. —KBK, GMA Integrated News