Access to medicine

I WORRY at times that all the publicity about "AIDS drugs," especially with the ongoing international AIDS conference in Bangkok, might be making people complacent, as they begin to rationalize, "Oh, there's a cure now for AIDS, so why worry?"

Sorry, but there are many reasons to still worry. First, these drugs are not cures. The more accurate technical term is "anti-retrovirals," which means they work against the virus that causes AIDS, but only in terms of slowing down their reproduction, with completely eliminating the virus from a person who has been infected.

No doubt, the results can be dramatic. Up to the mid-1990s, whenever I had to lecture in workshops and seminars, I'd point out that a person with HIV (the virus that causes AIDS) would be very fortunate if he or she lived 10 years after an infection. These days, I meet people who acquired HIV almost 20 years ago, and are leading very normal and productive lives, because they are taking the antiretrovirals. In effect, the medicine has transformed HIV infection into a chronic disease like diabetes, with lifelong treatment.

Sadly though, that lifelong treatment of HIV happens mainly in developed countries. In the Philippines and many other developing countries, a person with HIV will live only a few years. Which takes me to the second reason why, in this age of "AIDS drugs," we still need to worry: The antiretrovirals are much too expensive, with the cost running to about 10,000 dollars a year. That's more than a half a million pesos.

The situation isn't all that hopeless though. The 10,000 dollars applies to medicine produced by large multinational drug companies. In recent years, there have been attempts, mainly in Thailand, Brazil and India, to bring down the costs. One Indian company, Cipla, has dramatically brought down the cost to about 250 dollars a year.

Considering that Cipla is still able to make a profit offering the medicine at that price, you can imagine what's being raked in by the multinationals. As usual, these companies claim Cipla's drugs are inferior and that the Indians are violating patent laws, but in the meantime, they have also lowered the prices of their medicine, supposedly as a humanitarian gesture. The United Nations and the US government have also gotten into the act, offering funds to help purchase the medicine from these larger companies.

Has all this helped Filipinos with HIV and AIDS? Not really. Access to the medicine remains limited. A few are able to get their drugs in Thailand, or from support groups in developed countries, but most Filipinos with HIV are resigned to a short life. The funerals continue, and I am sometimes shocked to hear the deceased was infected only three or four years ago.

But then, I remind myself, we also have Filipinos dying of other diseases for which curative drugs are available, from hypertension (high blood pressure) to tuberculosis. This high death toll from curable diseases only highlights the very pressing need to implement a national policy on medicine.

There is, foremost, the problem of prices, and I will use a personal example to show how serious the problem of affordability can be: the drug propranolol, which I have to take for high blood pressure. In the Philippines, a 40 mg tablet of Inderal, a branded preparation, costs 11 pesos but over the last few months, because age often makes me forget to pack in my medicine for travel, I've had to occasionally buy that medicine in other countries, and the differences have been shocking.

In Thailand, where you can actually go around drugstores and bargain, the same branded preparation, Inderal, costs between six and eight pesos each. I was amazed at how cheap it was, until I got to India, where drug prices are fixed and the price of Inderal came tumbling down to something like four pesos.

Curious, I asked about the costs of other versions of propranol, both branded and generic. Lo and behold, the prices went further down to as low as two pesos, and I've learned some of these generic versions are available locally.

I know that local multinational companies are going to be writing to the editor and to me attacking these cheaper versions as "inferior" and "counterfeit." Give me a break and spare me the excuses. My Indian and Thai physician friends did warn me too about that problem and would refer me to reputable sources, so the prices I gave are for "real" drugs, which I've taken without problems.

Let me use one more drug as an example: the antihistamine cetrizine. Sold under the brand names Virlix and Zytrec, a single tablet costs almost 30 pesos. In Bangkok, generic versions are available for about five pesos each. I asked several drugstore owners why it was so cheap and the answer was always the same: competition. The Thai government has its own drug manufacturing facility, and also supports local generic manufacturers. When the patent expires for a drug, several manufacturers will rush in to produce it, creating true competition as capitalism should have, and even the multinationals are forced to bring down their prices.

Some of my friends in the multinationals apologetically explain that they price drugs according to what the local purchasing power is, yet they can only smile when I point out that Thailand is wealthier than the Philippines. And in developed countries, where the prices of medicine are indeed higher than in Third World countries, governments often subsidize the costs of medicine.

It's sad that we've modeled our health care system, including our pharmaceuticals production and supply, after that of the US, which leaves prices mainly to "free market forces". Sure, there's Medicare, similar to our PhilHealth, but reimbursements for medicine are terribly limited. It's not surprising that even American patients, especially the elderly with their many drug needs for chronic diseases, are complaining bitterly and pressuring their politicians to find ways to bring down the costs. This has included exploring the possibility of importing lower-costing medicine from Canada.

Our own government has experimented with a bit of parallel imports, bringing in cheaper branded preparations from India, but the supplies are limited to government health facilities.

Access to medicine certainly involves more than costs, but affordability remains the key issue and government must exert more effort to intervene, perhaps even going into drug manufacturing and importing, or providing incentives for local drug companies that are serious about producing generics or cheaper branded preparations. Both government and private insurance companies also need to find ways to increase support for essential drugs. Ultimately, we need to introduce real competition into our pharmaceuticals market to bring down prices so Filipinos won't have to continue to suffer, and die needlessly.