Pharma incentives

At the height of the pandemic, a guy I know lost his father to COVID-19. Vaccines were not yet available at the time to the general public, but there were drugs being used for treatment, with some verified measure of success.

Those drugs, as we know, were expensive. But the guy is well-off and the family could afford to have the father confined in one of the top hospitals in Metro Manila.

Yet the father succumbed to COVID just days from admission. Maybe he had too many comorbidities.

The son, who contracted the virus while watching over his father and also needed treatment, wondered why the patient wasn’t given the drug that was touted at the time to be effective for surviving COVID. The son discovered this while going through the fine print of the rather long itemized expenses in the hospital bill for the emergency confinement.

Did the patient get the best treatment possible?

This question can crop up when doctors fail to cure a person with no chronic or terminal affliction, or worse, when they lose such a patient.

And this is a key concern related to the ongoing controversy over a local pharmaceutical company wholly owned by Filipino physicians.

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Doctors themselves first alerted the public about the activities of Bell-Kenz Pharma Inc. that have been described as unethical.

As detailed by Sen. Jinggoy Estrada in a speech last Monday, Bell-Kenz’s doctor-owners give fellow physicians expensive gifts including cash commissions, luxury vehicles and trips to prescribe the firm’s generic products, including antibiotics and medicine for diabetes and hypertension as well as health supplements.

There are over 60 doctors serving as directors and other officers of Bell-Kenz, Estrada said. The “entry investment” supposedly ranges from P250,000 to P500,000, with the top executives, who apparently are “Star Wars” fans, calling themselves Jedi and second-level investors called Padawan.

Bell-Kenz has a multi-story office building, the Bell-Kenz Tower, in Diliman, Quezon City. Its slogan is, “We make life better.”

Yesterday, Bell-Kenz chairman and CEO Luis Raymond Go faced the Senate and admitted giving “incentives” including clinic equipment and “continuing medical education locally and abroad” to doctors who include the company’s products in their medical prescriptions.

He tried to distinguish incentives from commissions, and discounts from rebates. Maybe he should shift to politics.

“We offer hope in the face of illness,” through products that he described as “both dependable and affordable for all,” Go told the Senate panel on health and demography.

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I support any initiative to boost the domestic pharmaceutical industry. I have been impressed by the robust pharma industry in India, the world’s largest vaccine maker, which supplies many of the generic drugs sold in the Philippines. Drugs and medical treatment are so cheap in India compared to the Philippines.

In the depths of global suffering from COVID, the Indian pharmaceutical infrastructure was developed enough to produce vaccines for both domestic and global consumption – one mass-produced by the Serum Institute of India Pvt. Ltd. for Big Pharma AstraZeneca, and the other an indigenous one, Covaxin, developed by Bharat Biotech.

But I’m also aware, despite not being part of the medical profession, of ethical standards followed by doctors in prescribing medication. As far as I know, doctors are not supposed to accept incentives from pharmaceutical firms to prescribe any drug or other forms of treatment.

Because of this controversy, people will wonder if a doctor is prescribing a particular medication because it is needed and efficacious, or because the doctor wants to win a foreign junket from the drug company.

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Go, facing the Senate yesterday, declared: “Let me unequivocally assert the following truth about Bell-Kenz Pharma: we are a law-abiding pharmaceutical entity diligently adhering to all regulations set by the FDA, SEC, PMA, and other relevant governing bodies… We operate in a pharmaceutical marketing method and ensure that we do it in transparency, ethical integrity, with our practices upholding the highest standards of corporate conduct.”

He was referring to the Food and Drug Administration, the Securities and Exchange Commission and the Philippine Medical Association.

The controversy has grown to such proportions that the government found it necessary to issue this circular last week: “The Department of Health strictly reminds all doctors, nurses, medical professionals and DOH personnel in all medical centers, hospitals and medical facilities regulated by the DOH that the acceptance of gifts, grants or emoluments from biopharmaceutical companies or members of the industry, in exchange for any act benefiting such company or member of the industry is unethical.”

I learned about the ethical rules governing doctors and the drugs and treatment they prescribe from Big Pharma officials in Switzerland, and from US pharma executives based in the Philippines. Some multinationals have their own “generic” and affordable products. They said there are lines they cannot cross, on pain of stiff sanctions, in the commercial distribution of their products.

Among outsiders in the medical profession, the concern is that doctors “incentivized” by Bell-Kenz to prescribe their products could miss out on better treatments available.

For Bell-Kenz itself and the domestic pharmaceutical industry, this may be a useful reminder: if such “incentives” are allowed, Big Pharma can also do it, much better and on a more extensive scale, because of their deeper pockets.