MANILA -- Senator Raffy Tulfo and Health Secretary Ted Herbosa engaged in a verbal tussle Tuesday, with the issue stemming from questions about expensive medicines that patients take while under confinement, without their prior approval.

During Tuesday’s Senate Committee on Health and Demography, Tulfo asked Herbosa why hospital patients are given expensive medicines without first informing them about the price.

“Hindi po nabibigyan ng option ang mga pasyente kung ano ang ibibigay sa kanila yun na lang po talaga ang tatanggapin nila. At bakit po branded. Dapat po sa mga public hospitals habang maaari dapat yung mga gamot na kine-carry po ay generic. Do you agree with me, doc? Kasi most of the patients in these public hospitals are poor,” Tulfo asked. 

(Patients are not given the option to choose the medicine that they will take. Why branded? Public hospitals should carry generic medicines because their patients are poor.)

Herbosa explained that while public hospitals procure medicines through public bidding, there are times that pharmaceutical companies producing branded medicines won the process.

He said there are cases when government hospitals give branded medicines to patients because the generic brands can’t cure the patient.

“Ang only reason I can give as a doctor, cause there are cases nung nagpa-practice po ako, may cases na generic ang binili ng hospital pero hindi siya clinically effective... nire-report namin yon sa procurement service and that’s the reason why some hospitals will carry the probably the branded because the efficacy clinically is different at may ganong mga observations,” Herbosa explained.

(As a doctor, there are cases where generic medicines are not clinically effective. We reported that to the procurement service and that’s the reason why some hospitals carry branded medicines because the efficacy clinically is different, and there are those observations.)

“Kung patient po yan usually may tawag sila na hiyang sa kanila. Like if you’re taking certain medications, magpapalit ka ng mas mura generic pero makikita sa monitoring hindi bumababa ang sugar mo, hindi bumababa ang blood pressure mo, so yung doktor mismo ibabalik ka don sa gamot na inumpisahan niya,” he added.

(If you are taking certain medications and you’re sugar, or blood measure are not stabilizing with the cheaper generic medicine. So, your doctor will revert to the old medicine that you are taking.)

Herbosa’s explanation, however was rejected by Tulfo, who claimed that some doctors prescribe branded medicines in exchange for perks from pharmaceutical companies.

Tulfo also claimed that there are doctors who do not prescribe generic medicines at all.

“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. Alam nyo po yon. Yung mga doktor ginu-good time ng mga pharmaceutical companies mga seminar, sa abroad, schooling, free airfare, business class, hotel accommodation, food, entertainment... and we're talking by the millions of pesos, or even dollars. Now syempre itong mga pharmaceutical companies, hindi ito manlilibre, manggu-good time ng mga doctor nang walang kapalit,” Tulfo alleged.

(I’ll tell you why they prefer branded medicines in hospitals, in the pharmacy. Because of the junket. Pharmaceutical companies treat doctors in seminars, abroad, schooling, free airfare, business class, hotel accommodation, food, entertainment. And we’re talking by millions of pesos and even dollars. And these pharmaceutical companies will not treat these doctors without nothing in return.)

Herbosa, in defense, referred Tulfo to the “Mexico Protocol” which prohibits medical practitioners from accepting gifts from members of the pharmaceutical industry.

The protocol, which the Philippines is among the signatories, charges pharmaceutical companies that are found giving favors to doctors, the Health Secretary said.

“Doc, hindi ko na matiis po. Were you born yesterday?” Tulfo aksed.

“Hindi po! Alam ko yan. Nangyayari yung junket nung araw, pero sinasabi ko po,” Herbosa said.

(No! I’m saying that that junket was happening years ago.)

“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 said.

“May mga doktor na gumagawa niyan pero may mga doktor na wala. Hindi nilalagay yung generic name because busog-busog sila doon sa pharmaceutical companies na nag-good time sa kanila. Pasintabi sa mga doktor na natatamaan. And you know that’s reality, doc, and don’t tell me na na-stop na yan, because if you tell me na na-stop na yan next week, sa next hearing babalik ako mapapahiya po kayo, Secretary,” the senator added.

(There are doctors who do not put the generic name because pharmaceutical companies are giving them a good time. And that doesn’t stop. But if you will tell me that that’s no longer happening, I’ll show the proof to you the next hearing and you will be embarrassed.)

“Mr. Chair, we welcome if there are charges against doctors or cases against them should be filed with the Professional Regulations Commission,” Herbosa said.

“Let me finish first please. Ang question ko po sa inyo Mr. Secretary, do you still stand by your word na wala nang junket, yes or no?” Tulfo asked.

“Hindi ko po sinabing wala nang junket ang sinabi ko po meron tayong Mexico Protocol at code of ethics at kung may kaso na doktor at pharmaceutical na nagba-violate nito, pwede pong mag file ng kaso yan po ang sinabi ko,” Herbosa said.

(I’m not saying that there is no more junket, what I’m saying is we have a Mexico protocol.)

“Then it's your job diyan sa DOH para to find out bakit nangyayari pa rin ito. At kung nangygyari ito, sampa kayo ng kaso meron bang nasampahan ng kaso? Wala,” the senator said.

“Yes, Mr. Chair this is practice of medicine, the regulation of the Department of Health by law is their facilities. The practice of medicine is under the Professional Regulation Commission,” Herbosa said.

Tulfo then pressed Herbosa to file appropriate charges against erring doctors.

Herbosa also vowed to investigate doctors allegedly being used by pharmaceutical companies.