Na­tional health care cri­sis: Is your medicine work­ing for you?

Life-sav­ing medicine can be cheaper per unit than candy, and in­tra­venous nu­tri­tional sup­ple­ments may fetch even less than bot­tled wa­ter. But does such cheap medicine come at an un­bear­able cost?


As a physi­cian in the Depart­ment of In­ten­sive Care Medicine at Chi-Mei Med­i­cal Cen­ter, Dr. Che-kim Tan is noth­ing if not metic­u­lous, do­ing ev­ery­thing in his power to save crit­i­cally ill pa­tients.

“In­ten­sivist physi­cians are like guardians of the gates of hell. Of­ten­times we only get one chance at sav­ing a life,” says the doc­tor, a man with the mus­cu­lar physique of a rugby player.

But lately his con­fu­sion has grown as, de­spite their ob­vi­ous youth and good chances for sur­vival, some pa­tients have been un­able to out­run the Grim Reaper.

At first Dr. Tan chalked it up to the na­ture of ill­ness, un­til one day when he hap­pened upon a pa­per in an in­ter­na­tional med­i­cal jour­nal that com­pared an orig­i­nal branded man­u­fac­turer’s an­tibi­otics against 23 generic prod­ucts. The study found that, with the ex­cep­tion of one generic medicine that had the same ex vivo ef­fi­cacy as the branded medicine, the other 23 medicines were only 60 to 90 per­cent as ef­fec­tive.

Among the medicines shown to have only 80 per­cent ef­fi­cacy, two of them were vi­tal weapons he fre­quently re­lied on to save pa­tients’ lives.

“Could that have been one of the rea­sons?” a shocked Dr. Tan won­dered.

Though he was aware of the dif­fi­culty of prov­ing that the ef­fi­cacy of a sin­gle medicine was com­pro­mised or had any con­nec­tion to whether his pa­tients lived or died, the ques­tion still gnawed at him.

With a heavy heart, in an en- try on his per­sonal blog en­ti­tled “Please Give In­ten­sivist Doc­tors Life-sav­ing Weapons,” he wrote the fol­low­ing: “With the con­stant down­ward ad­just­ment of medicine prices by (Tai­wan’s) Na­tional Healthcare In­sur­ance sys­tem, a con­sid­er­able num­ber of orig­i­nal phar­ma­ceu­ti­cal man­u­fac­tur­ers have aban­doned Tai­wan, cit­ing nonex­is­tent prof­its. Mean­while, those stick­ing around are tak­ing ac­tion in re­sponse to the ex­ces­sively low rates. So the ques­tion is, when the price of a pill is less than a piece of candy, how can we ex­pect ven­dors to care about safety and qual­ity?”

In his in­ter­view with Com­mon­Wealth, Dr. Tan stressed that he does not in­sist on us­ing only drugs from branded orig­i­nal man­u­fac­tur­ers, nor does he dis­miss generic drugs out of hand, in­sist­ing, “I just care about be­ing able to use good qual­ity medicine.”

Over the past year, in his dual ca­pac­ity as an in­ten­sive care de- part­ment physi­cian and his hos­pi­tal’s di­rec­tor of pa­tient safety, he has de­liv­ered a se­ries of talks at a num­ber of med­i­cal con­ven­tions. At them, he has en­cour­aged doc­tors to in­form hos­pi­tal author­i­ties and con­duct fur­ther eval­u­a­tions if they sus­pect that the clin­i­cal ef­fi­cacy of drugs their hos­pi­tals have switched over to could be lack­ing.

“Doc­tors be­lieve that the medicine they pre­scribe has the same ef­fi­cacy as it says in the book. How­ever, they are un­aware just how many dif­fer­ent brands are out there, as well as all of the busi­ness jostling that goes on be­fore they get their hands on it, let alone the fact that there are dif­fer­ences in the qual­ity of dif­fer­ent drugs. That’s scary!” ex­claims Dr. Tan.

Cheaper in Tai­wan than China

Tai­wan’s Na­tional Health In­sur­ance sys­tem is world-renowned for its cost con­trols; from new drugs to old drugs, the cost of drugs in Tai­wan is fa­mously low.

Jan­ice Chen, chief of the Cen­ter of Ed­u­ca­tion of Com­pre­hen­sive Drug Uti­liza­tion at the Sun Yat-sen Can­cer Cen­ter in Taipei, has been a mem­ber of the NHI’s Phar­ma­ceu­ti­cal Ben­e­fits Ad­vi­sory Com­mit­tee since the scheme’s in­cep­tion two decades ago. As such, she has long ob­served the ar­ti­fi­cially low prices for new drugs in Tai­wan.

Her in­ves­ti­ga­tions have found that the ap­proved pric­ing for new drugs un­der the NHI sys­tem is a frac­tion of what new drugs cost in the top 10 most ad­vanced coun­tries, greatly damp­en­ing the big global phar­ma­ceu­ti­cal com­pa­nies’ in­ter­est in in­tro­duc­ing new drugs to Tai­wan.

“Our new drugs reach the mar­ket here four or five years af­ter the first coun­try that gets them, and the sit­u­a­tion ap­pears to be wors­en­ing,” says Pro­fes­sor WengFoung Huang of the In­sti­tute of Health and Wel­fare Pol­icy at Na­tional Yang-Ming Univer­sity.

And never mind the low prices; Tai­wan even fur­ther slaps a tonne of re­stric­tions on the use of new drugs.

One of pro­fes­sor Huang’s Ph.D. stu­dents is writ­ing a doc­toral the­sis com­par­ing new drugs for pre­vent­ing os­teo­poro­sis. Over­seas, pa­tients use the drugs as a pre­ven­ta­tive mea­sure be­fore they break their bones, whereas in Tai­wan they only take it once they have suf­fered bone break­age — an ab­surd prac­tice.

In ad­di­tion, av­er­age an­nual out­pa­tient visit drug costs in Tai­wan are lower than the in­ter­na­tional trend, hit­ting US$322 (NT$10,000), which is around 70 per­cent of that of South Korea, less than half of that of Ja­pan, and only one-third of U.S. prices.

Story con­tin­ues on page 2


A packet of pills is shown in this photo taken Feb. 11 in Quim­per, western France.

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