Pa­tients’ rights be­ing sac­ri­ficed for cheap drugs

The China Post - - BUSINESS -

One hema­tol­ogy and on­col­ogy doc­tor con­fided that when it came time to set­tle the bill of a Chi­nese can­cer pa­tient seek­ing out-of-pocket ra­di­a­tion ther­apy in Tai­wan, the pa­tient was as­tounded to find that the price for tar­get drugs was only one-third of that in China.

“The pa­tient said he didn’t want to leave, and even asked if he could buy some drugs to take back with him to China,” the on­col­ogy spe­cial­ist said.

Tainted Di­etary Oil Fears

Not only are high-end medicines rel­a­tively in­ex­pen­sive in Tai­wan, pop­u­lar drugs also cost less per unit than a bot­tle of wa­ter or a cho­co­late bar, even go­ing for less than NT$1 (about three cents in U.S. dol­lar terms).

For in­stance, one tablet of the ma­jor in­ter­na­tional painkiller brand Panadol typ­i­cally sells for NT$13.5, and mem­bers of the public must buy it at their own ex­pense. How­ever, in or­der to grab the mar­ket of hos­pi­tals and clin­ics us­ing lo­cally made anal­gesic pain re­liev­ers, some sup­pli­ers have slashed prices to less than NT$0.2 per tablet.

One physi­cian ad­mits that when he gets a cold, in­stead of us­ing the Panadol tablet that he can get at his own hos­pi­tal for just a few cents per dose, he prefers to head to a phar­macy and pay over 10 times higher the price for a brand he trusts.

At a meet­ing of the Leg­isla­tive Yuan’s So­cial Wel­fare and Envi- ron­men­tal Hy­giene Com­mit­tee, Leg­is­la­tor Lin Shu-fen ques­tioned whether phar­ma­ceu­ti­cal man­u­fac­tur­ers could source in­ex­pen­sive and sub-par raw ma­te­ri­als be­cause the price of drugs is too low to profit oth­er­wise. Lin’s line of ques­tion­ing re­sulted in Food and Drug Ad­min­is­tra­tion Di­rec­tor-Gen­eral Chi­ang Yu-mei promis­ing to un­der­take an au­dit of low-cost drugs. When cheap is the rule, whether drug safety fol­lows food safety and leads to the un­cov­er­ing of a se­ries of trou­ble­some is­sues is a pal­pa­ble fear hang­ing over the health care field.

“Will the health care field have its ver­sion of tainted cook­ing oil?” wor­ries Jay C. J. Jeng, Di­rec­tor of the In­ter­na­tional Med­i­cal Ser­vice Cen­ter at Kaoh­si­ung Med­i­cal Univer­sity Hos­pi­tal. Low drug prices could not only drive ma­jor in­ter­na­tional drug mak­ers away and leave the Tai­wanese public with­out de­cent drugs, he warns, it could even force drug mak­ers to use sub­stan­dard raw ma­te­ri­als or cut corners.

Ten Times the Price Low drug prices have re­sulted in med­i­cal sup­pli­ers ceas­ing man­u­fac­tur­ing or no longer im­port­ing cer­tain drugs, re­sult­ing in short­ages, so that the NHIA has even been forced to pay more for some drugs, such as long-act­ing peni­cillin.

One doc­tor of i nfec­tious dis­ease at a med­i­cal cen­ter in North­ern Tai­wan re­lates that this drug is the first treat­ment op­tion for syphilis, and is also used as a pre­ven­ta­tive drug for breast and cer­vi­cal can­cer pa­tients to guard against cel­luli­tis caused by post-op­er­a­tive lym­phedema.

In the past, Na­tional Health In­sur­ance paid NT$ 79 for a dose of peni­cillin, but med­i­cal sup­pli­ers stopped im­port­ing it af­ter sev­eral rounds of price cuts by the NHIA, re­sult­ing in an is­land- wide short­age.

But pa­tients still need medicine, and the NHIA even­tu­ally ar­ranged a spe­cial or­der for sup­pli­ers to im­port peni­cillin at over 10 times the price, pay­ing out NT$800 per dose.

“The Con­trol Yuan should con­duct an in­ves­ti­ga­tion!” the doc­tor says.

More­over, the front-line peni­cillin short­age forced doc­tors to re­sort to treat­ing pa­tients with back-line an­tibi­otics like cephalosporin. “Won’t this raise the risk of bac­te­rial re­sis­tance, so that a su­per bac­terium could show up in Tai­wan? What a crazy pol­icy!” another doc­tor said, shak­ing his head.

Short­ages Ex­pected

to Worsen

Tai­wan’s generic drug mak­ers are also con­cerned about medicine short­ages.

In an ef­fort to i nsti­tute drug reg­u­la­tion at the source, Tai­wan’s Food and Drug Ad­min­is­tra­tion has man­dated that al­lo­pathic phar­ma­ceu­ti­cals man­u­fac­tured do­mes­ti­cally must be pro­duced from GMP-ap­proved raw ma­te­ri­als (the ac­tive in­gre­di­ent used in man­u­fac­tur­ing drugs).

How­ever well-in­ten­tioned the pol­icy may be, in­ter­na­tional GMP drug sup­pli­ers have re­cently hiked prices en masse, and with the prices the NHIA pays for medicine re­main­ing low, some lo­cal phar­ma­ceu­ti­cal sup­pli­ers have given up on some drugs due to cost con­sid­er­a­tions.

“Ac­cord­ing to the pre­vail­ing ground rules, drug short­ages will only con­tinue to get worse, be­com­ing a trend,” re­lates Chi Sheng Chem­i­cal Cor­po­ra­tion chair­man Tung-mao Su.

Apart from the NHIA, hos­pi­tals have also been keep­ing a watch­ful eye on costs, aid­ing and abet­ting low drug prices. A sea­soned ob­server of the phar­ma­ceu­ti­cal in­dus­try and for­mer di­rec­tor of the Depart­ment of Health’s Phar­ma­ceu­ti­cal Af­fairs Bureau, pro­fes­sor Weng-foung Huang points out that Tai­wan has never had a real phar­ma­ceu­ti­cal pol­icy, only a drug pric­ing pol­icy, which is like los­ing sight of the for­est for the trees. “The Min­istry of Health and Wel­fare, Na­tional Health In­sur­ance Ad­min­is­tra­tion, med­i­cal com­mu­nity, and phar­ma­ceu­ti­cal in­dus­try are all in on it,” he charges.

And pa­tients’ rights are be­ing sac­ri­ficed. Trans­lated from the Chi­nese by David Toman Ad­di­tional read­ing se­lec­tions can be found at http:// english. cw. com. tw

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