Recently in Medicine Category

By Dr. Kenneth Hartigan-Go CONGRESS has recently allocated P100 million for the deployment of a National Telehealth System. It is about time we do this because the technology is available and its application in health care can improve the health status, indicators and track the outcomes. It addresses the various health inequities that we currently observe. Telehealth may be as simple as two health professionals discussing a case over the telephone as a referral or mentoring call, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different locations. Telemedicine is a general term for the use of communications and information technologies for the delivery of clinical care. Telehealth addresses the lack of human health resources in remote areas. It can bring limited clinical expertise to areas where the expertise absent and is badly needed to save lives. Furthermore, the system can save cost of travel and unnecessary expenditures in poverty stricken areas or in facilities with inadequate expertise. It also can be used to improve PHIC (Philhealth) services. Imagine a patient due for check out from the hospital, his relatives need not have to absent from work, and to get a certificate from the employer of the patient to prove that Philhealth remittances are paid over the last 3 months to be considered eligible for health coverage. A computerized system will make the process of payment, checking payment by PHIC and hospital convenient and easy for the patient. Telehealth can also be used for long distance health professional education, cutting down the dependence on pharmaceutical industry to use corporate funds for continuing education of doctors and hence cut the cost of medicines. There will be less expenditures for travel and various fees. In addition, telehealth can also improve the coordination of blood banking to save lives. At the moment, the system for blood banking is dangerously inefficient because there is no centralized inventory and information system. Moreover, telehealth can also track the number of health professionals and monitor where they are so that there is better utilization of resources and expertise when needed and to project investment for the future. In aid of better disease tracking and creating an up to date epidemiological database for evidence informed policy making and implementation, telehealth can generate the statistics from the community in real time. This deployment is a result of the successful pilot of the UP Manila National TeleHealth Center (UPM-NThC) system led by Dr. Alvin Marcelo, which is currently in service between UPM-NThC and its provincial sites in Batanes, Pasay, Marikina, Quezon Province and Capiz, among others. The current UP Manila telehealth system is able to provide basic electronic health record registry via the Community Health Information System (CHITS), audiovisual education to local health workers and professionals through E-learning and video conferencing, and tele-referral and tele-mentoring to Doctors-to-the-Barrios (DTTB) using SMS technology through the Buddyworks Program. Unless we want to remain in the backwaters of healthcare in this new millenium, this P100 million for telehealth is a good way to improve healthcare and affect the lives of Filipinos in our far flung communities. *Kenneth Hartigan-Go, MD is the Executive Director of the Zuellig Foundation. He was a former professor of pharmacology and toxicology of the UP College of Medicine and was also a former deputy director for the DOH-Bureau of Food and Drugs. He is also a regent of the Philippine College of Physicians. He is also with the Congressional Commission on Science and Technology and Engineering Expert Panel on Health.

By Jennifer Gonzalez Agence France-Presse CLEVELAND -- Doctors hailed a groundbreaking transplant to replace 80 percent of a woman's face, saying Wednesday it is a means for the severely disfigured to "face the world" without humiliation. It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. "We need the face to face the world," said lead surgeon and researcher Maria Siemionow of the Cleveland Clinic. "There are so many patients there, in their houses, where they are hiding from the society because they are afraid to walk to the grocery stores. They are afraid to go to the streets, because they're called names, and they are humiliated. "So we very much hope that for this very special group of patients, there is a hope that one day they will be able to go comfortably from their houses and enjoy the things which we take for granted." Doctors released few details about the patient, save to say that she had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago which left her without a nose, right eye and upper jaw. The hospital said the woman, who did not wish to be identified, had exhausted all conventional reconstructive surgery. They hoped the operation would allow her to regain her sense of smell and ability to smile and said she had a "clear understanding" of the risks involved. The woman is doing well and showing no signs her body is rejecting the new face, doctors said. Facial transplants are controversial because they carry heavy risks and are performed to improve a patient's quality of life rather than as a life-saving operation. There are also concerns that the operation could eventually be used for purely cosmetic purposes or as a means of altering someone's identity. Doctors at the Cleveland Clinic stressed that such operations should be limited to a medical context in order to free severely disfigured people from the suffering associated with social isolation. "The relief of suffering is at the core of medical ethics, and provides abundant moral justification for this procedure," said the clinic's chair of bioethics Eric Kodish. "A person who has sustained trauma or other devastation to the face is generally isolated and suffers tremendously. The damage to the quality of life cannot even be put into words." Leading medical ethicist Arthur Caplan agreed that this suffering was sufficient to "risk possibly killing someone to improve their appearance for a better quality of life." "If there is nothing else to be done, it actually makes sense for them to take a risk that involves death," Caplan, the director of the center for bioethics at the University of Pennsylvania, told AFP. "It's ethically justifiable." Doctors in France performed the first partial face transplant in 2005 on a 38-year-old woman, Isabelle Dinoire, who was disfigured in a dog attack. In 2006, a Chinese man underwent a facial transplant including the connection of arteries and veins, and repair of the nose, lip and sinuses. A bear had mauled the 30-year-old farmer as he looked for stray sheep. A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man couldn't eat or speak properly. The Cleveland Clinic became the first US hospital to approve the procedure four years ago. The latest operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels and nerves. "Multiple layers of tissue from the bone to the skin to the muscle, this all had to be - kind of like a jigsaw puzzle - fit into the appropriate position and put in," said plastic surgeon Daniel Alam. The woman received a nose, most of the sinuses around the nose, the upper jaw and even some teeth from a brain-dead donor. Doctors paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures, as they recovered the donor's facial tissue. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure.

By Kenneth Hartigan-Go, MD WHILE Filipinos complain that the cost of medicines is prohibitive, they need to understand some of the problems associated with the local pharmaceutical industry. We hope that an enlightened public can participate in meaningful discussions and debates and offer solutions. The Philippine Pharmaceutical Industry in general, lags behind its global and even Asian counterparts. It has been continuously confronted and impaired by various challenges for so many decades. A number of issues have been raised and addressed both locally and internationally. Comparative studies and criticisms were brought into the limelight leading to some attempts at reform. Nonetheless the Philippine pharmaceutical industry as a whole remains incompetent as indicated by inaccessible and poor-quality drugs, aggravated by the threat of inappropriate use, the insufficient quantity and quality pharmacists, poor research and technological development. We are not exactly self-sufficient and hence pose a problem in drug security. Despite regulatory efforts from both the government and some of the private sector, the pharmaceutical market remains inflicted by perception of substandard, counterfeit drugs that threaten the life of the patients. This observation also contributes significantly to pharmaceutical market failure. While substandard drugs may be cheaper, there is a perceived quality problem and thus there is lowered patronage for their use, affecting even true quality generics products. Aside from the regulatory mechanisms, accepted standards in manufacturing, such as the Good Manufacturing Practice (GMP), are still just an ideal concept. There are fewer than 10 drug companies complying fully with GMP. The implementation of full compliance to GMP has been repeatedly postponed. The prevailing argument of domestic drug companies is that they cannot afford to invest in compliance to GMP. Compliance to regulatory bodies and accepted standards remain widely unimplemented. The inability of the bureau and low compliance in accepted standards undermines the quality, safety and efficacy of the pharmaceutical product. The Philippine Pharmaceutical industry, in general, falls short of generating research to extract and produce raw materials and chemicals from local sources. Some reports assert that there is research that is happening. However the problem is that it remains at the academic level and is not translated to commercial development. The research fails to reach industry and thus is not utilized into marketable innovative products or processes. Local industry hardly innovates, in terms of basic research to provide inputs for further local development. The industry’s manufacturing capacity is primarily limited to compounding, formulating, and packaging. It remains highly reliant on imported raw materials and chemicals. The production process in the local pharmaceutical industry basically involves the conversion of the imported basic raw materials into pharmaceutical preparations or finished pharmaceutical products, except for a few companies engaged in the manufacture of active substances. As shown by the World Health Organization Study in 2005, about 95% of the materials compounded in the country are imported and that the industry is dependent on products discovered and developed in another country. Industry reasons out that this is either due to the absence of these raw materials or that producing innovative products or processes entails high cost that the industry can not sustain. As it is cheaper to import finished medicine products or readily available raw materials than come up with innovative one, reason coerces industry to take advantage on it. From a philosophical perspective, our country has to decide and resolve how to treat medicinal products and the health professionals who are proxy to access to health care. Are medicinal products a regulated public good to serve the needs of a growing but poor population or are they treated as like ordinary commodities of trade subject to the market forces? Are health professionals who exercise great power over access to health care services and products to be treated like an economic commodity likewise subject to the laws of market forces or are they regulated professions intended to serve the public good? Kenneth Hartigan-Go is a former BFAD Deputy Director and is currently Executive Director of a foundation. He is an appointed expert member of the Congressional Commission on Science, Technology and Engineering (COMSTE) Health Panel.

By Kenneth Hartigan-Go MUCH of the clamor now in the pharmaceutical sector, both globally and locally, calls for transparency in pricing to lower the cost of medicine. International and local organizations and alliances have been formed to clamor for it. Prices are monitored and compared within and between regions throughout the world. Various mechanisms have been placed to demand transparency in pricing worldwide. However, prices remain high and thus the clamor remains. An important factor to consider why prices remain high is the inability of the government to systematize a transparent pricing mechanism. It is as if the imperfection of the market, its profit-maximizing nature, is irreversible and thus has to be accepted as innate. This should not be the case. There can be a better equitable way out of this. The government must put up a transparent mechanism in medicine pricing to influence the market to respond to the public’s call and moderate their profit-orientation. Though this first action will address the imperfection of the system, it is not enough. The second half of action involves addressing the market failure by developing a proper and responsive competitive pharmaceutical sector capable of undertaking science and technology activities. The Philippine Government has tried to respond to the call for transparency. The Department of Health and PhilHealth have come up with Drug Price Reference Index (DPRI). It works basically under the principle of informing the public of the prices of medicines, as being sold in the market, thus giving them the choice. However, though the intention is good, it does not really address the problem of high medicine prices. The DPRI is not enough. It accepts that the market may impose high prices as long as there is a cheaper counterpart. And that regulation will be left with the market forces. Further, the assumption of the PhilHealth that the public is objective enough to choose a cheaper counterpart may not be completely true, as they may be shaped by the misleading advertisements. DPRI is only a short-term solution. Drug pricing in the Philippines remain non-transparent and drug prices remain high and access by the public is adversely denied. From the account of the WHO survey for 2005, high drug cost in the Philippines is not really induced by high manufacturing or importation costs. Rather, it is caused by the price mark-up for every step of the way the drug has to go through before reaching the consumers. These prices are raised by business groups who do not contribute to research and development of the product but who merely sell the medicines through dispensing activities supposed their value added advantage. In the said survey, WHO examined both the minimum and maximum figures of the mark-up. Considering the minimum figures, the cumulative mark-up adds up to 89.51 percent of the original price, with retail as having the greatest share in mark-up (69.20 percent). On the other hand, considering the maximum figure, the cumulative mark-up adds to a maximum of 273.24 percent of the original price using the maximum figures with retail also as having the greatest share. Wholesale and retail mark-ups in this case can reach 65 percent and 50 percent, respectively. Such high mark-up hinders the accessibility of patients and is further aggravated by the consumers’ lack of capability to pay. Studies have shown that a typical Filipino family (can) only allocate less than 5 percent of monthly incomes for health care (NSO, 2006). With this financial capacity, a typical Juan dela Cruz is doomed to suffer of supposedly curable diseases such as tuberculosis, without even having the medication. Such imperfect market system can be reversed into a more competitive system by putting up a transparent mechanism. A mechanism that can be considered is the Medicine Price Ratio Survey, which is not really new and thus, there is no need to reinvent the wheel. This survey is being used by the World Health Organization in different countries including the Philippines as conducted in the year 2002 and 2005. In fact, WHO advocates the use of the abovementioned survey to determine the cost and availability of essential medicines throughout the country. The Medicine Price Ratio can be used as a research-based evidence to analyze the existing market mechanisms and formulate policies. The survey findings specifically the Median Price Ratio can be used as reference for price negotiations and auditing of medicine procurements. This referencing process can introduce a more transparent pricing process and link the study to the discourse on fair pricing of medicines. The discourse on fair pricing, equity issues in access to medicines and the rights based approach to development programs will establish the issue of medicine prices as a human rights issue and therefore an integral part of one’s basic right to have access to basic health services. The government may argue that it does not have the resources to implement such national survey and that it will divert already meager resources from public service delivery like hospital support. But in fact the survey may be conducted as part of another existing national survey. Moreover, various government agencies may pull their resources to allocate for it. A part of the limited resources that will be used for the survey can not be considered as wasted as the survey will pave way for making drug access efficient through installing a competitive market. Upon correcting the system, competition may now come in and industries will be encouraged to invest in innovation. The pharmaceutical sector may go beyond the traditional activity of trading but will move towards innovation through our abundant natural resources. Kenneth Hartigan-Go is a former BFAD Deputy Director and is currently Executive Director of a foundation. He is an appointed expert member of the Congressional Commission on Science, Technology and Engineering (COMSTE) Health Panel.

By Izah Morales INQUIRER.net MANILA, Philippines -- Mass hysteria caused the unusual behavior of a number of students at the Pedro V. Panaligan Memorial National High School (PMNHS) in Calapan City, report from a medical team deployed by the Department of Education obtained by INQUIRER.net said. The team -- composed of psychiatrist Dr. Ma. Arlene Briones, psychologist Jennilyn Ebio from the National Center for Mental Health (NCMH), and Dr. Minda Meimban, medical officer IV of DepEd Health and Nutrition Center -- conducted psychosocial intervention sessions or PSIs of faculty members and the supposedly possessed students on August 27, 2008. Based on the PSI sessions, the team reported that before the students experienced the so-called “initial attacks,” most of them had family-related problems, such as parents separating and deaths in the family. Students reportedly declared on August 8, 2008 that “the gates of hell will be opened and bad spirits will be let out to roam the Earth.” During the supposed possessions, students who were affected experienced chest pains, difficulty in breathing, cold sensations on the palms and weakening of the knees, the report said. However, the medical team stressed that while the students were allegedly possessed, most of them could still hear and understand what people around them were saying. Based on the diagnosis of the medical team, they suggested that special counseling be given to afflicted students after a month, while all school personnel were advised to undergo PSI or Critical Incidence Stress Debriefing training during the second week of September. The alleged spirit possession of PMNHS students, which caused what appeared to be seizures, began on July 25, 2008. It was reportedly recurring every Tuesday and Friday until the number of afflicted students increased to 26 on August 8, 2008. Here are video clips of the alleged possessions.

By Alex Villafania INQUIRER.net THE DEPARTMENT of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD) is planning to expand the local herbal products industry to reduce dependence on imported drugs. In a press conference Wednesday, DOST-PCHRD Executive Director Jaime Montoya said building the local herbal industry was aimed at reducing the cost of more expensive drugs and dependence on foreign imports The use of herbal products for functional foods and personal care are major markets for the agency, Montoya said. "There has been an emergence in threats from infectious diseases and disorders from differing lifestyles, thus there is a shift towards preventive measures for health protection," Montoya said. Montoya said in his presentation that the herbal products industry in the Philippines was worth 2 million dollars per year relative to the revenue of the pharmaceutical industry. But this figure is only 3.5 percent of the total size of the pharmaceutical business, he said. Montoya said that the Philippines was rich in flora that could be utilized for local herbal development. There are 3,500 plant species endemic to the country and 120 species are scientifically validated to be usefu, he said. Among the plant species that can be commercially expanded is a local chaste tree (Vitex nagundo) otherwise locally known as lagundi, which is useful against cough and asthma; ngai camphor (Blumea balsamifera) otherwise known as sambong useful against kidney stones; wild mint (Mentha cordifolia) or yerba buena for pain relief; and candlebrush (Cassia alata) as an anti-fungal medication. Montoya identified other plant species that could be processed and commercially sold. Some of these are used for skin and hair care, as well as food products such as fortified health drinks. "Apart from the local market, our herbal products can be exported to Malaysia, Australia, United Arab Emirates, Taiwan, Indonesia, Singapore and Hong Kong," Montoya said. Among the plans of the PCHRD include starting research and development studies and intensifying current research on plant development and their viability for human consumption, said Montoya. In particular, the PCHRD will conduct and prioritize research on unique diseases in the Philippines and finding the corresponding species of plants that can prevent these diseases from spreading, Montoya said. "We would also increase information dissemination among R&D institutions across the country so we can build a database of commercially viable herbal products," Montoya said.

By Alex Villafania INQUIRER.net TO HONOR the services and achievements of the late scientist and educator Paulo Campos Members of the esteemed Governing Board of the National Research Council of the Philippines (NRCP) have named the NRCP executive boardroom the Paulo C. Campos Conference Room on August 31. Campos, who died last June 2 at the age of 86, was a medical doctor who was the Philippine pioneer in the field of nuclear medicine, a relatively unknown branch of medicine that delves into diagnosis and therapy using nuclear properties. He took his medical degree at the University of the Philippines under full scholarship and practiced at the nearby Philippine General Hospital. Back then, he already conducted various researches in medicine and often offered his services to the poor for free. One of the most prominent results of his work on nuclear medicine was the use of injected iodized oil into goiter patients. Some of his patients became doctors themselves. His own wife, Dr. Lourdes Espiritu-Campos, also became his patient. Campos’ research and subsequent development of goiter treatment became the basic routine adopted by the World Health Organization for goiter patients worldwide. For this, he was identified as the Father of Nuclear Medicine in the Philippines. Campos is survived by his wife and three children -- Jose Paulo, Paulo Junior and Enrique Placido -- all of whom are professionals in their own fields.

By Alex Villafania INQUIRER.net BALDOMERO OLIVERA'S name may not ring a bell for many Filipinos. He is not an actor or a politician -- and he certainly is not a criminal whose name lands in the headlines of local newspapers. Yet he has given Filipinos all over the world a reason to be proud by being named Harvard Foundation’s 2007 Scientist of the Year. Dr. Olivera is a distinguished professor of biology in the University of Utah. The man is so popular and respected in that institution that a research laboratory is named after him. Olivera’s scientific research into the medicinal aspects of the ubiquitous but deadly cone snails landed him the distinction of being named Scientist of the Year. In keeping with his modesty, Olivera did not expect to win the award but merely worked hard to come up with comprehensive studies on the cone snails. Luckily, Dr. Olivera is back in the Philippines to talk with fellow scientists and aspiring students regarding his work on the viability of cone snail venom for medicinal purposes. His foremost research has already become the basis for a commercial drug called Ziconotide (Prialt), which blocks out extreme pain. Ziconotide is considered more effective than morphine and does not result in addiction. The soft-spoken Olivera was the key speaker during the quarterly Innovation Forum held by the Ayala Foundation and Information Development Program. Olivera, who comes back to the Philippines at least twice a year, spoke to a small group of scientists, businessesmen and journalists regarding his work and the potential of Filipino scientists in the field of biotechnology. Olivera was a summa cum laude graduate from the University of the Philippines in 1960 and moved to the US to take up his graduate degree in chemistry at the California Institute of Technology. Long before his days in college, Olivera already started wondering about cone snails, which are common in Philippine seas. Cone snails are among the deadliest animals in the world, with a harpoon-like proboscis that injects lethal doses of venom that could kill a person within hours. The deadliness of the venom left the young Olivera wondering why the venom of such small creatures could be so deadly to humans. His curiosity took on a different form when he wanted to learn if the venom of cone snails could actually have pharmacological purposes and, after college, Olivera worked on various aspects of cone snail venom. The genus Conus magus, a more common and bigger type of cone shell, was the main focus of Olivera and he produced over 150 publications on the cone shell toxin. Olivera said during the Innovation Forum that his research only involved a handful of cone snail species and he estimated that over 10,000 species of the sea creatures reside in the Philippines. He also said that in each cone snail, one can find at least 700 compounds that each have different potential efficacies for medical uses. "Scientists are researching on useful medicinal compounds from hundreds of thousands of plant species but there is also so much to acquire from cone snails. It's one of the least understood creatures of the sea but it may hold the key to solving many of today's diseases," Olivera stressed. Olivera added that very few scientists like him are focused on cone snails and he went on to invite aspiring young scientists to enter the field of biotechnology research. Likewise, he also invited potential businessmen to focus on providing assistance to Filipino scientists who can do research on commercially viable projects, not just on biotechnology, but also in other fields of research. "Our work as scientists does not involve just winning these [awards] but to find ways to make lives better. I would like our Filipino scientists to strive hard in their chosen field and be proud of what they do no matter how small it is," he said.

By Erwin Oliva INQUIRER.net DR. Baldomero Olivera, a Filipino award-winning scientist who has discovered new drugs for pain, Alzheimer’s and epilepsy in the Philippine wildlife, is set to visit the country next month. Technology Business Incubator and the Brain Gain Network have invited Dr. Olivera to an innovation forum in Filipinas Heritage Library on July 6 to speak on his discoveries of new sources of painkillers, including deadly sea snails, among others. Olivera was recently awarded by the Harvard Foundation as Scientist of the Year following his three decades of work in developing drugs from the animal wildlife, according to a copy of his brief profile. Dr. Olivera has published about 158 works on Conus toxins, and is co-founder of Utah-based startup Cognetix. A summa cum laude graduate from the University of the Philippines in 1960, he eventually took his PhD in Chemistry from the California Institute of Technology (1966), and did postdoctoral work at Stanford University from 1966-1968. Olivera then returned briefly to the Philippines to become a research associate professor of Biochemistry at the UP College of Medicine before returning to the US to become an associate professor at the University of Utah in 1970. He has held the title of Distinguished Professor of Biology since 1992. His work on conotoxins was eventually picked by Forbes Asia which published it on its July 2007 issue. Olivera and his team made a breakthrough when they discovered a family of biomolecules they collectively called conotoxins from Cone shells found in tropical waters of the Philippines, another online biography said. “As a boy in his native Philippines, Baldomero Olivera spent countless hours scouring for seashells on the beach. Once he’d made his finds, he’d rush home and pore over marine-life books to identify his treasures. He was particularly intrigued with cone snails, beautiful but deadly sea snails that kill their prey with venom. Thirty years later Olivera’s fascination with cone snails would open a new pipeline of drugs for discovery,” the Forbes article, penned by Dennis Posadas, said.