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Physicians from Nevada, United States, to a Central Visayas town reacted to the ?gutting? of Philippine Medical Association's Code of Ethics. Two Viewpoint columns - ?Heal yourself? (Sept. 18) and ?When some doctors cha-cha? (Sept 23) spotlighted the issue. Here are comment excerpts:
From Las Vegas, Dr. Aristeo Villasenor (University of the Philippines, Class of 1957) writes:
?I'm a retired surgeon who, at least once a year, goes back to the Philippines to serve in medical missions. Although these medical missions are just band-aid cures, they show that many of us care.
?Hundreds of well-qualified physicians here in the US (are) anxious to help. But (they) pass their time playing golf, etc. So I suggest the Health Department and PMA post a list of government hospitals and communities in dire need of physicians.
?(Then) doctors like me can choose any place where we can serve for several weeks or months. Some ask only for a roof over our heads, three square meals a day or whatever stipend is available. Many will serve without monetary consideration.?
Face the facts, insists Jaime L. Manzano. From Bethesda, Maryland, this retired Federal Senior Executive and foreign service officer e-mailed:
?The Philippines cannot hold on to physicians and nurses it currently produces. It will have to develop a system that extends health care without them.
?Train literate motivated individuals who have no MD or RN degrees to cover basic preventive and primary care. It's been done in less-developed countries. [Is that where we're backpedaling to? - JLM] Common recurring illnesses account for about 80 to 90 percent of health interventions. These can be addressed through such trained workers.
?This would free up medical professionals to cover health problems (that call for their) special skills, e.g., operations, complications in deliveries. Train more doctors and nurses for export.
Develop Internet-based health delivery systems through automated medical records and diagnoses, independent of physician/nurse's physical presence. Promote the domestic medical tourism industry, given the high medical cost in industrial countries.?
Name withheld on request is a University of Santo Tomas School of Medicine graduate. He serves in a Central Visayan town of 33,000 residents. A specialist, his wife practices in the hospital of the province's capital.
?Yes, those junkets happen,? he writes. ?(But they're) for every tier of practice and specialty.? I availed of paid trips to resorts and conventions by drug companies. These two-to-three-day trips usually include a dinner-symposium on products the host-drug company promotes. The rest is for sightseeing, meals galore and shopping.
?'Symposia' justify tax deductions of the drug company (disguised as) 'continuing medical education.' A symposium focus may stem from declining sales, introduction of new products or perceived threats launched by a competitor.
?As I practice in a small town, our trips are local, e.g. Subic and Palawan. I declined last year's offer to Boracay and have not joined any since. The reason is: persistent visits by sales representatives after a trip, as to remind that it's payback time.
?Specialists are offered foreign trips. This year, my wife got two invitations: one for Kyoto and another for Hawaii. She rejected both. She was taken aback by the sales representative's direct approach: the trip in exchange for a month's prescription of their then newly launched drug.
?Often the product 'pushed' is an add-on drug. It is not necessary to the therapeutic regimen of the illness. Yet these add-ons constitute a very significant percentage in the bill of patients. Thus, you've seen patients taking up to eight drugs for an illness.
?Often, there's a spike in sales after six months. There's the possibility the same doctors prescribe another drug, following invitation from a competing firm. This shift is called ?Flavor of the Month? phenomenon. And patients foot the bill.?
Viewpoint column ?Tomorrow's bribe? (Sept. 25) is right that ?another crisis is already upon us,? commented former UP professor and retired Department of Science and Technology undersecretary. ?The lack of quality water in many parts of the country has become a significant economic, social and health issue.?
?To meet the expanding need for food, like rice, the Department of Agriculture proposes the use of hybrids, etc. These need water. And that comes from watersheds. But the DA and Environment Department never mention about rehabilitating watersheds.
?In her State of the Nation Address, the President spoke of allocating two billion pesos for reforestation. That can rehabilitate only about 67,000 hectares of watersheds. Over half a million denuded hectares, however, need to be restored.
?Given the fund constraints, DENR should prioritize the important watersheds to be revitalized. Priority should be set according to demand from domestic, irrigation, and commercial/industrial needs. It should spur investment in commercial tree plantation by the private sector in portions of watersheds classified as production areas.
?Depending on species planted, some trees can be harvested in 10 to 12 years. While growing, they provide invaluable environmental services: prevent soil erosion, recharge aquifers, become carbon sinks that help reduce climate change, and curb flash floods.
?The Forest Management Bureau and DENR can spearhead this policy thrust. Private plants, that process logs, encourage farmers to plant trees, as we have seen in the Caraga Region.?
