The writer is Dr. Primitivo Chua. He serves as adviser to the Association of Medical Doctors of Asia. From 1992 to 1994, he headed the Philippine Medical Association. That capped 25 years of serving in every other PMA post.
Did Chua’s grief also stem from what the Washington Post reported: “The proportion of Filipinos, dying without medical attention, has risen to 70 percent—a figure not seen in this country since the mid-1970s… A healthcare brain drain is strangling rural hospitals across the Philippines”?
The Philippines exported more than 164,000 nurses in recent decades. “Since 2000, at least 11,000 Filipino doctors retrained as nurses and joined the exodus,” the Post reported. “More than 6,000 doctors-turned-nurses have left the country, and about 5,000 more are soon to go.”
The Post article validates concerns reflected in an earlier detailed analysis by former secretary of health Jaime Galvez Tan. Out of every 100 Filipino doctors, 68 work abroad. And eight out of 10 public health doctors are training to be nurses—as a first step toward a visa.
Essential services, like immunization, have declined. Local health expenditures have shrunk. Local officials grant themselves bonuses from the 20 Per Cent Development Fund originally meant to meet the basic needs of the poorest.
Here’s a health system on the verge of collapse. And the law (Republic Act 8423) on traditional and alternative medicine, so essential for the poor, has been given short shrift. This crisis deserved the summit’s full attention. Instead, it dithered over a doctors’ “cha-cha,” or charter change. The PMA charter on ethics, critics claim, had been changed to “legitimize filching from drug companies.”
The drafters squirreled a new Section 7 into General Principles (Article 1). Thus, the phrase “the health products industry” was injected into the traditional priority of patient care over physicians’ benefits.
New provisions—Articles IV, Sections 10 to 14, plus Section 3 of Article 6—gut code strictures on perks: subsidies, honoraria, travel costs, “gifts,” scholarships, etc. Drug companies often pick up the tab.
“The American Medical Association’s Opinion 8.061 similarly dealt with ‘gifts to physicians from the industry,’” Viewpoint noted. “It is far more stringent.”
Politicians lost their monopoly over charter change. The watered-down PMA Code proves some doctors can cha-cha too. But they’re not the only ones who, when standards prove rigorous, scramble to lower them.
Take the old National Elementary and Secondary Achievement Tests. “Mean scores below 50 were typical,” noted the Philippine Human Development Report. But the tests were “transmuted.” That’s a polite term for adding unasked-for 60 points. “The message conveyed is we are doing well… But whom are we kidding?”
Shameless conduct unfairly hurts other upright doctors. “In nothing do men nearly approach gods than in giving health to men,” the Roman philosopher Cicero wrote in 106 B.C.
Many doctors live up to his ideal. All of us have, at one time or another, benefited from their skills. And places without a doctor are severely deprived. “Is there no balm in Gilead? / Is there no physician there?” The Pintuyan (Southern Leyte) district hospital, for example, has only one doctor. “And she spent time scrounging for funds to get medicine and supplies for patients.”
Chua helped draft the original PMA Code. And the association traditionally invites senior members whenever major issues arise. But the Sept. 15 summit pointedly shut out senior members and local drug firms. The PMA instead rolled out the red carpet for multinationals, i.e., the Pharmaceutical Health Care Association of the Philippines.
“The general membership never saw any draft of any amendments” now embedded in the new code, Chua wrote. “(This) was revised without our knowledge… If invited…we would have cautioned our present leaders to slow down on these questionable amendments. [They are not] consistent with our PMA Code of Ethics.”
“In a radio interview, I called upon our PMA leaders [to] ‘take back’ the PMA Code of Ethics for a second look,” Chua said. “[Only then] should they present and seek the concurrence to amended provisions from all component medical societies, without interference of drug companies.”
Hindi siya nag-iisa. “We urge the leadership of PMA to immediately repudiate and remove… all the new provisions therein,” wrote a group of physicians to PMA president Dr. Rey Melchor Santos. These provisions “make it permissible and ‘ethical’ for doctors and medical associations to receive contributions from commercial companies.”
“Add to the Code of Ethics new provisions that excise conflicts of interest,” wrote Doctors Gary Sy, Edwin Bien, Elinor Roquel, Francis Raz and Rainier Villanueva. “Unethical practices should be subject to the severest sanctions by the Professional Regulatory Commission.”
Don’t hold your breath. Bickering over what “reasonable benefits are ethical,” spawned this new charter of values. Yet, the loftier the calling, the more demanding are the responsibilities.
Does this gutted code square with that principle?
Perhaps, the PMA would like to try this yardstick for size: Be perfect as the Divine Physician is perfect.
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Email: juanlmercado@gmail.com
