Saturday, March 14, 2009
Wednesday, March 11, 2009
Monday, March 9, 2009
Thursday, March 5, 2009
Monday, March 2, 2009
Mongkol Na Songkhla is the Minister of Public Health in Thailand. He has served in the Ministry of Public Health since his appointment on October 9, 2006. Dr. Mongkol Na Songkhla spoke with Asia Society's Nermeen Shaikh during a visit to New York where he joined a press conference with President Bill Clinton and the Clinton Foundation to announce a global pooled procurement of anti-retroviral drugs.
Thailand has been at the center of a controversy over affordable access to medication because of its recent decision to pursue generic versions of patented pharmaceuticals. As a member of the World Trade Organization, Thailand is obligated to abide by the rules and regulations in the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). TRIPS sets a minimum international standard for forms of intellectual property such as patent pharmaceuticals. Compulsory licensing is a flexibility of TRIPS that permits all member countries to manufacture generic alternatives of patented pharmaceuticals to increase accessibility to affordable medicine. Thailand's universal healthcare system is one of the country's strengths, but the country lacks affordable access to high priced antiretroviral HIV treatment and medications for priority health conditions such as cancer, hypertension, and heart disease. Dr. Mongkol Na Songkhla defends his government's contentious policy and talks about the critical issues that plague Thailand's healthcare system.
Thank you very much, Your Excellency, for your time. I'd like to begin by asking you what the key issues are that you have confronted as you have assumed the leadership of the Ministry of Health. There are issues having to do with access to medicine, to clean water, and of course the spread of HIV/AIDS. Right now you just spoke about an aging population as well. What would you say are the highest priorities?
The highest priority right now is to respond to the top causes of death in the Thai population. The first one is HIV, the second one is cardiovascular disease, the third one is cancer, the fourth one is accidents, and the fifth one is chronic diseases associated with aging.
Moving to one of the initiatives that you have been responsible for, could you just explain for our audience, many of whom will not be familiar with this, what the importance of compulsory licensing is? First of all, what does it mean, and second of all, why is it relevant in terms of access to medicine for people in countries like Thailand?
Access to essential drugs is not possible for all people. There are problems with the national health insurance plan. We provide health services free of charge for the Thai people. There are three main schemes to achieve this. First, about 48 million people are under the Social Welfare scheme, and the budget is provided by the central government. Another five million are part of the Civil Servant Medical Benefit Scheme. The last group is the Social Security scheme, which includes nine million private and temporary public employees. In these three schemes, the budgets come mostly from the central government and are paid to private or public hospitals. However, in spite of increases in the budget, it is not enough to cope with the rapid increase in demand. For high-priced patented drugs, the central government cannot shoulder the costs, especially for some second line HIV drugs, cancer drugs, chronic disease medications, or even hemodialysis-they cannot shoulder it.
So you can see that even though we try to provide health services free of charge for people, it's actually not for everyone because the budget is not enough. Some people can use health services with payment from their own pocket. It is possible for rich people; they have access. But more than 80 per cent cannot access necessary drugs such as carcinoma drugs and second line HIV drugs. We know that the patent holder invests a lot for each medicine but actually the percentage who can access patented drugs is only 20 or 25 per cent. These are the groups of people who are paying for the research and development costs. The rest of the people who have no access do not contribute at all to the research and development cost, as they cannot pay for the patented drugs. How can we take care of the other 80 per cent of the people who are left behind? So we decided to try to find the generic alternative to serve these neglected people. Actually, we never disturbed the current consumer of patented drugs - those 20 per cent of people who can afford to pay out of pocket to get access to these drugs. They will never change, they will never switch from the original drug to a generic drug. These are well-off people who receive their services from the private sector and pay out of pocket, and also civil servants whom the government pays for their high price patented drugs, as well as about two million foreign patients a year.
But we only want to share the patent. We are very willing to buy the original drug for neglected people from patent holders if they want to compete with the generic drug in this new market for 80 per cent of Thais-paid by the government budget not out of pocket. We tried to negotiate with them officially for more than two years and unofficially for more than four years. But it's never a success.
Why is it not successful? What are the main problems?
Patent holders did not want to negotiate when we tried to find out their thoughts about making their drugs accessible to more people. They haven't agreed to talk. We have the paper to confirm that the negotiations fail every time. For the last two years they set up a subcommittee to negotiate officially and before that unofficially. Even officially during the last two years, the report back to the Ministry has shown failure because no company or patent holder wants to talk about lowering the price or sharing drugs with poor people. When they saw the report and after discussions with lawyers, many groups were concerned. So we decided to announce our intention to implement compulsory licensing on a few patented drugs. We made the first announcement for one first line anti-retroviral drug Efavirenz, and the second announcement for Lopinavir/Ritonavir (Kaletra), then the third one for an anti-platelet drug, Clopidogrel (Plavix). But actually right now after the announcement only one item was put into practice, Efavirenz. Negotiations are now going on: two years before they never wanted to sit down to talk with us and right now they are coming to sit and talk. But one of the companies requested that we abolish the compulsory licensing announcement before negotiations. We cannot go back on our announcement. An announcement is an announcement. Our announcement was not put into practice; it was made to allow for negotiations. The announcement will be put into action if and when the negotiations fail, and we need to buy the drugs.
Do you think that governments either in the North or in the South can play any role in persuading pharmaceutical companies to permit licensing under particular conditions? In other words, what role do you see for governments to play?
I think that we already have that under international law, namely the regulation under TRIPS flexibility. All member countries should try to strongly support every country to use the TRIPS flexibility in cases of necessity, in only some cases, even though there are so many patented drugs. There are very few items that need and can be implemented under compulsory licensing. Not more than that. Given the costs, we just really try to allow our low-income people to live a little bit longer and I think that no one wants to do compulsory licensing for a cosmetic drug or something like that. It's only for life saving drugs.
What has Thailand's experience been?
In Thailand, I do not think that we have enough people who can conduct comprehensive drug research. With malaria drugs they tried to do research for many years and the same with Dengue Hemorrhagic fever, but they only achieved some progress. They have to collaborate in research with other countries. We do not have enough scientists and budget for research and development.
So the last question Your Excellency: as my colleague Betsy mentioned, one of Thailand's leading HIV advocates and former Public Health Minister Mechai Viravaidya has just been appointed to design a new federal HIV prevention plan that will target the country's youth. Could you comment on the significance of this?
It is significant because he has so many tactics to tackle HIV/AIDS. He especially knows the nature of young people. I don't think that anyone knows a better way of dealing with young people than Senator Mechai. After his appointment he launched a condom for children. So many people were excited, but also criticized him for children condoms. Actually, children condoms are not really put into use, but I know he wants to educate the young people from the beginning.
From what age?
Six or seven. In kindergarten, everyone knows about condoms and the benefits of condoms. Children can become acquainted with prevention, which is very helpful for their life in the future.
That's extremely impressive at such a young age. Are there any countries that have started sex education at that age?
Not yet. You see that Senator Mechai Viravaidya has a lot of tactics! I am so glad that he accepted our invitation.
Is there anything else you would like to add before we close?
I would like to ask the rich countries from the North to cooperate with countries in the South-to take care of poor people. Let them live a little bit longer, save their lives, and let them die with some dignity. Don't let them die without any treatment. Especially in Thailand, there are so many cases of cancer when patients have to die without any medicine because the hospital refuses to treat them with very high priced patented drugs. For some chronic leukemia, a tablet per day costs 4,000 Thai Baht, and you can multiply it by 365 to get the figure for a year [$US 120 per day or $US 44,000 per year].
Some of them have to turn to herbal medicine that has no proven effectiveness. There are no studies, just only believing or faith that it can help. Finally they die without any modern medicine. There are so many cases like this. I used to work in the rural areas, and I saw so many cases. I just ask for kindness from rich countries to pay some attention to granting humanity to poor people. That's all.
Thank you very much.
Tuesday, February 24, 2009
Monday, February 23, 2009
Friday, February 20, 2009
Tuesday, February 17, 2009
Sunday, February 15, 2009
Saturday, February 14, 2009
Monday, February 9, 2009
Sunday, February 8, 2009
Saturday, February 7, 2009
Friday, February 6, 2009
Wednesday, February 4, 2009
Wednesday, January 28, 2009
The only thing on my mind that is vaguely relevant that is not to do with Thai health care or HIV coverage (or about my grade 1, 2 and 3 students) is international monetary organizations such as the WTO, IMF, the World Bank and others. Question came up in my class last Sunday about whether or not these organizations are used to keep the developing world under the thumbs of the developed world. As the name of this blog came from a song written on the IMF, I thought it appropriate that I do comment on it, at least once.
It is my opinion...my belief that these organizations are aware of the role that they play in keeping the poor poor. It is my opinion that these organizations and the world leaders who support them do so out of a power politics, realist desire to ensure the dominance of the Washington Consensus and to prevent other, dangerous systems or a change in the domination/sub ordinance world structure. China presents a real danger to the Washington consensus hegemoney because normally countries are too afraid of sanctions and having cash lines frozen to ignore the IMF and friends, but China doesn't rely upon western capital.
Okay, brief, rambling and full of errors, but that's all the time I've got now.
Thursday, January 22, 2009
Wednesday, January 21, 2009
The basics are that a religious cult person by the name of Winston Blackmore is accused of having 19 wives. None of them are minors, but the point is more about whether or not these women really made a choice to be with him in marriage or not. So, in terms of law he broke the Parliament's current version of marriage which is a union between two people whether they be one man and one man, one man and one woman, or between two women, or even between two people with alternative genders. Gender doesn't matter so much now, but the number of people does matter.
Anyway, the Globe article states that experts on both sides of the "gay marriage" debate have anticipated that this could be used as a defence of polygamy. The article cites a political scientist who says that he doesn't think the argument will work as the legal view is that there is a restriction on the number of people who can be married to each other.
I don't really want to defend polygamy but I would like to separate this kind of polygamy from other sorts, just to be fair. Some time ago I watched some program (I think on Oprah) that had several polygamous families speaking about their lives (couldn't find the link, but did find this) The woman and men that Oprah brought on gave a very different impression of what polygamy can be. One of the women said that the current laws were written (in the U.S in this case) to prevent abuse of woman. She argued that the laws are not relevant to the happy union that she has with her husband and with his other wife. She claims it makes all sorts of personal and financial sense as they can share expenses and raise the children together. Also, she said that when she is tired, it's nice to be able to get the other wife to cook and look after their husband.
I don't want to come across as someone trying to push the marriage debate to extremes, but I can see the validity of the argument that these people are making. I can also see that this case in BC is nothing of the sort. What is happening among these extreme religious groups is, in my opinion abusive and I don't think that it should necessarily be put into the same category as what some of the guests on the Oprah show were talking about.
That leaves open the question of how to stop polygamy that is abusive if polygamy itself is legalized. That would be difficult, I think. Perhaps it is better to just leave it illegal but focus police efforts on cases that are believed to be abusive while ignoring situations that show no signs of abuse. Also, there is really nothing stopping three or more people from living together outside of legal marriage.
That argument could also be used against "equal marriage". One could say that "there is nothing stopping two men from living together and living like they are married without actually getting married". My answer to that would be that as a society we give men and women equal legal standing. As such, we have created a legal system where gender does not have much relevance. Therefore, if gender does not have legal relevance than there is no justification for not allowing two people of the same sex to enjoy all of the same legal protections, benefits and duties as those of opposite genders. Society does not view men and woman as being the same, and biologically speaking men and women are clearly different in many ways (not only anatomy), though most of these differences could likely be attributed to environment, some appear to be deeply ingrained (perhaps at the chromosomal level). Those factors though are not very relevant to law, and marriage is a legal matter. Of course there is a religious aspect to marriage, and marriage began as a religious matter (as did science and education), but marriage has long since entered into the world of legal contracts and as such, in our system, it should not be based on gender.
In conclusion, I think we shouldn't adjust polygamy laws unless we can find a way to ensure that we have the tools to deal with abusive religious cults. Also, I think that the "slippery slope" argument is flawed because our legal system doesn't recognize gender differences as being valid reason for discrimination, but does allow discrimination based on other factors. For example, I cannot practice medicine, not because of my sexual preferences, race, religion, language et cetera, but because I am not a medical doctor. I did not go to medical school therefore the state discriminates between myself and someone who is a doctor. The quantity and quality of education is a factor in employment and is entirely legal. I know this sounds so elementary, but I'm trying to get to my point which is that quantity and quality (that is to say the nature of something) are legally relevant. Who a person is is not as relevant as what a person can do. Likewise, contracts between two entities to the exclusion of others are a basic legal concept. Contracts between parties that I am not associated with, by necessity exclude me.
Two put it more simply; two is not one. Two people cannot be re-interpreted as three people. There is no slippery slope toward polygamy. To allow polygamy would be an entirely separate discussion from the one that already occurred (in Canada) regarding "gay/equal marriage". Perhaps that debate will happen at some point, but that in and of itself would require many years of a very different social and legal paradigm from the one that we have now. In our current paradigm, the differences between numbers of parties to a contract are significant...certainly more significant. Not that we do not allow for some personal discrimination based on some matters (such as legal age). I hope that some of this is making sense and that the careful reader can distill (through this very unorganized blog entry) what it is that I'm trying to say.
Tuesday, January 20, 2009
Monday, January 19, 2009
So, this is what it is like to live in a period of deflation. I save on transportation costs, and tuition so in that way it's good for me. Also, a while back I bought some clothes...real name-brand stuff from a department store for cheaper than the fake stuff on the street! They were unsold items from the U.S. I don't think I've ever seen that before. Yes, the sales can be good at times but name brand stuff in obvious U.S sizes are not that easy to find at such a huge discount. I'm not a fan of American Eagle particularly, but I'm fairly sure that $5 for on of their shirts is a good deal And, the material is better than the usual $5 shirt so it will probably last me more than a month. I think I might be benefiting from the breakdown in the financial system.
Sunday, January 18, 2009
As I wrote earlier, the HIV infection rate in Thailand presents great challenges to the current government and a great deal of attention needs to be paid regarding how to provide anti-retroviral medications to all of these people, as Thailand currently does.
A topic of much debate (at least at my university) is regarding the overall health care system in Thailand. The government of Thaksin Shinawatra created a 30Baht (.90 cents U.S) universal health scheme. Many middle class Thais feel that they already pay way too much tax to a government that redistributes it disproportionately to the poor. I tend to disagree and personally am happy to pay tax here knowing that it is going to helping people who really have nothing.
Saturday, January 17, 2009
The Globe and Mail's Andrew Steele wrote an excellent entry on his suggestions for Minister of Finance Jim Flaherty. Steele states that the Canadian consensus that simply fixing old infrastructure will help is flawed. He states that it might even take more of the banks cash thus making them even more "tight-fisted" than what they are now. According to Steele, this will take even more cash away from cash starved Canadian business.
He suggests that Flaherty calls the head of the chartered banks (yes, there are only 5) into his office and tell them that he is going to create a $5 billion dollar loan guarantee fund. The government will secure 25% of it. If the banks don't hand out that cash by a fixed date than Flaherty should tell them that he will nationalize the banks and hand out the money himself. According to Steele "That will inject some money into the economy faster a speeding bullet. "
He's right. The Canadian banks were not allowed to take the risks that the U.S banks did and are now actually all profitable. Their desire for caution is good, but we are not going to get out of these problems by allowing the money supply to dry-up. If anything, I would argue that now is the time for the banks to extend themselves.
I would like to add to Steele's argument, though I'm sure he wouldn't agree with my next point. I think we should use the Canadian banks (threaten them with nationalization even) to promote Canadian economic interests. Think of how much we could end up owning that we didn't own before if the Canadian banks were to adopt some sort of Canadian business first policy. This could help Canadian companies to buy up pieces of foreign business operating in Canada at a discounted rate. Problem with this is though that that could anger our foreign partners and cause them to do similar things to our industries. Another question that would need to be addressed is how much do we actually still own and what is the number of Canadian companies that are operating abroad.
There might be an advantage, from a national perspective to having stable banks with money reserves backed up by the federal government at a time when many other banks are not so stable.
Tuesday, January 13, 2009
I think it is possible that we could develop a much nicer way of doing things in the future. The way things have been is not always an indicator of how things will become. I mean that though we have certain expectations and understandings of how economics run we have those ideas based only upon what we have seen in our short lives and not upon any other sort of higher power. We really have no idea what the future will hold and we are too frequently limiting what we expect is possible. Someone said that the difference between fiction and fact is that fiction has to be credible, or something along those lines. Who said that, anyone know?
Anyway, I think there is a chance that a new economic system could arise. That economic system could be more just than the one we have now. I think people are really angry at the simple fact that those who caused the economic problems are not suffering but the average person is. I think people are upset by this whole "privatize profits and subsidize losses" thing that we have been going with. I think the Washington consensus is quickly becoming part of history and that something new is going to take shape.
I don't think it's going to look anything like what the old Socialist systems looked like, but I think it might be a bit closer to what Marx prescribed than what Locke did. I can see the basic outline beginning to take shape and I think I would like to do some in depth research on this once things begin to settle a bit.
There is never any reason to think things are going to always stay the same and I think people should be aware that this economic situation could, and likely will have some benefits. It's hard to think like that when you can't pay the bills...I for one had a rough couple of months partly over the economic problems in Thailand and it seems to me that no one has any money here now, but this needed to happen. We've all been living in this sort of economic bubble and it had to break. There are interesting historical parallels that take into account the wealth of the average person and the overall strength of the economy.
One book I'd like to read soon is what Margaret Atwood recently wrote on debt. She is by no means an economist, but why should economics be only the realm of economists? Perhaps we need more art in economics.
Monday, January 12, 2009
A seat-warmer Dr. Mongkol would soon prove to not be. Not only did he preserve Thaksin's 30 baht (about a dollar) healthcare system for the poor, but he actually made it entirely free. Not ony did he do that, but he also fought for more funding for the program (though some of it was later removed). And, not only did he do those things but he also did something far more controversial.
Dr. Mongkol in November of 2006 ( I think) sent a letter to the Thai branch of Merck & Co. to tell them that their HIV drug, Efavirenz is "highly effective" but costs too much for Thailand to afford, so Thailand would break the patent and begin buying generic varieties produced in India. With this one letter, Dr. Mongkol began "war over the use of compulsory licenses" (Montlake).
According to the WTO, only 28% of the world's 7.1 million (as of 2006) HIV infected people in low and middle income countries are able to get the antiretroviral drugs that they so desperately need. Thailand is unusual in that everyone who needs them, gets them...for free. The number of Thais on antiretroviral medication was at 100,000 in 2006 (sorry that I don't have any more recent numbers...I'll look around in the next few days to see if I can find some figures for last year) and the number is expected to increase as more people become ill from HIV.
The problem that Dr. Mongkol took on was that the bill for these drugs was so high that at some point it might have become impossible to provide all of the medication required by the infected. first-line antiretrovirals such as Efavirenz are expensive but as time passes HIV infected patients may require second-line (and highly expensive) medications such as Kaletra. The latter, sold by Abbott's negotiated a deal to provide a year's worth of medication for Thai patients at the discounted price of $1,000 per year.
According to Simon Montlakes article, The World Bank has already concluded that Thailand's provision of antiretrovirals has had a positive economic impact as breadwinners are able to keep providing for their families for much, much longer while doing so more productively.
Without treatment, 9 out of 10 infected people survive for 10-15 years. With optimal treatment, that number balloons to 32 years. So, yes HIV research has had amazing results and it is realistic to expect a cure. It is also clearly important, economically speaking, to provide these antiretrovirals.
Going beyond what is simply economic, we should also think about the human side of this. The suffering that HIV infected people endure is high. They are often socially isolated, depressed and too sick to look after their families. The progression to full blown AIDS can sometimes happen very quickly (without proper treatment) and, well you only have to do a quick web search to see how these people live.
Those with HIV here in Thailand should be thankful that Dr. Mongkol Na Songkta didn't think of himself as just an interim Minister, but instead took action that will help ensure that everyone who needs these pills is able to get them.
For me, this is personal. I have a number of friends who are HIV positive and at least they know that they can get the medication that they need. For just a moment, try to imagine going for a test and finding out you are HIV positive. Just picture yourself suddenly finding that out. Think of your families, think of your friends, think of the people you've had sex with. Now imagine finding this out and also knowing that you have absolutely no financial means and that you have a family that will starve if you can't go out and earn money. Imagine that you have no means to buy these pills that will keep your family from starving and that you might only have a few years before you can no longer work. What do you do? Where do you go? Who do you turn to? In many countries, you have no one to turn to. You have no help. So, for countries that do provide this help, they are indeed doing something really admirable.
Sometimes good things do happen from military appointed regimes.