This is a lengthy piece, but hear us out.
In John 8 verses 3-11 of the Bible, we saw a throng of people led by religious scholars and the Pharisees dragging a woman who was reportedly caught in an act of adultery. One of the Pharisees, with a prominent goatee and mustache, asked Jesus.
“Teacher, this woman was caught red-handed in the act of adultery. Moses, in the Law, gives orders to stone such persons. What do you say?”
This pharisee, along with several others, including one who dispenses “holy” herbal drugs in the whole of Jerusalem and the chief Pharisee appointed by Herod to oversee the health of the people, wanted to trap Jesus into saying something incriminating so they could bring charges against him.
Jesus bent down and wrote with his finger in the dirt. They kept at him, badgering him.
He straightened up and said, “The sinless one among you, go first: Throw the stone.” Bending down again, he wrote some more in the dirt. Hearing that, they walked away, one after another, beginning with the oldest. The woman was left alone.
Jesus stood up and spoke to her. “Woman, where are they? Does no one condemn you?” “No one, Master.” “Neither do I,” said Jesus. “Go on your way. From now on, don’t sin.”
This was not the first time Jesus questioned these religious scholars’ judgment and sagacity. In Matthew 7:3, we find Jesus criticizing them for judging another person when they themselves sin profusely.
“How can you say to your brother, ‘Let me take the speck out of your eye,’ while there is still a beam in your own eye? You hypocrite! First take the beam out of your own eye, and then you will see clearly to remove the speck from your brother’s eye,” the disciple Matthew wrote in 7:4-5.
Let’s apply this in the ongoing “ethical controversy” surrounding the Philippine medical profession today.
An internist going by the name of Dr. Tony Leachon hugged the headlines when he denounced certain “unethical” marketing practices allegedly being practiced by his colleagues in the medical industry. Leachon’s rant came a week or two after Senator Raffy Tulfo berated his friend, now, Health secretary Ted Herbosa. Herbosa got the heat from Tulfo after the senator claimed in a now famously shared video online that he had information of certain doctors allegedly in collusion with several big pharmaceuticals see link: https://www.gmanetwork.com/news/topstories/nation/902341/tulfo-herbosa-argue-over-pharma-sponsored-trips-for-doctors/story/. These doctors, Tulfo claims, are prescribing medicines being sold by their pharma friends in exchange for monies, foreign trips, houses and even expensive cars. Herbosa admitted hearing this and said that he will take a look at it. Tulfo asked several agencies to take a look at this practice see link: https://politiko.com.ph/2024/04/30/nagmamaang-maangan-raffy-tulfo-calls-herbosa-out-for-downplaying-alleged-collusion-between-pharma-firms-doctors/features/#google_vignette
And here comes self-proclaimed public health advocate, a certain Leachon. It is not a secret to everyone how close Leachon is to Herbosa. The fact is, they are described as the “batman and robin” of the Philippine medical sector. In certain issues, Herbosa and Leachon usually sing similar tunes, something described by some medical doctors as akin to The Everly Brothers or Daryl Hall and John Oates or even Sonny and Cher. Both claimed to be “public health” advocates. And to highlight this friendship, Herbosa even appointed Leachon as the Health department’s special adviser on communicable diseases see link: https://www.philstar.com/headlines/2023/08/11/2287924/doh-appoints-tony-leachon-special-adviserfor-non-communicable-diseases#:~:text=MANILA%2C%20Philippines%20—%20Health%20Secretary%20Teodoro,adviser%20for%20non%2Dcommunicable%20diseases.
After being scrutinized by Congress for getting a 100,000 pesos a month fee as adviser and his qualifications severely questioned, see link: https://politiko.com.ph/2023/09/07/p100000-suweldo-garin-questions-leachons-qualifications-as-doh-adviser/politiko-lokal/, Leachon quits the post: https://newsinfo.inquirer.net/1830219/leachon-resigns-as-doh-adviser-for-non-communicable-diseases.
Some medical doctors say that Leachon’s resignation was just a ruse to ease the heat heaped by legislators on Herbosa because after resigning, Leachon of course, went back as “volunteer” see link: https://mb.com.ph/2023/9/8/herbosa-confirms-leachon-s-return-as-doh-volunteer-consultant. Why is Leachon very interested in getting this title of “consultant.” ? Well, if you are a consultant, people will immediately think that you are close to the Powers-that-be and you somewhat influence their decisions. We don’t know of any instance in other foreign jurisdictions if advocates are appointed by the government as “consultants” whether “volunteer” or “paid.”
By the way, let us understand how several international scholars define public health advocates. “Public health advocacy, “ writes Al-Qudah (2022), “refers to gaining political commitment for particular health goals or programs. It targets decision-makers, policymakers, and more generally, those who can influence individuals’ actions in the community.”[1] The New York University School of Global Public Health defines it as a process of increasing political commitment for a distinct goal or program.”[2]
Since any Tom, Dick and Harry can definitely proclaim himself as a “public health advocate”, normally in the medical profession, such a claim of being such requires one to finish a Masteral program on public health advocacy. And quite normally, medical associations themselves take the lead in advocating changes in the medical profession, not an inexperienced or self-proclaimed medical practitioner. [3]
We don’t want to dwell on the policies that Leachon has influenced in his career as a “public health advocate.” It cannot be denied, however, that his name became infamous in the public sphere when he, along with Herbosa, verbally attacked former Health Secretary Janet Garin for allowing the use of dengue vaccinations during the time of former President Pnoy. They questioned the inefficacy of the vaccine used and claimed that several people died in the process, including children. Until now, there has been no validated incidence of death due to Dengvaxia. See link: https://www.philstar.com/pang-masa/punto-mo/2023/08/18/2289543/kaso-ng-dengvaxia-vaccine-masalimuot-pa.
Sadly though, Leachon’s so called “antics” led to the now infamous vaccine scare see link: https://www.aljazeera.com/news/2021/1/29/philippines-covid-vaccination-policy which Leachon himself admitted as the cause for the low public support of vaccination during the COVID-19 epidemic. A medical research article validated this.[4]
Okey, so now, is Leachon still a “public health advocate” since we know that he is the “volunteer consultant” of our health secretary Ted Herbosa? Isn’t it a conflict of interest that an advocate now shares and swaps ideas with the chief government implementor of health policies? How would, then, “public advocate” Leachon criticize the erroneous public health policies of his friend, Herbosa? Will Leachon rant about rising cases of diseases in the country? How will Leachon advocate for the rights of medical workers who are being given palsy pay yet required to spend 12 or more hours in hospitals?
Okay, now Leachon is at it again; this time, his targets are his own colleagues whom he accuses of colluding with pharmaceutical companies. According to Leachon, pharmaceutical companies which he eventually named to be Bell Kenz in his X twitter feed, are luring doctors into a marketing scheme when they prescribe medicines manufactured by the pharma firm, even if the patients do not need it. See link: https://newsinfo.inquirer.net/1932589/fwd-leachon-on-doctor-and-pharmaceutical-scheme.
Leachon says doctors are given a sales quota in that interview or testimony. Okey, let us discuss this.
First, granting for the sake of argument that a doctor is given a sales quota by a pharmaceutical firm, how would a doctor find the means to achieve this quota? Leachon says it’s through prescription, “by prescribing medicines which the patients do not need.” So, he alludes that harm on public welfare is being done because of what he accuses doctors are committing—over prescription.
Question for this “public health advocate” – how did you come up with this accusation? What is your basis? And even if there is a basis, are you not concerned, Mr. Public Health advocate, of the social repercussions of this “baseless” (since there is still no clear evidence or even an adjudication of this as of this writing) allegation that you now again posted publicly? Are you not scared that people would lose their trust in their doctors and affect all the rest of the members of the entire medical profession, similar to what happened in the Dengvaxia controversy?
Some MD’s expect this from Leachon since, hey, he never attended a class conducted by a university or school offering masteral programs on public health advocacy. We are disputting this since we haven’t researched about this.
True public health advocates are responsible people, period. We are being clear here—we are leaving it to the people to decide for themselves whether Leachon is really a public health advocate or even a “health expert.” Could one cite just one thing that made Leachon an expert? We identified one based on our conversations with his peers—Leachon is one of our best propagandists, of the Roberspierrian mold.
Many doctors are concerned that Leachon is now questioning every doctor’s medical prognosis for their patients. If you are a diabetic, for example, who is to say that you need a tablet or two of Metformin? Leachon? The Senate? The DOH? The Professional Regulatory Board or PRB? The medical associations?
No. Everybody knows it’s the doctor.
Are you saying that Leachon goes now to the Senate to tell every one of our highly esteemed legislators to enact a law that if you are a diabetic or a hypertensive person, the Senate will now dictate how many pills or tablets someone of that disease or illness needs? Senator Bong Go says he conducted the hearing in “aid of legislation.” If the core issue is over prescription, how would the Senate now fairly adjudicate what is best for the people’s welfare when they are questioning the very integrity of the prescribing doctors already? Who’s to say that a doctor oversubscribed? Senator Go? Senator Tulfo? The sibling senators, Jinggoy and JV? Health secretary Herbosa? Leachon, who is not even one of the top cardiologists in this country?
Some even chastised Senator Jinggoy for including in his slide the anti kickback law. Well….
Ah, they say, we are not after all doctors—we are after some. Okay, some are doing it. Yet, the fact is that Leachon, as he did during the Dengvaxia controversy, likes to see himself always on the radio, being interviewed by Kabayan Noli de Castro or other journalists who happen to be some of his patients. He always wants to see his name plastered on several broadsheets for reasons that I dare not state here. It is up to you readers to determine for yourselves what his reasons are, maybe “public health advocacy.”?
We dare Dr. Leachon—since you are trying to convince the public that these doctors are committing un-ethical practices, and we presume that you want the public to believe that you are not, are you confident that you, yourself, did not issue any prescription endorsing any drug being sold by your friends in the pharmaceutical industry? That you, at any instance in your career, did nothing but prescribe generic medicines and not their brand names? This is the core issue.
Is there a direct correlation between prescription and drug sales? At this point, there is simply none. The only knowledgeable people who know the sales figures of each drug in the market are the drugstore people. They know what medicines sell and what lingers on their shelves. Do doctors know? Of course, they don’t! Why?
First, are doctors psychics that they can predict how many patients they will have for a day, or a week, or a month? This is a variable. Some smart aleck would say, well, doctors have their list of patients who are under maintenance medicines. True. Yet, how would this be a basis for agreeing with a pharma that a certain doctor can get 3, 4,5 or 20 million pesos worth of sales in a month when the number of patients varies? Are doctors gods that they are able to predict who among their patients would continue using their prescribed drugs or who would not? Or who among their patients would die in a month or two, and who are those who will live continuously to buy their prescribed meds?
Even if these doctors include the brand names of these generic drugs in their prescriptions, it is still up to the patients to decide whether to consider the doctor’s “endorsements” or not. This is, again, a supervening variable. Usually, and most patients would agree, the issue is price. If the recommended medicine is pretty expensive, especially those sold by some big pharmaceutical companies, including Pfizer and Unilab, then patients will opt for cheaper alternatives, like Rhea, TGP, Watson’s et al.
So, if you were a marketer, how would you know if the doctor was achieving his quota? You would probably ask the drug stores. Are the drug store sales data sufficient to conclude a direct correlation between the doctors’ prescription with the pharma’s sales? We tested this and found there is no correlation whatsoever.
So, if a certain doctor cannot achieve a quota, how then will these pharmaceutical marketing heads justify giving the giving of these doctors plentiful “rewards”? It is highly improbable to link prescription with sales.
The core issue: Ethics
Leachon says the marketing schemes he claims pharmaceuticals undertake with doctors are “collusions” and borders on the “unethical.” Okay, here comes the kicker.
Ethics, the National Health Institutes states, “is the study of morality – it involves careful and systematic reflection on moral decisions and behaviour and helps achieving a correct analysis of situations.”[5]
Okay, the reason why ethics is the core issue here is the allegation by Leachon that the marketing schemes of pharmaceuticals influence the “decisions and behavior” of medical doctors. So, what now is the most ethical thing that doctors and all members of the medical profession in the Philippines must do?
The truest standard of ethics in this profession is simply this: to forbade, by law, any doctor or any member of the pharmaceutical companies from seeing each other. Period. No ifs or buts. That is the true essence of ethics—to avoid pharmas influencing the decisions of doctors.
Treat pharmas like how lawyers treat judges—no meetings while the case being handled by the lawyer is being heard. Treat pharmas like how engineers treat directors of DPWH—no meetings while these engineers are batting for their projects for approvals. Treat pharmas as how teachers treat politicians during election times—no meetings while these teachers tend the polling places where these politicians vie for positions. Treat pharmas as how policemen doing their rounds do—they are forbidden of hob-nobbing with small businessmen, vendors and entrepreneurs. Treat pharmas as how anti-drug operatives do—they don’t negotiate with drug smugglers and small time pushers.
The medical associations qualify ethics by allowing doctors to go on educational trips. For them, this is a way for doctors to know the latest medicines to prescribe to their patients. We all know what happens in these junkets, err, trips.
There are medical journals available online where doctors can keep themselves updated with the latest advancements in medicines and discoveries related to diseases such as diabetes and hypertension. It raises the question of why drug exposure workshops are necessary, where pharmaceutical companies host doctors to promote their products and encourage them to prescribe their medicines.
Some people believe that it is acceptable to provide doctors with free samples of the latest medicines marketed by pharmaceutical companies. However, we disagree and assert that such practice is still unethical. The question is, do we consider the size or quantity of gifts given to doctors as the basis for determining whether or not the gifts are ethical? For example, is it okay to give doctors a few sheets of sample medicines but not a house, car, or luxury bag or watch? Does ethics depend on the value or quantity of the gifts? We believe that giving gifts, regardless of their size or number, is unethical.
Ethics becomes an important element here because there is a malicious imputation that these marketing schemes influence the way a doctor behaves or thinks or decides. That’s the core issue.
We presume that our doctors and medical authorities know this. This leads us to the penultimate question—why Leachon and Herbosa and some members of the medical profession are doing what they are doing?
We heard that some even released a copy of doctors who reportedly engage in marketing practices with pharmas. Why? What’s the end goal of these people and we are not asserting here Leachon, Herbosa or anybody else, but why?
There is still no decision yet of any body, whether judicial or not, that these doctors committed unethical practices. As far as everybody is concerned, these doctors are still innocent in the sight of the law and of morality, even. Why? We guessed why.
Someone wants to force these doctors to leave this small Filipino-owned pharmaceutical firm and consider moving to bigger pharmaceutical companies. This giant of the pharmaceutical players is not really interested in ethics—he is interested in poaching the doctors from this small pharmaceutical firm and getting them for himself by using legitimate channels of pressure in our political system. Meaning—someone is pulling his political strings as the puppetmaster in this controversy by unleashing some dogs of hell and providing our good senators some headline hugging “facts” kuno to bait them and get free publicity.
It seems that there is reason to believe that a certain individual, who is referred to as the “puppetmaster,” has been manipulating the minds of our legislators and public health advocates. Although there is only a small amount of evidence supporting this claim, it is a positive sign that some information has surfaced about this individual’s actions and intentions. It is likely that someone with inside knowledge will eventually come forward and reveal more information about this “puppetmaster.” In fact, one individual has already come forward and disclosed some of what they know about this person’s goals and activities.
A large pharmaceutical company, which will remain unnamed, lost its leading position in the sales of diabetes and hypertensive medicine. In their frustration, they pointed fingers at a smaller pharmaceutical company for their misfortune. Instead of blaming others, however, the larger company should hold its marketing head accountable for its lack of creativity in promoting its products.
Or maybe, just maybe, patients are not buying the products of this big pharma because they are either not “hiyang” or they just think that these products are not efficacious enough compared with similar products sold by this small pharma firm.
Conclusion
Health secretary Ted Herbosa created an investigating panel to look at what his buddy, Leachon “exposed.” See link: https://www.manilatimes.net/2024/05/04/news/national/joint-panel-to-investigate-unethical-pharma-scheme/1944508.
For us, this is understandable considering that Herbosa is holding a political position. Herbosa needs to answer to his principal, President Ferdinand “Bongbong” Marcos Junior. Marcos Junior might have his head chopped off figuratively, if Malacanan sees that he is doing nothing about this controversy.
But, it is pretty, pretty obvious—Herbosa and his associates probably realized that senators have seen thru their game and these legislators want out. The fact is, Senator Bong Go, during a caucus with his peers, agreed to allow the Blue Ribbon committee to investigate this see link: https://www.philstar.com/headlines/2024/05/04/2352436/doh-set-probe-pharma-firm. Politically, this is interpreted by some analysts as passing the buck tactic.
The blue ribbon committee is the one tasked by the Senate to investigate government agencies. Meaning, the core issue will be if there is a misfeasance or malfeasance committed by a governmental agency see link: https://mb.com.ph/2022/08/27/the-blue-ribbon/. This committee, says Economics professor Solita Monsod, has the power to put everybody under investigation see history of the blue ribbon here in this link: https://econ.upd.edu.ph/perse/?p=3161
So there. This committee will now put the health department under the spotlight. And other committees as well. That explains, some kibitzers say, why the DOH immediately formed an investigating panel. It’s like communicating to the senators that hey, leave this thing to us and stop from investigating this thing further.
The big question everyone is asking is this: Since Herbosa himself is a doctor and Leachon is the “advocate” in this issue, who does not hide his close association or “friendship” with Herbosa, what is Herbosa’s moral ascendancy to adjudicate this issue as health secretary? If this probe is about ethics, then what is the moral ascendancy of every member of this panel? Is there at least one or two of them without any past or present ties with executives of pharmaceutical companies? And if there is at least one, how then will this issue be resolved by putting it into a vote? How will it be adjudicated? And what is the authority of this one person to say what is moral or ethical or not? Is he a priest a monk or a Buddha?
And what is the moral authority of a political agency, the Senate blue ribbon committee, to dictate to the medical profession what is ethical and what is not? is’nt that the medical profession, like all other professions, self regulate themselves when it comes to professional behavior? For lawyers, the Supreme Court created that Code of Ethics. Is this an over-stretched in terms of jurisdiction?
And if the Blue Ribbon is not in the position to determine ethical or unethical behavior, then what would be the basis for ascertaining whether or not any form of feasance was committed by government officials?
And if we cannot see beyond the ethical dimension, how then do we now see these marketing acts—illegal? What is the legal basis? The Mexican protocol is all about reportage, and is the byproduct of legal considerations to address a perceived ethical conduct. Unfortunately, this is a protocol.
Something to ponder. At the end of the day, as one radio commentator said, we, ourselves, in our best pondering of morality, dictate what is ethical or not. In so doing, we often decide erroneously, being human, to consider an act ethical when, in all circumstances, every single thing is unethical.
[1] Al-Qudah, R.A., Barakat, M.M., Batarseh, Y.S. (2022). Public Health Advocacy. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_45-1.
[2] https://publichealth.nyu.edu/careerhub/advocacy.
[3] Wilson L, Hamwi S, Zanni F, Lomazzi M. Global public health policies: gathering public health associations’ perspectives. Glob Health Action. 2023 Dec 31;16(1):2183596. doi: 10.1080/16549716.2023.2183596. PMID: 36856722; PMCID: PMC9979982.
[4] Berdida DJE, Franco FMC, Santos XAG, Dacol CB, Dimaano M, Rosario ESD, Lantin CC. Filipinos’ COVID-19 vaccine hesitancy comments in TikTok videos: A manifest content analysis. Public Health Nurs. 2023 Jan;40(1):135-143. doi: 10.1111/phn.13143. Epub 2022 Oct 27. PMID: 36300833; PMCID: PMC9874770.
[5] Pitak-Arnnop P, Dhanuthai K, Hemprich A, Pausch NC. Morality, ethics, norms and research misconduct. J Conserv Dent. 2012 Jan;15(1):92-3. doi: 10.4103/0972-0707.92617. PMID: 22368346; PMCID: PMC3284025.
