Tuesday, August 15, 2006

Letter to a President

The President (2005-06)
Malaysia Paediatric Association

Dear Sir,

I read with interest your articles “Boutique Vaccine” (Berita MPA April 2006) and “Pneumococcal Awareness and More about Vaccine (Berita MPA July 2006). Let me at the start state that I have no doubt about your integrity and have the utmost respect to you as one of the foremost paediatricians in the country. Also I am aware of the dangers of pneumococcal infections and its subsequent sequelae on our young patients. However, I wish to comment on a few trends that are happening in this country.

First, there appear to be a change in the marketing strategy in certain pharmaceutical companies recently. The pharmaceutical companies used to approach doctors to inform them of any new products and let them act as the gatekeepers to inform and educate their patients. Lately, it seems that companies have taken on themselves to marketing their products directly to the public by taking full or half page advertisements in the local newspapers, and distributing information pamphlets directly to the public.

Take, for example the vaccine in question. The wording of the advertisement is such that it implied that parents are not responsible if they do not get their children vaccinated. It also implied that pneumoccocal infection is so deadly that all infected children will be brain damaged. Of course, the heart wrenching photographs and testimony of the affected parents added weight to their statements. You mentioned, “We know this is a powerful message and looking at the possible outcome, there is no easier way to convey the message.” Is that true? Does instilling fear and panic in our patients’ parents constitute good education? It may not be MPA’s policy to create fear but the advertisement and the pamphlets given out to patients has already created a climate of fear. When parents came to see us, they are already in a state of panic and wanted the vaccine out of fear or in extreme guilt because they cannot afford to pay for the vaccine. How many parents do you really expect to consult the source references given? Or to understand them if they did?

Second, the fact that MPA logo appears on the advertisements implied that MPA endorses the product. It does not matter whether it is placed next to the company’s logo or not. And to say that the brand name was not mentioned is moot as there is only one company producing and marketing the vaccine in Malaysia at this moment and that said company is sponsoring all of the talks.

Third, we are talking about multiple vaccinations cost ranging from at least RM 1,200.00 to RM 300 which is a significant portion of some people’s salary. The average price of a single dose is more than RM 250.00 This multiplied by the number of children and we can end up with a large sum of money. This may give the impression that MPA is interested in catering to the rich only. I am a bit doubtful about the argument that if we increase the usage, the company will decrease the price. Why not the reverse? Why did MPA not insists that the company decrease the price then its members will use more of the vaccine?

Fourth, I find it fascinating that the MPA suddenly wanted to create public awareness about pneumococcal infections after the end of 2005 (which is when the vaccine was launched). What happens before that? Why were there no public awareness talks about pneumococcal infections before the launch of the vaccine? Was it not a big problem before? And was the incidence of pneumococcal infections as bad as it was painted to be when you wrote in your article that Malaysia did not have accurate disease burden data? The MPA’s Vaccine 2006 Update may not have any companies present. However the public awareness “Fight PnD” campaign is definitely a marketing event with Sheila Majid and Adriana Teoh. Where does MPA draws the line in public education and helping companies in their marketing?

Finally, on the same page of your article is a new Ministry of Health Immunisation Schedule with effect from August, 2006 using a new 6-in-1 vaccine. Please confirm that this is the new schedule because I have not heard from the Ministry of Health or from any other sources regarding a change in immunisation schedule. This schedule was delivered to all the doctors by the sales representatives of another pharmaceutical company which also happens to be the one marketing a 6-in-1 vaccine since March and also is the company with the only such vaccine on sale in Malaysia. If the Ministry of Health has not changed its schedule, why did Berita MPA print the schedule? If there is a change, why did Berita MPA not inform its members? Looks like the pharmaceutical company is doing the work of MOH and MPA for them in informing the medical fraternity.

Mr. President, I hope you do not take this letter personally. As I said, I have the utmost respect for you. I am however wary about the marketing strategies of multinational pharmaceutical companies. Next, we shall be hearing about a vaccine that can cure cervical cancer (cure cancer or prevent a viral infection? These are two different claims). I feel it is the responsibility of medical organizations like MPA to stand out and not be manipulated by pharmaceutical companies to endorse their products. I am all for disease and health awareness and I acknowledge that MPA is doing a good job about this. We have a duty to our patients and their parents to educate them, to be their advocate against the high cost of medications and vaccines and to provide equitable healthcare services to both the rich and poor.

Thank you,

Yours sincerely,

Dr Alex Tang
Consultant Paediatrician
Johor Specialist Hospital


Blogger jacksons said...

Hi Dr. Alex. I am one of those scared parents, who rushed my toddler to the doctor and paid RM 290 x 2 for my shots. I am so glad to have an advocate like you, looking out for our interest, but I am must ask you, is the Malaysian Healthcare scene ready for blogging doctors. Last I heard (I have a good friend involved in building information systems for the local healthcare scene) there was alot of sensitivity around doctors posting stuff on blogs. Just thought I would let you know. Your Agora Friend, Leon.

8:11 AM  
Blogger Alex Tang said...

I am sure the Malaysian Healthcare scene is ready for blogging doctors. It will be a matter of time when there will be more of us online.

There is no restrictions on doctors posting to blog as far as I know. However there are two rules of conduct of the medical fraternity: one is that we are not allowed to self-promote our professional expertise (advertisement) and the second is that we are not allowed to disclose confidential patient information. This applies to all media which includes the newspapers, Internet or television.

Unfortunately, because of these two rules, many doctors are afraid of speaking out because of the fear of being accused of advertisement. This is sad because doctors are the best people to educate the public on medical matters and policies. Because of this vaccuum, medical information is being disseminated by pharmaceutical companies and alternate medicine practitioners. There is nothing so dangerous as pseudo-science and too little knowledge.

However, I do hear you, Leon, and I thank you for your concern.


6:28 PM  

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