The long-delayed NMDP
t was cold-blooded murder; we hold Transnational Pharma[Mafia] answerable for the life of the 57- year- old greatest medical benefactor of third world’s human race; who shed sunshine on their lives.
President Maithripala Sirisena and his Health Minister, Dr. Senaratne,[former and present Health Ministers] have a golden opportunity to place before the relevant authorities the long delayed National Medicinal Drugs Policy (NMDP), hindered due to sabotage under the former rule, when the third-world’s abject poor commemorates the great man on his 95th birth anniversary on February 13. Prof. Senaka Bibile’s policies and proposals had to be dropped due to pressure from USA and other European nations on which governments since 1977 were heavily dependent upon. Insiders say the then US Ambassador in Sri Lanka met Premier Sirimavo Bandaranaike in 1976 and told her that if the Bibile policy was not scrapped and if Sri Lanka did not import thousands of drugs from the TNCs the US would cut off aid to Sri Lanka. The Premier had no option but to give in because Sri Lanka at that time depended far too much on US aid. She immediately called Prof. Bibile to Temple Trees and when going there with his faithful pupil, Dr. Kumaraiah Balasubramanium, who had worked closely with him for more than 20 years, Prof. Bibile had said “We are finished”. So it was. Sad and disappointed, Dr. Bibile quit the SPC and went to British Guyana while Sri Lanka was forced to allow the Big Pharma’s Mafia to virtually run our pharmaceutical sector. Bibile, the Professor of Pharmacology, and first Chairman of State Pharmaceuticals Corporation, a dejected man left the country and took up an assignment with the United Nations (UN) in introducing his programme in third world nations. Born on February 13, 1920, the menace he was to the powerful trans-national pharmaceutical corporation had some bearing on his untimely death in British Guyana, while working there to introduce his policies on the sensible use of pharmaceuticals. It was cold-blooded murder; we hold Mafia responsible for the life of 57 years old greatest medical benefactor of third world’s human race; who shed sunshine on their paths.
On the last occasion, when our President was the Health Minister, the bureaucracy prevented the draft bill being distributed among relevant professional bodies or individuals. A bill concerning far-reaching changes in the medical drug supply was kept a secret for unknown reasons by the Ministry Officials who were on Mafia’s pay roll. If the bill was made an act after passing through the legislature in a faulty manner, it will impair all medical processes and destroy the entire health system.
Being questioned the spokesman said, “Nobody outside of the ministry has seen this 84 page draft bill. I wonder how they could make any remarks as such without seeing the contents of the draft.” but stopped short of explaining why it was not shown. However, the Government Medical Officers Association, [GMOA] and other concerned watchers were confused and perturbed by the Ministry’s choice with regard to the draft Bill (NMDDCRA) that was presented last time. A national drug policy has been left in abeyance for four decades. Then in the Rajapaksa era, some mysterious force enticed by the Transnational Pharma Mafia prevented the implementation of NMDP, blaming it on the then Health Minister, who made a genuine attempt to introduce it. It is imperative on the part of the new minister to seek the approval of all stake-holders to ensure the conformity of the draft before it was presented for parliamentary approval.
Over 16,000 registered medicinal drugs are being prescribed by the medical profession in the island. At least 13,000 of them imported into the country are unnecessary and expensive new drugs. Prof. Carlo Fonseka, former President of the Sri Lanka Medical Council (SLMC) and Chairman of NATA [National Authority on Tobacco and Alcohol] called it a mockery of Prof. Bibile’s principles, and that it is totally inappropriate compared to Bibile principles, where the model of necessary medicines had not been spoken of.
The patients are burdened with exorbitant costs just for the brand name. Medical professionals except for a negligible few, prescribe drugs by brand name, also a violation of Bibile principles, counterproductive and costly.
The other vital principle was for the exploitation of drug imports and distribution to be arrested through calling for worldwide tenders. Prof. Bibile had also commended the manufacturing of drugs in the island as against imports. The principles also wanted to regulate the actions of the Drug Mafia, where high-priced drugs dictate to other equally effective quality products. Many drug companies affiliated to Big Pharma are in the habit of indulging unethical promoting practices to an extent where competitive cheaper drugs with a similar composition would find it impossible to compete.
Local manufacture, as suggested by Professor Bibile would avoid this discrepancy and the excessive foreign exchange losses. The market is flooded with overpriced branded products; doctors and Pharma Mafia are making money at the cost of the poor patients. The Bibile Principles specifically recommended that the patent laws be studied and reviewed. The Big Pharma had the tendency to patent their drugs to dodge competition. When they introduce a new drug, competition would be avoided for a specified period, usually 10 years on average or extended further at a massive cost.
However, such a move would permit the monopoly of the drug and hence avoid competition. Such moves eventually lead to exhorbitant prices. The standing committee appointed by the State was supposed to study the dictates of Senaka Bibile programme and formulate the bill consequently, before it was presented to the Attorney General for final legal draft, and from there to consultative committee appointed by the President for further study. The passing of the bill was highly anticipated and will be hailed by the sick who awaits a ‘quality drug at an affordable price’. Many in the medical profession who had been reliably informed of the flaws in the bill said it was not in accordance with the Bibile Principles. The Bill had been drafted well short of the stipulated structure for the proposed institution.
Prof. Carlo Fonseka an authority on the subject criticized the draft asserting that it was not ‘toeing the line’ with the Bibile Proposals. “There was neither a concept nor a mechanism for quality control nor a regulatory mechanism” he claimed. The Peoples Movement for the Rights of Patients (PMRP) and GMOA expressed similar fears too. They doubted the trustworthiness of the draftsmen: in an independent regulatory authority there should be a chairman appointed by the Minister, further, there is no supervisory apparatus for the authority to make decisions.
However, the spokesman rejected the views and assured that the bill was in conformity with the Professor Senaka Bibile Principles and that they have been studying the concepts for a long period. “I can be certain that there has been no deviation from that goal,” he said. Though they attempted to hide it from others, some of the clauses and sections got leaked out.
The other vital principle was for the exploitation of drug imports and distribution to be arrested through calling for worldwide tenders. Prof. Bibile had also commended the manufacturing of drugs in the island as against imports.
Prof. Bibile insisted that the drug used had to be of the highest quality and this could be ensured only by having an effective and efficiently run quality control laboratory. Bibile was Sri Lanka’s first Professor of Pharmacology, he was well aware of the economic neo-colonialism that is being continued by the rich western states to plunder the wealth and resources of the poor Third World countries. This is being done mainly through the powerful trans-national corporations which loot the third world’s resources in the vital areas of food including milk, pharmaceuticals and agro-chemicals.
Cost and quality factor
Senior medical professional and former academic Dr. Mark Amerasinghe, a close friend and admirer of Prof. Bibile has in an article pointed out the most significant aspect of Senaka Bibile’s thinking regarding drug recommendation and usage. Prof. Bibile did not advocate the usage of a drug simply because it was the cheapest presented by the market. His main concern was the patient’s well-being. If the patient’s needs could be met equally well by drug A, which cost the patient less than drug B, then Prof. Bibile spared no pains to make the low-cost, yet effective drug obtainable to the people and he admonished doctors to recommend the low-cost drugs.
Prof. Senaka Bibile’s policies and proposals had to be dropped due to pressure from USA and other European nations on which governments since 1977 were heavily dependent upon. Insiders say the then US Ambassador in Sri Lanka met Premier Sirimavo Bandaranaike in 1976 and told her that if the Bibile policy was not scrapped and if Sri Lanka did not import thousands of drugs from the TNCs the US would cut off aid to Sri Lanka.
But the purchase of raw materials from foreign countries -a practice that helped to cut costs by by-passing the powerful trans-national drug corporations was an element of his policy where he claimed on effective quality guarantee of the product before it was used by patients.
With this in mind Prof. Bibile along with Communist Party Leader Dr. S. A. Wickremasinghe worked out an essential medicines concept or a policy for the rational use of pharmaceuticals. It was not a case of giving only cheap generic drugs, as some local agents of the Transnationals, politicians and some medical specialists try to make out.
Prof. Bibile did not advocate the usage of a drug simply because it was the cheapest presented by the market. His main concern was the patient’s well-being
This policy was accepted by Prime Minister Sirimavo Bandaranaike’s United Front government and implemented in 1971. The State Pharmaceuticals Corporation was set up and Prof. Bibile was entrusted with responsibility of running the institution. His concern and care was not only the maintenance of quality drugs available to the people at affordable prices, but also looking after the staff and its workers as he became the head of its trade union too; possibly the first head of a state corporation to hold both positions. Prof.Bibile continued the policy of rational use of pharmaceuticals, amidst severe odds. The Big-Pharma was so powerful that they exerted so much influence on the US to take harsh action to halt Bibile’s programme being successfully implemented.
For more than one and a half decades Health Ministers have pledged to re-introduce regulations, but all attempts, real or dubious have been thwarted. We hope that at least this time one of the greatests of modern medicine will be respected on his 95th Birth Anniversary by successful implementation of his policy and programme.