dear all... maaf kalau sudah pernah baca. these articles highly recommended to read.
begitu byk obat generik dikemas ulang dan diberi merk. Harganya jadi mahal spt obat paten,tapi isinya generik. di sisi lain begitu banyak obat dihambur2 untuk pengobatan yang mungkin hanya membutuhkan home treatment.. *"That's why children in Jakarta go to the same doctor every two weeks, with the same disease, to receive the same, wrong medication which reduces their immunity," he said (Prof Iwan Darmansjah)* regards, reyna =========== http://www.thejakartapost.com/detailheadlines.asp? fileid=20060214.B01&irec=1 Pill-popping public 'victims of unregulated market' Hera Diani, The Jakarta Post, Jakarta If you are a health consumer in Indonesia some of these situations may be familiar to you. -- You go to a doctor instead of self-medicating for your cold and fever and end up with three different types of medicines, plus vitamins, which cost you a cool Rp 400,000 (US$43.50). -- You are stuck in an emergency room of a hospital with a bad case of food poisoning, when you get another reason to vomit -- the price of your bill for the medicines is Rp 700,000. Then the doctor gives you a shot and you feel fine, but annoyed. -- *You take your toddlers to the pediatrician almost every month, forking out good money for many packets of medicines to treat the same reoccurring cold and flu symptoms. Your pocket hurts and you worry about the effect the many pills are having on your children's development. * -- Unable to afford your medical bills, you pay half -- and get only half -- of the prescribed drugs. Or you risk all and go to the Pramuka black market in East Jakarta for cheaper medicine. Health is wealth, as the saying goes, which in this country could translate to mean "getting sick can rob you blind". Experts say doctors here often overprescribe drugs to unwary patients, who are also paying too much for medicines -- a situation they say is caused by a lack of regulations and monitoring. University of Indonesia medical school professor and pharmacologist Dr. Iwan Darmansjah said an absence of regulations governing the retail prices of prescription drugs here had caused some doctors and companies to inflate prices to ridiculous, rip-off levels. "The amoxycillin antibiotic, which in other countries only costs between Rp 400 and Rp 500 (about 4 U.S. cents) a tablet, is being sold here by several companies for as much as Rp 2,800 a pill. That's deceiving, unfair business," Iwan said. Health Ministry rational drug use department director Husniah Rubiana Th-Akib said manufacturers were also taking advantage of the erroneous public perception that generic drugs were less effective than their patented counterparts. Husniah said all drugs were categorized as either generic or patented. Patented drugs were generally the latest generation of a drug, and were usually more expensive. But generic drugs -- often made specifically for low-income consumers -- should be no less effective and prices should be considerably cheaper in most cases, she said. Patented drugs have only a 2 to 3 percent market share but make up 15 percent of national drug revenue. "What manufacturers do, however, is take a generic drug, make it more appealing with packaging and everything, and then slap a 'brand' and a high price on it. We can call this type of drug a 'branded' generic drug," Husniah said. *"For amoxycillin, for example, there are over 100 brands on the market, with (wildly) fluctuating prices, while the content (in the tablets) is the same." * Often cheaper generic drugs are sold at the same price as patented drugs -- or worse, were packaged as such, she said. Marius Widjajarta of the Indonesian Health Consumer Empowerment Foundation said drug prices should not fluctuate much. "(Prices) tend to decline because newer, more sophisticated drugs enter the market." However, international Pharmaceutical Manufacturers Group director Parulian Simanjuntak said drug prices here were based on the simple market mechanisms of supply and demand. Because health insurance is not common in Indonesia, about 80 percent of drugs are being bought by individuals or companies, Parulian said. Large insurers, as big buyers of drugs, could help set market limits on prices, he said. With a total market value of about $2 billion a year, many companies here are involved in drug manufacturing -- 34 multinational companies and another 170 local ones, according to data from the group. In such a competitive market, companies often pay doctors commissions to prescribe drugs, meaning patients often get medicines they do not need. Indonesian Doctors Association chairman Farid Anfasa Moeloek said the government should subsidize drugs for low-income groups, who were supposed to get free medical treatment. Farid said the unregulated system, not doctors, was to blame for the high prices. Husniah, meanwhile, said the Health Ministry planned to regulate the packaging of drugs to ensure consumers could easily tell the difference between generic and patented medicines. Branding on generic packaging would be 20 percent smaller and retail prices and ingredients would also be listed, she said. "It's important for consumers to know what is in the tablets they buy," she said. If they had a choice between three chemically identical drugs, they could then choose the cheapest one, she said. Manufacturers are opposed to the new labeling rules, which they say are against trade laws and will only increase their costs. Parulian said international manufacturers already labeled their drugs clearly and included tablet ingredients. "The plan would change the layout of the whole packaging. Besides, (the idea) goes against the regulation for Trade-Related Intellectual Property Rights on brands." "We need brands, we invest in them. By including a drug's generic name, it will weaken our brands. We are going to protest this plan," Parulian said. The industry has yet to make up its mind on price labeling, but Parulian believes it would be difficult to impose. "Price labeling already exists on the primary packaging that (doctors' buy and) consumers do not see. If there was a change in prices, it would be impossible for manufacturers to relabel the old stock." ========= http://www.thejakartapost.com/detailheadlines.asp? fileid=20060214.B02&irec=4 Embattled BPOM chief says agency doing its job to monitor drugs Although known for his Javanese politeness and fine manners, Food and Drug Monitoring Agency (BPOM) chief Sampurno was clearly irritated when asked about criticism his organization has failed to properly monitor and regulate the pharmaceutical industry. "It's all talk with no proof," he said. After the flak BPOM received last month, when carcinogenic formaldehyde was found being used to preserve tofu and other food, his sensitivity is understandable. Many also fault the agency for the haphazard drug situation in the country, which is not limited to high pricing and overdosage. Prof. Iwan Darmansjah of the University of Indonesia's medical school said the local market was awash with useless drugs which drained the funds of unwitting consumers. "False drug claims and wrong doses are blatantly condoned and fill the pages of the formal drug information (guide) called MIMS Indonesia," said the pharmacologist and doctor. For those who like to self medicate, cheap drugs are readily available on the black market, such as Pasar Pramuka in East Jakarta and Pasar Senen in Central Jakarta. There are dozens of drug stores, selling products of questionable quality, safety and efficacy over the counter. Cases of fake drugs are rampant, as well as substandard drugs, which contain less active compounds than defined on their labeling. "In Indonesia, governance of drugs has never been well organized. The BPOM never had the manpower and the organization to protect the public from the presence of bad drugs on the market. The BPOM has been closer to and more protective of the industry than the public," Iwan said. Marius Widjajarta of the Indonesian Health Consumer Empowerment Foundation said the situation worsened after the BPOM was removed from the auspices of the Health Ministry in 2001. The agency was separated to become a stronger, independent body (the only other country to do this is China) after butting heads with the ministry on authority. "The agency liked to usurp the ministry's authority, from drug registration to issuing permits to build pharmaceutical factories. >From 2002 through 2004, the agency approved 240 import licenses, which they had no right to do. Monitoring drugs is already a gargantuan task, so why trespass on other's authority?" he said, adding the agency should be moved back to the health ministry. Sampurno defended his ministry against all the allegations, saying the BPOM did its job. He noted it was selected the fourth best agency in the world according to the 2005 audit of WHO. He denied drugs were too pricey here, saying there was a wide selection of products available with a varied price range but of similar quality. "When it comes to generic drugs, it's very competitive. The key is to exercise patients' rights, so they don't just bow to doctors' prescription prices," Sampurno said. Effectiveness of drugs, he added, was a subjective matter. He also termed "an emotional recommendation" the calls to return the BPOM to the Health Ministry. "Come on, compare the performance of the agency (now) to when it was still part of the ministry. You can see that we perform better as an independent body." http://www.thejakartapost.com/detailheadlines.asp? fileid=20060214.B03&irec=6 Overmedication of children does more harm than good Whether it's a simple case of the sniffles or the worrying onset of diarrhea, parents here are likely to trust a doctor and his prescription pad to put their children right. Yet it's children who stand to suffer the most as victims of the chaotic drug situation in the country. With doctors prescribing them medicines they do not need, and the danger of significant side effects, the country's kids are considered overmedicated. In a society with a tradition of self-medication, a recent study showed about 70 percent of parents gave their toddlers more than four kinds of drugs at one time to treat their illnesses. More than 35 percent of toddlers were taking from five to seven different kinds of medicine, according to Foundation of Concerned Parents' spokeswoman Purnamawati S. Pujiarto. Moreover, 85 children in the study had taken antibiotics, on the advice of doctors, for every malady they suffered. *"This phenomenon is dangerous. First, not all diseases can be treated with medicines -- like influenza, for example. Second, such an amount of consumed drugs could harm our children's health, especially their livers," said the pulmonary specialist. * Pharmacologist and physician Iwan Darmansjah said there were few clinical trials -- tests done on humans to determine the efficacy of a new drug -- specifically for children. Tests showing the different reactions of the drugs in adults and children, whose smaller body mass would affect how they were absorbed, are also extremely rare. "It was only in 1998 and 1999 that the FDA required pharmaceutical companies to do the study on all medicines for children," the professor emeritus at the University of Indonesia said, referring to the U.S. food and drug regulating body. "Before then, the data was always based on adults. It's not like a child is a small adult that you can just halve the adult dosage the dosage." There have been a few studies since, he said, but none conducted in developing countries. *"That's why children in Jakarta go to the same doctor every two weeks, with the same disease, to receive the same, wrong medication which reduces their immunity," he said. * "Ninety-five percent of the children are suffering from cough, fever and cold, which should've been treated with a symptomatic drug instead of stuffing them with antibiotics." Executive director of the International Pharmaceutical Manufacturers Group Parulian Simanjuntak said that clinical trials of children were difficult to conduct due to ethical concerns. "A trial must be carried out voluntarily, where a person knows what s/he is doing, the risks and so on. It is still being debated whether children can give informed consent, as an adult could, or whether parents can decide for the children. That's why studies on children are not as wide as adults," Parulian said. "And it's why pharmaceutical industries estimate the dosage for children based on the dosage for adults." Parulian said developed countries have discussed "assent consent", where children can say yes or no about participating in trials. "But so far, it's still only under discussion." -- JP/Hera Diani This Website is designed for The Jakarta Post by CNRG ITB. All contents copyright © of The Jakarta Post. [EMAIL PROTECTED] [Non-text portions of this message have been removed] ------------------------ Yahoo! Groups Sponsor --------------------~--> Music that listens to you. LAUNCHcast. What's in your mix? http://us.click.yahoo.com/8mKGzA/FARHAA/kkyPAA/iPMolB/TM --------------------------------------------------------------------~-> ================================================================= "Morning greetings doesn't only mean saying 'Good Morning'. 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