Whenever multi-national corporations (MNCs) announce price increases in drugs, it only triggers rhetoric concerns from certain quarters without any solution close by. The MNCs have increased the prices of their patented drugs almost every year, but it has simply passed by as non-event to the public and those involved in the healthcare businesses, though not lately.

Not so long ago, this kind of price announcement was simply deliberate to ignite all-out purchases by the dispensing doctors, private hospitals and pharmacies in order to beat certain deadlines. No wonder the pharmaceutical industry always registers a higher growth index. Economic enthusiasts would probably take it as a sign of prosperity. Only those who were left to fight for their lives in the ICU or on the operating tables, and pensioners who have to encounter terms with chronic illnesses knew the difference.

Now the MNCs are announcing the price increases again. Some said it is associated with merging of MNCs.

The price of other consumer goods can be controlled by the government, especially those that have to deal with tariffs, like imported motor vehicles, though the imposition of AFTA (Asean Free Trade Agreement) will mean opportunity to buy imported goods at cheaper prices.

But no such good news for imported drugs. Drugs are somehow exempted from tariffs, including the raw materials used in the manufacturing of local generic products. It looks like with the full implementation of AFTA, only patented drugs enjoy price increases, while our own local manufacturers have to slog in order to absorb the costs.

Why should patented drugs be an exception? No government in the right mind will impose tariffs on drugs, because the tax will be passed on to the consumers. It may not be easy for a small country like Malaysia to directly control the price of patented drugs, especially those from the MNCs. There were some formal dialogues and discussions on this issue between the healthcare professionals, the consumer movement, the MNCs and the PH, but they never ended with clear solution. For the moment, the MNCs are the true winner. They do not have to intervene directly on our administration, but the informal approach will always rule the game.

In some poor and inefficient countries, they can intervene directly. Not very long ago, a country in Central America was brought to court by a group of MNCs for trying to impose price control on patented drugs. It was no coincidence that this was the first country near the western hemisphere which suffered serious currency trouble, only to be rescued by direct IMF intervention.

Some people are in favour of the so-called Essential Drugs List as a mechanism to counter overpricing of patented drugs. This approach was originally designed to curb prescribing habits. It is seen rather as an internal issue in the healthcare practice.

To apply Essential Drugs List will also need some determination, beside countering resentment from our doctors. Again this approach is irrelevant when it comes to our doctors in the private practice. On the government side of the equation, as currently practised, the MNCs will always find informal ways to include all their new drugs into the list.

This is already happening with the MOH drug list or the so-called Blue Book. When the MNCs announced the price increases, the government drug expenditure will also be affected, unless the local supply contractors are prepared to share the costs. On the other hand, the Essential Drugs List approach is not supposed to deny people access to new drugs or our doctors to advance their therapeutic practices, unless this nation is prepared to spend billions on R&D; to develop the new technology.

So we come to another approach, that is to enforce compulsory licensing on life-saving drugs like anti-cancers and anti-AID. Even if this is to become a reality after encountering all the legal barriers, we still have to work on ways to procure raw materials that are under the control of the MNCs. For newly developed drugs, the production of raw materials is carried out in the most monopolistic manner, in order to counter any effort by unscrupulous parties to procure it through the trade.

This can be overcome if we have the expertise and technology in our inventory to undertake such venture in the immediate future. Perhaps the recovering economic tigers in Asean can offer suitable partners if they are ready to do that.

The MNCs will always use the high cost of developing new drugs as an excuse for increasing drug prices. But who actually benefits from these multibillion projects? Why should people like us in Malaysia and other developing countries to be content with paying for patented drugs at whatever prices, while the money spent on R&D; would only ensure full employment and technological deployment in the rich countries? Anyway, the ultimate objective of any industry is to meet the desire of the shareholders.

R&D; to the MNCs is treated like a new ball game ultimately only to attract few players. Some players simply disappeared from this game either through merging or acquisition. But the game style sometimes can be quite cruel to the mankind. Earlier efforts by developing countries to check against this practice have been futile.

Recently a member of European Union requested for a special grant to develop new vaccines against the mad cow disease, simply because it was understood that the incidence involving human beings was not prevalent enough for the MNCs to take up this responsibility.

At the other front, the expatriates working in the developing countries can live like kings just like their predecessors in the East Indian Company. While the operators of the East Indian Company hired an army of local people to subdue the weak governments, their descendents continue to apply the informal approach to maintain superiority. Only those who have worked long with MNCs in Malaysia can collect evidence of malpractices along the market trails.

A new drug that enters the local market never goes through local R&D.; Any such activity at our local higher institutions is carried out only as part of the marketing manoeuvre. We would like to see if data collected from the so-called clinical trial in Malaysia would be used to obtain a drug licence with the Food and Drug Administration in United States.

If the MNCs claim that cost of developing a new drug has already exceeded US1 billion, think of what that money can do for the economy. New drugs are coming into our market only through one route, this is trade. To fight against inflation of drug prices is to fight with the trade.

One mechanism that people in the local healthcare industry have been talking about for many years is to allow for some kind of laissez faire system to work within the drug trade. This is what they used to called parallel import. Parallel import means to allow market forces to work on the drug trade. This is supposed to be the most fundamental aspect of economy for influencing the price, supply and demand. It may occasionally show some deviations, but economic theory cannot be wrong all the time.

The MNCs have been trying to convince the pharmacy division on the possibly negative safety aspect of this parallel import. To stand by this reason alone means to put the whole profession of pharmacy to a corner. Denis Burley, a physician by profession and pioneer of the new field of pharmaceutical medicine once wrote, even if new drugs were to be subjected through the present screening processes, there was no assurance that the outcome could be totally risk-free to the mankind. Only the determination and professionalism of the healthcare professionals can minimise the risk.

All pharmacists are trained to serve as 'gatekeeper' against the use of faulty and unsafe drugs. Concern about the efficacy and safety of drugs in clinical practice has become the new paradigm for the training of modern pharmacists. The pharmacy division must be looked upon to have full integrity in the eyes of the profession, otherwise, maintaining the Register List of pharmacists will become a mockery.

The right to import, to posses and to store schedule poisons, dangerous drugs and therapeutic substances is like the last frontier of the pharmacy profession. All pharmacists should be treated equal with regard to this right. Dispensing can still be considered as no man's land in Malaysia.

Why should there be two set of procedures imposed on the licensing of the same drug manufactured by the same company, when different pharmacists with the same vested interest wish to do so? At the moment the Drug Control Authority (DCA) in the pharmacy division only allows a registered and licensed pharmacist working with the MNCs to register and import patented drugs through normal procedures, while the rest of the pharmacists who wish to do so will have to follow another set of registration exercise.

One of the strange requirements imposed by the DCA is that the other pharmacists who wish to import patented drugs must get the approval of the MNCs. Only the British who created the legacy of this bureaucratic instrument can escape the blame. No MNC in the right mind and vested interest would allow such thing to happen as long as they are here to trade drugs. It's like the old colonial days when only crown agents were allowed to supply drugs to the British healthcare services in Malaya.

It will not be a surprise if the MNCs come out strong against parallel import. In the last two years this nation is said to have the competency to deal with economic difficulties and defend our sovereignty against foreign influences. Let us prove we can also do just as well where the drug trade is concerned. It seems to be the most logical approach to fight against the unreasonable increase of the drug prices.