From tonn taz-zejt to the contraceptive pill
A fine battle for the government: getting the nasty capitalists to reduce the price of Yasmin contraceptive pills by 63 cents per month
The mere suggestion that a condom-dispensing machine might be set up on the university campus provokes something akin to national hysteria.
Vodafone hands out packets of condoms with student subscriptions to its service, and the Shocked and Disgusted Army marches out in force and colonises the on-line comments-boards.
Contraception? In Malta? As if – that’s a practice for the heathen nations.
The reason we now have 1.2 children instead of the regulation 20.1 of our grandmothers’ generation (well, not my grandmothers – the cunning minxes had a pigeon pair apiece) is because of contraception, and not because of the rhythm method or the safe period or whatever it’s called.
Learning that might be compulsory in pre-marriage Cana courses, but nobody actually uses it. If they did, sales of the contraceptive pill, the contraceptive implant and condoms would not be skyrocketing.
The big mystery is why Noel Arrigo needed to take that bribe at all. He could have lived the life of Riley off the sales of Durex alone.
I thought about this while reading the newspaper yesterday. There it was: a full-page advertisement placed and paid for by the Parliamentary Secretariat for Consumers, Fair Competition, Local Councils and Public Dialogue (terrible name – like something out of North Korea or Italy) listing the “62 cheaper medicines” whose new cheapness is the result of “discussions between Government and medicine importers”.
Several of the medicines on that list seem to my untutored but experienced eye – once upon a time, in another lifetime around 25 years ago, I used to sell them – to be creams and ointments for chronic skin conditions and fungal afflictions, like Canesten, Daktarin, Eumovate, Betnovate and Locoid, and the inevitable Benylin cough syrup for children and ‘top of the pops’ Augmentin, one of the antibiotics which has sent us straight to the top of the EU league table on antibiotic use.
Nestling among the cough syrups and the ulcer-prevention tablets and the creams for athlete’s foot and dermatitis, I spotted ‘Yasmin film coated tablets 21 x 3’, reduced from €27.49 to €25.59.
That’s right, girls: rush to the pharmacy now to save €1.90 on a three-month supply of contraception. Thanks to the stringent efforts of the parliamentary secretariat, which has jumped through numerous hoops on your behalf and made the importers and manufacturers do likewise, you will now be saving 63 cents a month on making sure you don’t get pregnant.
If you save that for five months, you can buy a glass of wine on a night out and toast the Parliamentary Secretariat for Consumers, Fair Competition, Local Councils and Public Dialogue for making contraceptive pills so much more affordable.
It is not just the hilarity of seeing the government go into militant ‘fight for the people against the nasty capitalists’ mode about the price of contraceptive pills; it is the sheer waste of public time and public money in negotiations over something so damned stupid, unnecessary and pointless that really gets to me.
If you don’t know what Yasmin is, you’ll look at that list and think: “My, €27.49 for a packet of pills! Imagine if the poor sod has to buy one of those every week for a chronic condition. He’s crucified! Cutting the price by €1.90 should help, because these things add up.”
The reality is that the price of €27.49 is for three months’ supply – hence 21 x 3. At €9.16 a month, this was very affordable contraception even before the grand government-induced price reduction of 63 cents a month.
Let’s put it this way: for those with an active sex life, it’s a hell of a lot cheaper than condoms, and the savings to be made on abortions or two decades of childcare when a condom accident happens are not to be sniffed at, either.
But that’s by the by. The real point at issue here is that the government should not be wasting time and money – its own and those of other people – negotiating for a decrease in the price of the contraceptive pill.
Negotiating for a decrease in the price of Malta’s most frequently prescribed antibiotic, Augmentin, is bad enough as this is in direct conflict with the government’s declared aim of cutting down on antibiotic use. The most obvious deterrent to capricious antibiotic use is a high price. You cannot rely on commonsense.
Negotiating for a decrease in the price of children’s cough syrup is just a farce. How often do children need cough syrup, for heaven’s sake? I raised three, and I don’t remember ever having to choose between cough syrup and food, even though we were really hard up in those years.
I find this bickering over an 85-cent reduction in the price of children’s cough syrup particularly poignant, because one of the most vivid memories of my own childhood is of several police officers turning up at our home at night and taking my father away for interrogation over a five-mils increase in the price of a cough syrup which his company imported. As they detained him in the hall by the front door, my mother was asked to pack some things for him as he might be some time.
I see that the thinking hasn’t changed – not that of a chunk of the electorate and not that of some politicians. Well, my thinking hasn’t changed either. The negatives of price control far outweigh the positives.
The government’s behaviour in this matter is in the spirit of those times. It might not use the same means and methods, but the thinking and reasoning which underpin its actions are identical. Merchants and manufacturers are capitalist dogs who are out to cheat the captive consumer in desperate need of cough syrup, and must be thwarted, if not actually punished.
The true test of the validity of these actions is a close examination of the results. Exactly how are contraceptive pills different to condoms on the scale of what must be price-controlled by government action?
Why children’s cough syrup and not children’s food or children’s clothes or children’s books and shoes?
Why pills for the prevention of stomach ulcers and not holidays and spa treatments and other relaxing amusements which have the same effect?
Why Betnovate scalp application and not Head & Shoulders shampoo – both of which are used for (different) chronic, itchy, flaky scalp conditions?
You test the logic of an argument by taking it to its extreme. Using this test, the government’s argument that it must become and stay involved in the pricing of ‘medicines’ is untenable. It might as well become involved in the pricing of a thousand other products and services that are essential to our way of life.
It is particularly risible that the government negotiates for a decrease in the price of ‘medicines’ on the grounds that they are essential treatments (you know, like cough syrup and Canesten pessaries and contraception) while watching its approval ratings plummet because of escalating water and electricity bills.
I think we can all agree that water and electricity are far, far more essential than children’s cough mixture and that women who are paying through the nose for their electricity couldn’t care less whether they pay €9.16 for their contraception every month or €10.98.
The solid argument which the government uses to justify the price of water and electricity applies to every other sector of the economy, and to every other good and service on the market.
The government should simply butt out, and let those who sell medicines price them in the same way that the government prices the water and electricity which it sells to us – and what is more, sells to us in a monopoly-provider situation.
If we are living in a country where people can’t even afford to buy a bottle of cough syrup for their children, and must have the government negotiate for a price reduction, then we are truly in dire straits. But the thing is that we are not.
Those who need to count every cent, and I know what that’s like because I had to do it for ages while bringing the children up, should know what to do when faced with a choice between buying cough syrup and buying scratch-cards or cigarettes (two habits which, thank heavens, I never had) or sitting down for a coffee with friends.
They don’t have another option called ‘trying to get cheaper or free medicine off the government and merchants’, but they are allowed to believe that they do, by politicians of all stripes.
The government is wrong to allow them to think that they can get cheaper medicine so as to have more to spend on, for example, hair-dye. Have you ever seen a woman in Malta with grey hair? We are the world capital of dyed hair. Even women of 70 and 80 sport dark brown or – this is particularly dreadful – black locks and people think of it as normal, whereas elsewhere it would be seen as deeply odd. So what next -price control of hair-dye?
What the government is doing now with medicines is the kind of thing that Labour did. It is the way Labour still thinks. So leave it to Labour. It’s called ‘enough rope’ – more of the very same rope, indeed, with which Labour hanged itself most thoroughly between 1976 and 1987.
Yesterday’s newspaper advertisement, in which the government lists the lower prices of medicines, is no different to those ghastly budget speeches which are burned into our memories, in which the Labour finance minister of the day read out a list of the new lower prices of tonn taz-zejt and laned tal-mekril?
The Nationalists are made of far better stuff, and shouldn’t be quibbling about the prices of medicines when they have made the country so affluent that those who look askance at paying for cough syrup or contraception think nothing of blowing small fortunes on mere luxuries.
From a visionary stance on EU membership and all it entailed, to bickering about a few cents on the price of the contraceptive pill: how are the mighty fallen.
This article is published in The Malta Independent on Sunday today.
33 Comments Comment
Leave a Comment
But politicians don’t govern based on common sense. They would never be re-elected if they did so. Decisions made using common sense are usually extremely unpopular whereas, “We reduced the price of medicines for the people by 8%!” sounds fantastic and no other politician can argue that you shouldn’t have done so because they’d be cut down in seconds.
People vote with their hearts not with their minds, and politicians over the years have evolved to cater to that.
Well said, Daphne – the government should concentrate on more serious stuff. When you approach government officials they state that they have no available time to discuss certain issues, based on lack of human and financial resources etc.
They had better cut off newly created hefty administrative fines and imposed water and electricity interest rates, which will in time incur huge financial loses to the local businesses and service providers.
Ultimately the added costs have to be paid by the consumers and thus this is reflected in the selling price.
I am still wondering how they negotiated, calculated and agreed on the retail prices of medicines?
When we changed over from the lira to euro, we had that FAIR campaign. I ran a cafe at the time and applied for a FAIR sticker to put on the cafe window.
I was asked to send an okld menu with prices in lira and the new one with prices in euros. Because the price of a capuccino was listed at one euro when it was previously 40 old cents (rather than 42 point something), I was sent a letter asking for a justification of this price hike, accompanied by my invoices for coffee beans.
This was when we had several government-imposed expenses like the hike in water and electricity. When I pointed out that the coffee beans were the least of it when pricing a cup of coffee in a cafe, and that the major expense is in keeping of the coffee machine on for the whole day, meaning that this was a government induced cost, they did not even care to answer. Of course, I did not even bother to follow up on the Fair sticker.
[Daphne – It’s not only the water, electricity and coffee that go into the pricing of a capuccino. It’s also your overheads – rent, wages, the works. People forget this. It’s the same with medicines: they look at the unit price at which the distributor buys a packet of pills, compare it to the retail price, and see the difference between them as profit. They never factor in the office overheads, the payroll, the delivery trucks racing up and down the island, the extended credit terms given to pharmacies, the HORRENDOUS WORST-IN-EUROPE costs of landing freight in Malta, and the rest of it. All of that has to be paid for out of – that’s right – the difference between the price at which the distributor buys and the price at which the distributor sells.]
One also has to factor in the free credit advanced to government by supplying medicines and getting paid months if not years after you have had to pay your supplier abroad through your bank overdraft.
[Daphne – Nice one. I forgot to mention that yesterday. The government has a direct hand in putting up the price of medicines by failing to pay its pharmaceuticals bills on time. The government has a bloody nerve, hectoring importers about the prices of medicines, when it owes those same importers millions of euros for the pharmaceuticals it bought and failed to pay for.]
Daphne, your arguments are sound. But why do you speak of abortion as something acceptable.
[Daphne – Did I pass a value judgement about abortion? I didn’t. I merely said that however expensive a contraceptive pill is, it’s always going to be cheaper than an abortion or two decades of childcare. That is not a value judgement. It is a statement of fact. The cheapest option of all, of course, is to have no sex at all. That is not a value judgement either.]
Whereas I understand your wish to describe things as they are, people tend to fudge the line of demarcation between description and prescription, mistaking a descriptive argument for a prescriptive one.
The impression one gets from your article is that abortion is to be encouraged. I am sure this is not what you believe.
[Daphne – Let’s see now: because I failed to hedge the word ‘abortion’ about with phrases like ‘I don’t agree with it, but…’ or qualify it with adjectives like ‘reprehensible’ or ‘horrendous’, then I am encouraging its use. How does that follow, exactly? My view about abortion is this: everybody should mind their own business. One day I will understand why Maltese men are so very exercised by this subject when Maltese women clearly are far more ambivalent. Is it because it is the one area over which Maltese men have absolutely no control?]
Dear Daphne, I don’t agree with you on this. That one out of these 62 medicines happens to be a contraceptive pill is quite irrelevant. It could have been ear drops for what matters.
Lawrence Gonzi wanted someone to seriously tackle rising medicine prices and this someone started delivering after two months. As he said this is just a little step and a much longer list should be published in a few months. Of course – importers and those who were or still are close to them, would prefer the situation to stay as it was. But most people don’t.
[Daphne – I am neither an importer nor close to anyone who is. I object because this line of thinking is fundamentally wrong and very dangerous. Why medicines and not other things? How are medicines different? Oh yes, because we HAVE to use them. But we also have to eat, get dressed, live in houses, drive cars, furnish our homes and the rest. Price control on medicines is the thin end of the wedge. It is completely unjustified and unjustifiable. On the one hand, the government puts up the price of water and electricity – far more essential than medicine, and things we can’t do without – justifying this on the basis of market forces. And on the other hand, the government spends time bullying importers and manufacturers into bringing down the price of medicines. Where is the logic in that? If I were a medicines importer sitting round that negotiating table, my leading argument would be: ‘You want to save people money? Put down the price of your water and electricity then. Go on. Let’s see you do it.’
If most people wish to see the government control the price of medicines, then all I can say is that Malta hasn’t come very far since the days when a mere 1,500 electors or so were responsible for getting rid of that vile government in 1987. The free market is like free speech. Any qualification has to be justified and justifiable. The objection to people making a profit horrifies me – is that really how communist we are? No, we are not: because apparently, the same people who object to medicines importers making a profit have no objection to buying a kitchen which has been imported at a cost to the retailer of EUR2000 and sold for EUR7000. I have always maintained that how businesses work and how they keep the economy turning should be a compulsory part of everyone’s education, and now I am even more convinced of it.]
I fail to agree. There are two fundamental differences.
1. Why medicines? Even the EU allows, when it comes to medicines, an element of price control. This decision is much less drastic then price control.
[Daphne – The European Union does not control the prices of medicines. It merely dictates that manufacturers cannot have different prices for different member states. In other words, the manufacturer must sell to distributors in Sweden and Greece at the same price. What the distributors then do is up to them. Some distributors have higher costs than others, and the highest costs are borne by distributors at the ends of networks, like tiny islands so remote from mainland Europe that they are very much closer to Africa in logistical terms, and where sales are restricted because the market is so small. Iceland, at the opposite end, will have the same problem once it joins the EU. All its imports – and that means virtually everything sold in the shops – are significantly more expensive than the same thing sold in mainland Europe.]
2. Why not other sectors? Pharma companies have monopolies in Malta on most medicinal products they import. Free market does not mean the ability to set any price. Exceptions exist, and monopolies cannot set whichever price they wish.
[Daphne – There are no longer any importation or distribution monopolies. Those ceased when we joined the European Union. Pharmaceutical manufacturers maintain exclusive distributorship agreements for specific markets – as is the case with Malta – because it is more efficient and convenient to deal with a single agent than multifarious ones. However, it is perfectly possible for companies in Malta to buy branded pharmaceuticals from distributors in other markets and sell them here. This happens, but only when the profit margin justifies it, which is rare. This is because you are buying from a distributor and not direct from the manufacturer, and so must factor in that mark-up. Then to compete with the established distributors here in Malta, you have to sell at a lower price. This eats even further into your profit margin. Selling small amounts at a high profit is worth the while. Selling small amounts at a low profit is not. What you see as the market ‘not working’ is in fact a market working very well. The mistake being made here is that intellectual property rights are being confused with monopoly status. A manufacturer which has spent millions and years on researching a medication which it then registers in its name is not ‘running a monopoly’ but selling its own unique product. The absence of competition at the manufacturing level, due to the failure of other companies to come up with a similar product for a similar purpose, does not justify state invention in price control. When there is plenty of competition from other brands – as with Yasmin contraceptive pill (it is far from being the only contraceptive pill on the market) – state intervention is particularly unwarranted.]
A truly hilarious article if it were not so sad. We have evolved in so many wonderful ways and yet some old socialist traits still permeate our waters. The sadness is, of course, that the government allows antiquated Labour thinking to infiltrate its perfectly established creed of competition and market forces.
Margaret Thatcher privatised water, electricity, sewage, telephony, you name it. Nobody out there wants to turn the clock back.
I think the reality of the situation is that if water and electricity were to be privatised ( i.e. having more than one operator), bills will then really reflect the cost of the service (and they won’t be lower than they are are now) or the operator will simply pack up or go bust, leaving swathes of Malta without W&E.
So I don’t think that this government is ceding to old Socialist thinking (although, in the case of the GO/Melita World Cup programming, it certainly is) but is constrained by the practical considerations.
Does the list include ‘medicinal brandy’?
Have you noticed that one of the medicines reduced is Levitra, which is an alternative to Viagra? Is it only me who is seeing the subtle connection of this to the reduction in the cost of contraceptive pills? Nicely balanced out.
[Daphne – No. I had no idea what it is. Thank you for pointing it out. What a joke.]
I love that it was eros who spotted that.
Eh, but you are missing the point of the well-thought out strategy:
http://www.webmd.com/sex-relationships/features/10-surprising-health-benefits-of-sex
Anyway, I love the line of this argument, Daphne.
While I must admit that I buy The Malta Independent every Sunday solely to read your article, I just cannot agree with you this time. We must have some price control here when it comes to medicine and I (MEAN MEDICINE ONLY).
You were right to point out that those stupid contraceptive pills and maybe some creams should have never been on that list: they were chosen just to put the number up, but surely you must have noticed other pills on that list the like of ZOCOR and others which had their price reduced substantially.
People are not stupid – they can compare the prices when they go abroad and if one is on some kind of medicine like my own husband the obvious thing to do is check these prices.
Must thank the prime minister for his interest although he should have taken these measures a long time ago.
This is not the only instance where the Nationalist Government’s policies have evolved into the Labour-style nightmares of yore.
Is anyone out there aware that the Junior Lyceums are no more and that as from next year, once again, the secondary schools are ALL going to be mixed ability?
Does anyone understand the implications of this? This is an utter disaster for people who care about their children’s education but who cannot afford a private school and just don’t happen to get lucky in the church lottery.
From now on the Junior Lyceum teachers, instead of focusing on teaching motivated and ambitious children, are going to dissipate their energies trying to discipline and control the children of people who are quick to tear down teachers, but who recoil when they are asked to read at home with their children, or to ensure that the child’s bag is packed according to a time-table.
I don’t care if this is harsh – it is the truth. Real learning that leaves results requires discipline and hard work, and it’s not fun – satisfying maybe, but not fun. And it needs a lot of back up from home.
And now teachers have to faff about with learning games and frigging flash cards that waste time and achieve nothing in a vain effort to teach the children of people who don’t care.
The Junior Lyceum exam was an abomination and a violation of children’s rights. It is not found in any other country that matters. It was peaking the children at too early a stage in their education – a good number of children, who used to pass the JL exam, never performed to that level again.
You are also assuming, very incorrectly, that people who care about the education of their offspring and who invest time in their education, invariably have children who pass their JL exams with flying colours and sail through the rest of their education. WRONG. Although intelligence is inherited, as are learning difficulties, anyone can have children who, according to you, should be bundled together and be shown flashcards all day.
Inclusion has been studied and evaluated in other countries for decades. No system is perfect but you can’t just label the rest of the world’s education systems as ‘lunacy’. Most students are visual learners, so don’t ridicule the ‘flashcards’ approach to all students. The power point presentations which are standard fare for all conferences, presentations and what have you, are nothing more than electronic flashcards.
Coincidently, the church school (then a private school) which I attended over 30 years ago had exactly the set up as our new senior schools will have. Children of mixed abilities and ‘settings’ for the core subjects. Most of today’s church schools and independent schools also have no streaming whatsoever. So, what is the problem? Why must we segregate our children when they are still so young?
@Not Tonight and Peter Vella
You both value education. One was sent to a church school and the other sent his children to a mixed ability school which – in Malta, means a private school if he is referring to the secondary years.
Now understand me here – there is a frighteningly large number of parents who do not care about their children’s education. Picture, if you will, parents who do not oversee home works, who do not read with their children, who will take their child shoe shopping on a school day, who do not check to see if a school bag is correctly packed, who do not even know in which year or class their child is, who will come to school in a froth of rage if the teacher suggests they buy a book, who do not care if their children fail exams, who will blame the teacher for poor results but take no corrective steps of their own.
The children of these parents are discipline problems in the class because they make very little progress, then they get frustrated and bored because subsequent lessons make less and less sense and finally they interrupt the progress of the others with rampant misbehaviour. Remember that children take things literally.
An instruction by Mummy to ‘tell me if the teacher yells at you and I’ll come and bash her up’ means ‘do as you please, be as outrageous as you please, answer back, rip charts, topple desks, hurt other children and when the teacher yells at you I will defend you’.
These parents are not equally scattered over the island. This explains why some Government primaries have wonderful atmospheres and get excellent results while others are nightmares.
The Junior Lyceum exams in English, Maltese and Maths are NOT difficult exams. In the government schools they had the (never mentioned) merit of separating the children of those who cared from the children of those who didn’t (always on the whole, in general terms, some always got lost in the flak). So, the great majority of children whose parents cared about their schooling, got a breather.
The distracting element in class was much reduced and education could progress. The rest, victims of their parents’ carelessness or late development, were shunted off into the secondary schools where they separated into 1) a group of late developers who blossomed and then set about getting an education, and 2) the rest.
The new system – tried and tested by the Labour government in the 70s and proven to be an educational disaster, now means that motivated children are going to be plagued by the ne’er do wells throughout their school life. They simply can’t get away from them.
What is so sad is that since we all attended school we all assume we are experts in the field.
You have to work in schools for as long as I have to see the different attitudes parents have. You Peter and Not Tonight, you sit there in front of your keyboards, arguing cogently, in perfect English. Why is that do you think? And do you think all parents are like yours were where the education of their children is concerned?
If I may chip in…state schools will always be state schools, whatever educational system they adopt. “Free” education is there for those who cannot afford to pay for it; those who can pay have the option of choosing the type of education they desire for their children.
My children also attended an independent school and I can tell you that even there you find parents who do not contribute at all in their child’s education.
All this may sound unfair on those who cannot afford to pay for their kids’ education, but life is not fair after all!
Fine, so you believe in streaming children, but that does not make mixed ability education a socialist policy. Mixed ability schools can work very well. I sent my children to one and they did very well both socially and academically.
” The Nationalists are made of far better stuff ” – now are they really?
[Daphne – Mhux ovvja. Comparisons might be odious, but it is wise to make them.]
I am ashamed to say I have always voted Nationalist but age has mellowed me and I can now see things for what they are.
[Daphne – You should be ashamed to say you voted Labour. Now that’s really some cause for embarrassment.]
So here it is – the reduction in price of various medicines should have come about ages ago and not now – why the delay?
The current situation in Malta:
1. Allow the rich to get richer through foul means and corrupt contacts.
[Daphne – The rich do not necessarily get richer through foul means and corrupt practices. Lots of people who are not rich (and some who are, but who cannot bear to see others get something too) prefer to attribute the success of others to unfair practices and corruption, in pretty much the same way that, 300 years ago, they would have attributed it to witchcraft or sorcery. The happy coincidence of good luck, hard work, determination and acumen is far too uncomfortable to acknowledge because it pinpoints, by default, shortcomings in the self. If we admit that X is successful because he is clever, able and in the right place at the right time, then we will also have to admit that we are not successful because we are not clever, able and in the right place at the right time. It is much easier to tell ourselves that others are cheats while we are honourable.]
2. Emphasise how lucky we are when compared to other EU countries.
[Daphne – How is that wrong? It is a fact. The only things that make Malta more uncomfortable than other EU states is the claustrophobia, nosiness, lack of privacy and the sourness and envy of so many of its inhabitants. In other respects, it is a gilded life – almost the life of a child. My friend’s (Maltese) mother, who raised eight children on three continents while working to help support the family, told me recently how tiresome she finds the complaints of people here in Malta, the turning of even the littlest problem into an insurmountable mountain of panic and worry. People here in Malta don’t know what real worries are, she said; they have never experienced tough reality. She’s right. The strange thing is that many thousands of those complaining and whining come from truly harsh situations: parents and grandparents who slept 15 to a room on piles of straw with animals, a childhood in which the bathroom was a pail of water and another pail as a chamberpot, that sort of thing. With real deprivation so close to them in time, you’d thing they’d have greater awareness of the relative comfort of their situation, but no. Somewhere out there, the grass is greener.]
3. Compare the government with old and Muscat’s new Labour
– as if you can compare something with nothing.
4. Tread over freedom of speech and expression – the courts have certainly done a good job of it!
[Daphne – Well, we agree on these last two, anyway.]
Fundamental human rights – the right to divorce, equal rights to homosexuals, a mature discussion about abortion, equality of the sexes in all respects and not a piecemeal approach handled by prejudiced individuals.
[Daphne – For the 100th time: homosexuals have all the rights that heterosexuals have, and let’s not get started on marriage, which derives from things other than sexuality. For the 100th time again, when homosexual Maltese men had the vote, Maltese women (gay and straight) did not. When homosexual Maltese men had full rights and full emancipation, married Maltese women did not – and we’re talking the early 1990s here. This might be really hard to accept, but denial of rights has historically derived from gender and not from sexual inclination. Throughout history, homosexual men had, by dint of being men, all the rights and freedoms that women could only dream of unless they were very rich and very powerful by dint of birth. As for the rest, we agree.]
All we need now is a confirmation that things are not quite as they should be at San Anton Palace!
And so on and so forth ad nauseam till death do us part.
Enjoy your summer holidays.
[Daphne – I am not a teacher, a civil servant or at school/university. I have none.]
Daphne – many thanks for finding the time to comment on what I said.
Kindly note that while respecting your journalistic contribution which is by far the best on this Don Quixote island I need to make it clear that I have never voted Labour and will never do so.
To be more precise I enjoy reading and learning from your diverse contributions
This government needs a kick in the butt as the Rip Van Winkle syndrome has taken over completely.
It would have been more appropriate to have an information campaign on generic medicines. Maybe by setting up an information division supplying the public with information about generics and their prices.
This could have been done in collaboration with the Medicines Authority and the Public Health Information Department. In that way the government would have stimulated the demand from the consumer for a cheaper price thus causing competition which would automatically drive the price downward. In fact, in Malta generic substitution is still lacking in this sector.
Public lists of products which are allowed on the Maltese market:
http://www.ema.europa.eu/htms/human/epar/a.htm (medicinals authorised for all the EU markets including Malta)
http://medicinesauthority.gov.mt/pub/PI%20List.pdf (medicinals authorised on the Maltese market)
http://www.medicinesauthority.gov.mt/pub/MA%20List.pdf (parallel imported medicinal products authorised on the Maltese market)
Any pharmacist and/or doctor may easily help you identify generics or cheaper equivalent medicinal products.
I am not sure if this has changed but generic substitution was not allowed if the doctor prescribes the branded product.
I would appreciate if someone can confirm or dispel my perception.
[Daphne – I doubt it. Aspirin (I don’t feel like thinking of anything else) is aspirin is aspirin. But perhaps a pharmacist will pop in and let us know.]
I had a quick look at the Medicines Act of 2003.
http://www.doi.gov.mt/EN/parliamentacts/2003/Act%203.pdf
Article 80 (2) (Page 110) and I quote:
“Upon presentation of a prescription for a medicinal product, unless the prescriber specifically requests a particular branded product by writing “branded” or “®” on the prescription, a pharmacist can dispense the medicinal product prescribed or an equivalent medicinal product having the same chemical entity, dose, dosage form, formulation and dosage frequency as the medicinal product indicated on the prescription.”
So generic substitution is available upon the discretion of the prescribing doctor or consultant either by omission or by conscious choice.
I’ll give an example:
If the doctor prescribes Viagra® Tablets, then the pharmacist has to dispense the branded product.
If the doctor prescribes Sildenafil Tablets (generic name for Viagra), then the pharmacist may choose to dispense the branded or any equivalent generic.
Apart from being a contraceptive pill, isn’t Yasmin also used to treat patients with endometriosis and other gyneecological medical conditions?
[Daphne – Back in the day when contraception was evil, girls were ‘given pills to regulate their periods and make them less heavy’. Those pills were contraceptive pills. They didn’t regulate periods. Yasmin is a contraceptive pill. It is not a medical treatment for a disease or problem. It is, in fact, currently Malta’s No. 1 contraceptive pill by my reckoning. Yasmin is sometimes promoted as being effective in treatment for acne – but treating acne with the contraceptive pill is like going at a mouse with 15 men armed with Uzis.]
Brilliant article, Daphne.
No one seems to have noticed, though, that an other on that list is Levitra, a drug used for erectile dysfunction.
[Daphne – Somebody else pointed that out earlier. I’ll upload it as a post, so that it gets more attention, because really, it’s so ridiculous.]
What about the migraine sufferers in Malta? Migraine leaves you helpless, miserable and in agony for at least one day or more. A packet of Zomig tablets containing 3 tablets only costs almost 20 euros in Malta. They are a blessing from god but very expensive. Could someone from the maltese authorities do something for the sufferers who could not afford these tablets?
[Daphne – What about food? We all have to eat. Going without food can leave you helpless, miserable and in agony, and will end in serious illness and death. Food costs hundreds of euros every month, and then you have nothing to show for it and have to fill up that fridge again. Food is a blessing from God but very expensive. Could the government do something for all those of us who can’t avoid buying food and can’t afford it because we have to buy Zomig migraine tablets instead?
Ms Maffei, your argument is untenable. And I don’t mock at migraine. Several members of my family are sufferers and I get the rare bout myself.]
If one cannot afford the contraceptive pill there are other solutions, but unfortunately for certain health problems there are no solutions or the solution could be so expensive that people couldn’t afford it.
I live in Italy, a country which is definitely not known for its efficiency.
1)People are being given the service of a free doctor or pediatrician in case of children. Each doctor who is working for the government has got a number of patients who could go to his clinic anytime without paying anything.
[Daphne – We’ve had that in Malta for decades already:completely free and truly excellent health-care.]
2) Life saving medicinals are given for free to anyone (as in Malta).
3) There is a very long list of pharmaceuticals which are given for free against the doctor’s prescription. Sometimes you have to pay a small amount of money as tax and sometimes nothing. It depends on the original price of the product.
[Daphne – Malta has this system already.]
4) After 8 pm there is the so called guardia medica who could visit patients at home in case of emergency and on 24-hour basis on weekends.
[Daphne – In Malta, you ring the ambulance service or pop down to the health centre or to the casualty department at the general hospital. How is this different?]
5) You could never buy antibiotics without the prescription of a doctor. Not only antibiotics, there are certain medicines that cannot be sold without a prescription and the pharmacists will never take the risk to sell due to the serious controls.
[Daphne – Same in Malta.]
In Malta you are given almost everything you want by the chemists, the most important is that they sell and gain.
[Daphne – Totally wrong. There is tight control on medicines which can be sold only against prescription.]
Daphne, I understand your position on protecting a free and unencumbered market but you have to agree that deregulation breeds abuses at the other extreme. We have seen the financial industry hose the world economy.
What do you think of the big pharmaceutical companies over-investing in lifestyle drugs and money wasted in marketing these instead of doing research?
[Daphne – It’s up to them. You can’t force businesses to research the things you want them to research. Why is this so hard to understand? A pharmaceutical company is a business, not a charity or a non-profit organisation. I would no more criticise a pharmaceuticals company for investing in lifestyle drugs research than I would criticise a car company for investing in speech-and-comfort research. It’s their business – literally – and hence, it’s up to them.]
What about the lack of proper control on new medicines? Don’t you think that “shareholder value” is turning these companies into money factories instead of medicinal factories?
[Daphne – See my comment, above. All businesses are there primarily to make money. If that were not the case, they would be non-profit organisations or charities, not businesses – like the foundation set up by Bill Gates, which funds research into cures for diseases where there is no money to be made. Again, why is this so hard to understand?]
As I understand it most primary research is done in universities and mostly funded by governments.
[Daphne – Wrong. Most research into diseases is funded by the drug companies of other stakeholders, even if that research takes place in universities.]
I’m not seeing big-pharma tackle any of the big intractable problems.They only want to sell half-backed solutions at exorbitant prices that end up not solving the original problem whilst killing the patient with something else… view NSAIDS and statins.
[Daphne – Total bollocks. The merest modicum of business sense would tell you that pharmaceutical companies have a major incentive in finding a cure for, say, cancer. It would put their profits and their share price through the roof.]
Dear Daphne, the question is not about lowering the prices of medicines but to bring the prices down as they are in other EU states.
[Daphne – How do you know how much each and every medicine costs in each and every other EU member state? I haven’t seen a published list of hundreds of branded pharmaceutical products across 27 columns, one for each EU member state. Have you? That aside, exactly why do you think that the price of medicines should be the same right across the EU when the price of nothing else is? What gives branded pharmaceuticals the special status that, for example, cars don’t have? Nothing. If you can think of something, please let me know. Fundamental need? I think we all need a car more than we need Benylin cough syrup or Canesten pessaries.]
I cannot understand how the prices of medicines are cheaper abroad.
[Daphne – Who told you that they are, Maria? Where did you get this information? Also, define ‘abroad’. Abroad is a big place.]
Something must be wrong. Either because of government-induced costs or else exaggerated profit by importers and pharmacy owners.
Medicine is an essential commodity.
[Daphne – So is food. So are cars. So are clothes. So is the roof over your head. So are water and electricity. Do you want price control or government interference in profits there too (scratch the water and electricity…)? On the scale of essential commodities, which of these do you rank highest: children’s cough syrup, tablets for erectile dysfunction, the contraceptive pill, creams for itchy skin, petrol, electricity, water, basic foodstuffs, clothes and shoes, furniture for your home, plates to eat off, cutlery to eat with, a cooker, a refrigerator, a car. I don’t know about you, but on my list, the pharmaceuticals came last, last, last – and by a long shot.]
You were wrong in saying that Augmentin is abused. Augmentin is an antibiotic and used when there is an infection.
[Daphne – I know exactly what Augmentin is, and I also know what antibiotics are used for, what they should not be used for, and how they are misused. If you think that antibiotics are not extensively misused in Malta, then you haven’t been following the news too keenly. With Italy, we are top by far of the EU league table on antibiotic use. The health authorities have sounded the alarm repeatedly on antibiotic over-use, which is building a worrying strain of antibiotic-resistant bacteria. Doctors have been warned of the dangers of prescribing antibiotics unnecessarily, and patients have been warned of the public risks involved in taking antibiotics when they needn’t. Over and above that, a very recent survey showed that the majority of Maltese don’t know that antibiotics are useless against viruses and only combat bacteria. Most of those surveyed said that they would take antibiotics for a cold or the flu.]
Nobody takes it capriciously. First because you can become resistant to it, and also because it is expensive to buy, so one takes antibiotics if necessary.
[Daphne – Define necessary. Necessary is when you have a serious infection or are at risk of a serious infection, e.g. when you have been bitten by an animal, when you have swallowed heavily polluted water, or when you have a bacterial infection that can cause pneumonia. How many times does this happen? Not often. And yet sales of Augmentin are through the roof. “Nobody takes it capriciously” – yes, thousands do. There are survey results, sales records and antibiotic resistance problems to prove this.]
Moreover one can only get it against a prescription. With regards to anti-dandruff shampoo and Betnovate scalp application, the answer is simple. One is not a medicine while the other is.
[Daphne – Really? Define medicine. Are pills that give you erections medicines? Are contraceptive pills medicines? Both Betnovate and Head & Shoulders shampoo are chemical treatments for scalp problems – I deliberately say treatment rather than cure, because the problems each deals with are chronic and they can only deal with the symptoms. The difference between them is that Betnovate is a registered pharmaceutical product while Head & Shoulders is registered as a cosmetic treatment, so they fall within different categories at law. That’s all.]
I’d just like to add that you can certainly get Augmentin and many other prescription medicines without a prescription from your local friendly pharmacist. Yes, it’s against the rules, but I guess the controls are quite lax.
I’m sorry – but we complain because the government is backwards when it comes to a healthy sexual policy, and then, when they DO do something about it, we complain as well?
The pill can be a contraceptive, and it can also be used for medicinal use, so what’s wrong with it being reduced in price as well?
I smell something else underneath this whole argument!
[Daphne – Yes. You smell somebody who recognises the thin end of a wedge when she sees one, and who can’t stand illogical ‘reasoning’.]
jiena nixiteq nistaqsi xi haga lil mrs caruana galizia wara li qrajt kumment li deher fil-blog.
Barra l-medicini life saving liema huma dawk il-medicini li jinghataw b’xejn f’malta? Jiena kull meta mmur ghand it-tabib tieghi sakemm ma jkollux xi free sample hu dejjem ikolli nixtri dak li jiktibli.
thanks
[Daphne – Jekk ikollok problema kronika – per ezempju tal-qalb jew diabete – tista tapplika biex tibda tiehu l-medicini b’xejn mid-Dipartiment tas-Sahha. M’hemmx ghalfejn ikunu ‘life-saving’. Ghalhekk hija daqstant stupida din il-bicca xoghol tat-tnaqqis tal-prezzijiet tal-medicini. Min hu vera fil-bzonn johodhom b’xejn.]