Philippine e-Jou nal o Applied Resea ch and De elopmen 10(2020), 50-60 ISSN 2449-3694 (Online)
h p://peja d.slu.edu.ph/ ol.10/2020.12.31.pd
Physicians’ Knowledge, Pe cep ions, A i udes and P ac ices ega ding
Gene ic Medicines in Baguio Ci y, Philippines
Ma y Luz C. Fiangaan1,*, Gas on P. Kibi en2, Jaime T. Ballena IV2, and Rhoda S. Lumang-ay1
1Depa men o Pha macy, School o Na u al Sciences; 2School o Ad anced S udies, Sain Louis Uni e si y,
Baguio Ci y, Philippines
* Co esponding au ho ([email p o ec ed])
Recei ed, 9 Sep embe 2020; Accep ed, 22 Decembe 2020; Published, 31 Decembe 2020
Copy igh @ 2020 M.L.C. Fiangaan, G.P. Kibi en, J.T. Ballena IV, & R.S. Lumang-ay. This is an open access a icle
dis ibu ed unde he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and
ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Abs ac
Physicians play a c i ical ole in he up ake o gene ic medicines in he Philippines, being in
con ol o d ug p esc ip ions while also enjoying high us om pa ien -consume s. Howe e ,
hei nega i e pe cep ions on gene ic medicines ha e a isen as an issue ha could in luence
hei p esc ibing p ac ices o gene ic d ugs. To gain u he insigh s in o he p oblem, a c oss-
sec ional su ey was conduc ed among p ac icing physicians in Baguio Ci y, assessing hei
s a e o knowledge, pe cep ions, a i udes and p ac ices ela i e o gene ic medicines and he
Gene ics Ac o 1988. Resul s e ealed knowledge gaps on he he apeu ic capabili y o gene ic
medicines, and he gene ic law’s p o ision on gene ic dispensing; pe sis en low ega d o gene ic
d ugs and hei quali y assu ance s anda ds; con inuing opposi ion o he speci ic p o ision on
gene ic dispensing; and, inally, low o e en non-compliance o gene ic p esc ibing. Aside om
ecommenda ions on con inuing in o ma ion and educa ion o physicians oge he wi h a s ic e
and consis en moni o ing o hei p esc ip ion p ac ices, he s udy calls o in es iga ion in o
he in luence o d ug companies on he pe sis ence o nega i e pe cep ions among physicians.
Keywo ds: medicines in he Philippines, challenges o gene ics, gene ic d ugs, gene ic
p esc ibing, gene ic dispensing, RA 6675
In oduc ion
Philippine e-Jou nal o Applied Resea ch and De elopmen
Websi e: peja d.slu.edu.ph ISSN 2449-3694 (Online)
Gene ic medicines a e manu ac u ed and
ma ke ed as equi alen al e na i es o inno a o
d ugs upon he expi a ion o he la e ’s pa en
(WHO, 2016; Gene ics and Biosimila s Ini ia i e,
2012). As gene ic d ugs a e way cheape han he
inno a o p oduc s, hese ha e been p omo ed
wo ldwide as a way o con ol heal hca e
expendi u es and imp o e access o medicines
(To e ud e al., 2015; Nguyen e al., 2013).
In he Philippines, he go e nmen has
adop ed he Gene ics Ac in 1988 in o de o
educe he p ices o medicines and ensu e he
adequa e supply, dis ibu ion, and use o gene ic
medicines (Republic Ac 6675). Two o he enabling
mechanisms en o ced by he law o acili a e he
use o gene ic medicines we e gene ic p esc ibing
a he le el o physicians and gene ic dispensing
a he le el o pha macis s and d ug ou le s.
Howe e , o e he yea s, se e al ba ie s ha e
been iden i ied pe aining o he implemen a ion
o he gene ics law, leading o he lesse han
expec ed up ake o gene ic medicines by he
gene al popula ion (Wong e al., 2013; Pabico,
2006a; Ha igan-Go, 2001).
Among he issues no ed was he ad e se
posi ion o physicians whose na ional ede a ion,
51
Philippine e-Jou nal o Applied Resea ch and De elopmen
Websi e: peja d.slu.edu.ph ISSN 2449-3694 (Online)
Philippine e-Jou nal o Applied Resea ch and De elopmen 10(2020), 50-60
he Philippine Medical Associa ion, has allied
i sel om he s a wi h big pha maceu ical
companies in challenging he enac men o he
Gene ics Ac (Tan, 2013; Co, 1998; Yadao-Guno,
1991). This was i e a ed in a s udy done a ew
yea s a e he law’s implemen a ion, which
showed ha as much as 70% o he physician-
esponden s we e opposed o i (Dan es, 1991).
The physicians’ nega i e s ance owa ds
gene ic d ugs is a cause o conce n, as his could
well explain hei low o e en non-compliance o
gene ic p esc ibing (Wong e al., 2013). Mo eo e ,
as he physicians a e solely esponsible o
p esc ibing medicines in he coun y as se by
he Philippine Medical Ac (Republic Ac 2382),
his can nega i ely impac he buying beha io
o consume s in ela ion o gene ic medicines
(Ku, 2017). This is e iden as 96% o Filipino
consume - esponden s claimed ha hey would
be con inced o he e ec i eness o gene ic d ugs
i so in o med by hei doc o s (Wong e al., 2016).
Gi en hei ull con ol on he p esc ip ion o
medicines, coupled wi h he consume s’ big us
es ed in hei p esc ip ions, he doc o s play
a pi o al ole in he accep ance and success ul
implemen a ion o he gene ics law in he coun y.
I is o consequence, hus, o conside se iously
his key s akeholde ’s no ed ad e se posi ion
in o de o shed ligh on whe e his is coming
om and how his can possibly be mi iga ed.
Un o una ely, he e is a dea h o s udies on
physicians in ela ion o he gene ics law and
gene ic medicines in gene al. To da e, jus a
couple o wo ks ha e looked in o hese, and only
on a limi ed numbe o i ems. In a p elimina y
s udy done in 1991, Dan es no ed ha mo e
han wo- hi ds o he sampled physicians did
no ag ee wi h he gene ics law, and likewise
hough ha he s a e’s egula o y body was
no capable o ensu ing he quali y o gene ic
medicines. A ela ed s udy done abou a decade
la e (Wong e al., 2013) also e ealed ha he
majo i y o physicians conside ed gene ic d ugs
o be o poo quali y due o pe cei ed easons like
impu e addi i es, inc eased side e ec s, shady
manu ac u e s, slow ac ion o he d ugs, and
egula ion p oblems. None heless, mos o he
pa icipan s claimed o ha e p ac iced gene ic
p esc ibing in conside a ion o he pa ien s’
wel a e and also o ea o punishmen as his
was manda ed by law. This s udy’s indings
should be aken wi h cau ion hough as only
a small numbe o pa icipan s (n=30) we e
in ol ed. Mo eo e , hese we e elici ed as hemes
om key in o man in e iew da a a he han a
sys ema ic su ey.
The p esen s udy will o mally assess he
knowledge, pe cep ions, a i udes, and p ac ices
o Filipino physicians ela i e o gene ic
medicines and he Gene ics Ac , emphasizing on
he law’s key p o isions on gene ic p esc ibing
and gene ic dispensing. This e alua ion is imely,
as i is now abou 30 yea s since he enac men
o he gene ics law, and wi hin which pe iod he
Depa men o Heal h has also implemen ed
addi ional measu es o p omo e gene ic
medicines. Fo ins ance, one key in e en ion was
he equi emen o bioequi alence e idence in he
egis a ion and app o al o pha maceu icals,
including gene ic d ugs (FDA, 2016). Thus, his
s udy hopes o p o ide upda ed indica o s on he
s a us o physicians’ knowledge, pe cep ions,
a i udes, and p ac ices, and a he same iden i y
speci ic a eas ha could be a ge ed o u u e
in e en ions among physicians.
Me hods
S udy design and su ey ool
A c oss-sec ional su ey was conduc ed
among p ac icing physicians in Baguio Ci y,
Philippines. The esea ch ool, which was
p epa ed based on he e iew o li e a u e,
was o ma ed as a pape -based ques ionnai e
ha comp ised ou sec ions. The i s pa is
conce ned wi h he pa icipan s’ demog aphic
cha ac e is ics, speci ically age and yea s
in p ac ice. The second pa con ains i e
s a emen s ha we e designed o elici co ec
o inco ec esponses o examine knowledge
ega ding gene ic medicines and he gene ics
law. The hi d pa is composed o wo
s a emen s ha measu e he ex en o p ac ice
on gene ic p esc ibing based on a scale o 1 o
10 (1 being “no p ac iced” and 10 being “always
p ac iced”). The inal pa includes s a emen s
amed in a ou -poin Like -scale o ma (4 =
“s ongly ag ee” o 1 = “s ongly disag ee”) ha
assessed pe cep ion on gene ic medicines and
a i ude owa ds gene ic subs i u ion.
52 M.L.C. Fiangaan, G.P. Kibi en, J.T. Ballena IV, & R.S. Lumang-ay
The esea ch ool was e alua ed o i s ace
and con en alidi y by physicians who a e
also academicians. Upon i s alida ion, he ool
was pilo es ed among hi y- i e p ac icing
physicians in San Fe nando Ci y, La Union. The
da a we e subjec ed o KR-20 and C onbach’s
alpha coe icien s o eliabili y. The compu ed
eliabili y coe icien s (0.77, 0.70, and 0.71 o
pa s II, III, and IV, espec i ely) implied ha
he esea ch ool is eliable.
Responden s
The sampling ame included p ac icing
physicians in Baguio Ci y wi h an es ima ed
numbe o 1,030, and om which a sample size
o 150 esponden s was compu ed using Coch an’s
o mula. In he absence o a comple e lis ing and
di ec o y o physicians in he ci y om whe e o
d aw andom samples, con enience sampling was
used, wi h he su ey ques ionnai es being se ed
o all physicians in all hospi als in he ci y.
The esponden s we e in o med ha
pa icipa ion in he su ey is olun a y, and
con iden iali y would be upheld. In o med consen
was sough om each esponden p io o gi ing
he ques ionnai e. Answe ed ques ionnai es
ha we e ound o be in alid we e ejec ed and
eplaced by answe s om new esponden s.
The esponden s ep esen ed a b oad ange
o age and yea s in p ac ice. The bigges numbe
all unde ages 46-55 (33%) and ha e been in
p ac ice o 1-8 yea s (34%) [Table 1].
Table 1. Demog aphics o he s udy popula ion
(n=150).
Age (%)
26 – 35
36 – 45
46 – 55
56 – 65
66 – 75
18 (12)
40 (26.7)
50 (33.3)
22 (14.7)
5 (3.3)
Yea s in p ac ice
1 – 8
9 – 16
17 – 24
25 – 32
33 – 40
51 (34)
44 (29.3)
30 (20)
11 (7.3)
5 (3.3)
S a is ical ea men o da a
Desc ip i e s a is ics such as equency,
pe cen age, and mean we e used o de e mine he
esponden s’ le el o knowledge and pe cep ion
on gene ic medicines, he ex en o p ac ice on
gene ic p esc ibing, and a i ude owa ds gene ic
subs i u ion. Pea son co ela ion analysis was
done o de e mine he ela ionship be ween
he esponden s’ le el o knowledge on gene ic
medicines, pe cep ion o gene ic medicines,
a i ude owa ds gene ic subs i u ion, and hei
age and yea s in p ac ice as physicians.
Resul s
Knowledge ega ding gene ic medicines and he
Gene ics Ac
Mixed esul s a e seen in he physicians’
knowledge on gene ic medicines and he Gene ics
Ac [Table 2]. They ha e high le els o knowledge
on h ee indica o s, namely, he conduc o
bioequi alence s udies o gene ic medicines p io
o being ma ke ed (100% co ec ), he objec i e o
he Gene ics Ac , which is o ensu e an adequa e
supply o medicines a he lowes possible cos
(95.3% co ec ), and ha he Gene ics Ac does
no allow physicians o w i e only he b and
name o he medicine in hei p esc ip ion (88%
co ec ). Howe e , mo e han hal (52.7%) did no
ge he igh answe on gene ic medicines being
he apeu ically equi alen o b anded medicines,
while a sizable pe cen age (40%) also go he
w ong answe on pha macis s being allowed o
subs i u e a gene ic al e na i e o he b and
w i en on he p esc ip ion.
Pe cep ions on gene ic medicines
O e all, he physicians ha e a nega i e
pe cep ion o gene ic medicines, and consis en ly
ac oss all indica o s [Figu e 1]. A li le mo e han
hal (50.6%) claimed ha gene ic medicines do
no ha e he same quali y as b anded medicines.
A sligh ly highe numbe (56.7%) also hink ha
he cu en s anda ds o quali y es ing and
egula ion o gene ic medicines a e no su icien
o a es o hei sa e y and e iciency. An e en
highe numbe (64 %) do no ag ee ha gene ic
53
Philippine e-Jou nal o Applied Resea ch and De elopmen
Websi e: peja d.slu.edu.ph ISSN 2449-3694 (Online)
Philippine e-Jou nal o Applied Resea ch and De elopmen 10(2020), 50-60
medicines should be used o se ious diseases.
The same pe cen age (64 %) likewise exp essed
disag eemen wi h he s a emen s ha b anded
gene ics a e as e ec i e as he inno a o b and
and ha incen i es should be gi en by he
go e nmen o doc o s o p esc ibing gene ic
medicines.
A i ude owa ds gene ic subs i u ion
The esul s a e mixed ega ding he
physicians’ a i ude owa ds gene ic subs i u ion
[Figu e 2]. Nea ly wo- hi ds (62.6%) ag ee
ha he ou come o he apy will no change
when swi ching medica ion om b anded o
gene ics. Howe e , a good 44% do no ag ee ha
Table 2. Knowledge on gene ic medicines and he Gene ics Ac .
I ems on Knowledge
Co ec
Responses
Inco ec
Responses
(%) (%)
1. Gene ic medicines a e he apeu ically equi alen o b anded
medicines. 69 (46%) 79(52.7%)
2. Bioequi alence s udy is necessa y o a gene ic medicines’
app o al o ma ke . 150 (100%) 0(0%)
3. The Gene ics Ac ensu es he adequa e supply o medicines a
he lowes possible cos . 143 (95.3%) 7(4.7%)
4. The Gene ics Ac allows physicians o w i e only he b and
name o he medicine in he p esc ip ion. 132 (88%) 18(12%)
5. The pha macis is no allowed o subs i u e a gene ic
al e na i e o he b and w i en on he p esc ip ion. 90 (60%) 60(40%)
5
and ha incen i es should be gi en by he go e nmen o doc o s o p esc ibing gene ic 161
medicines. 162
163
164
165
166
Figu e 1. Pe cep ions on gene ic medicines. 167
168
169
A i ude owa ds gene ic subs i u ion 170
171
The esul s a e mixed when i comes o he physicians’ a i ude owa ds gene ic subs i u ion 172
[Figu e 2]. Nea ly wo- hi ds (62.6%) ag ee ha he ou come o he apy will no change when 173
swi ching medica ion om b anded o gene ics. Howe e , a good 44% do no ag ee ha 174
pha macis s subs i u e he b and hey p esc ibed wi h gene ic medicines. Mo eo e , mo e han 175
h ee- ou hs (79.3%) wan ha pha macis s should consul he p esc ibe i s be o e dispensing 176
gene ic al e na i es. 177
178
179
180
Figu e 1. Pe cep ions on gene ic medicines.
54 M.L.C. Fiangaan, G.P. Kibi en, J.T. Ballena IV, & R.S. Lumang-ay
6
181
182
Figu e 2. A i ude owa ds Gene ic Subs i u ion 183
184
Ex en o p ac ice on gene ic p esc ibing 185
186
In e ms o hei p ac ice o p esc ibing gene ic medicines, he bigges numbe (30.67%) claimed 187
ha hey o en did his. Only 28.67% answe ed ‘always p ac iced,’ while a he opposi e end, 188
12% claimed ‘no p ac iced.’ When asked i hey p esc ibed gene ic medicines only i he pa ien 189
asks o i , he bigges numbe (30.82%) answe ed ‘some imes p ac iced’ while a li le mo e han 190
one- ou h (25.34%) said hey did no p ac ice his a all [Fig. 3]. 191
192
193
Figu e 2. A i ude owa ds Gene ic Subs i u ion
7
194
195
Figu e 3. Ex en o p ac ice on gene ic p esc ibing 196
197
Signi ican co ela ions 198
Among he pa ame e s co ela ed [Table 3], h ee eme ged as signi ican : he physicians’ le el o 199
knowledge on gene ic medicines and hei ex en o p ac ice on gene ic p esc ibing (p=0.008), 200
pe cep ion on gene ic medicines and yea s in p ac ice (p=0.001), and pe cep ion on gene ics 201
medicines and a i ude owa ds gene ic subs i u ion (p=<0.001). 202
203
Table 3. Co ela ions.
204
Pa ame e s Co ela ed
Pea son
Co ela ion
p- alue
Desc ip ion
Le el o knowledge on
gene ic medicines
a. Age
-0.026
0.768
No signi ican co ela ion
No signi ican co ela ion
b. Yea s in p ac ice
-0.140
0.098
c. Ex en o p ac ice
on gene ic p esc ibing
0.22
0.008
Signi ican Posi i e Co ela ion
Pe cep ion on gene ic
medicines
a. Age
0.169
0.051
No signi ican co ela ion
b. Yea s in p ac ice
0.279
0.001
Signi ican posi i e co ela ion
c. A i ude owa ds
gene ic subs i u ion
0.48
<0.001
Signi ican Posi i e Co ela ion
A i ude owa ds
gene ic subs i u ion
a. Age
0.017
0.843
No signi ican co ela ion
No signi ican co ela ion
b. Yea s in p ac ice
0.126
0.136
205
All h ee co ela ions a e posi i e. This indica es ha he highe he physicians’ le el o 206
knowledge is, he highe is hei ex en o p ac ice; he longe hey ha e been in p ac ice, he 207
be e is hei pe cep ion on gene ic medicines; and, inally, he mo e posi i e is hei pe cep ion 208
on gene ic medicines, he be e is hei a i ude owa ds subs i u ion. 209
210
Figu e 3. Ex en o p ac ice on gene ic p esc ibing
55
Philippine e-Jou nal o Applied Resea ch and De elopmen
Websi e: peja d.slu.edu.ph ISSN 2449-3694 (Online)
Philippine e-Jou nal o Applied Resea ch and De elopmen 10(2020), 50-60
pha macis s subs i u e he b and hey p esc ibed
wi h gene ic medicines. Mo eo e , mo e han
h ee- ou hs (79.3%) wan pha macis s o
consul he p esc ibe i s be o e dispensing
gene ic al e na i es.
Ex en o p ac ice on gene ic p esc ibing
In e ms o hei p ac ice o p esc ibing
gene ic medicines, he bigges numbe (30.67%)
claimed ha hey o en did his. Only 28.67%
answe ed ‘always p ac iced,’ while a he opposi e
end, 12% claimed ‘no p ac iced.’ When asked
i hey p esc ibed gene ic medicines only i he
pa ien asks o i , he bigges numbe (30.82%)
answe ed ‘some imes p ac iced’ while a li le
mo e han one- ou h (25.34%) said hey did no
p ac ice his a all [Figu e 3].
Signi ican co ela ions
Among he pa ame e s co ela ed [Table
3], h ee eme ged as signi ican : he physicians’
le el o knowledge on gene ic medicines and
hei ex en o p ac ice on gene ic p esc ibing
(p=0.008), pe cep ion on gene ic medicines and
yea s in p ac ice (p=0.001), and pe cep ion on
gene ics medicines and a i ude owa ds gene ic
subs i u ion (p=<0.001).
All h ee co ela ions a e posi i e. This
indica es ha he highe he physicians’ le el o
knowledge is, he highe is hei ex en o p ac ice;
he longe hey ha e been in p ac ice, he be e
a e hei pe cep ions on gene ic medicines; and,
inally, he mo e posi i e is hei pe cep ion on
gene ic medicines, he be e is hei a i ude
owa ds subs i u ion.
Discussion
This s udy p esen s se e al issues a ising
om he assessmen o Filipino physicians’
knowledge, pe cep ions, a i udes and p ac ices
ega ding he Gene ics Ac and gene ic medicines
some 30 yea s a e he enac men o he law.
Knowledge-wise, a couple o gaps ha e su aced
pe aining o a key p o ision o he law as well as
o he he apeu ic capabili y o gene ic medicines.
Fi s , nea ly hal o he physicians a e no awa e
ha pha macis s a e allowed o subs i u e a
gene ic al e na i e o he b and w i en on a
p esc ip ion. This is ac ually p o ided o by he
law unde i s p ocedu es on gene ic dispensing
as a s a egy o boos up ake o gene ic medicines
in andem wi h gene ic p esc ibing on he pa
Table 3. Co ela ion o pa icipan s' demog aphic p o iles and hei le el o knowledge, pe cep ions
and a i udes owa ds gene ic medicine (n=150).
Pa ame e s
Pea son
Co ela ion
p- alue Desc ip ion
Le el o
knowledge
a. Age -0.026 0.768 No signi ican co ela ion
No signi ican co ela ion
b. Yea s in p ac ice -0.140 0.098
c. Ex en o
p ac ice on gene ic
p esc ibing
0.22 0.008 Signi ican Posi i e
Co ela ion
Pe cep ion
a. Age 0.169 0.051 No signi ican co ela ion
b. Yea s in p ac ice 0.279 0.001 Signi ican posi i e
co ela ion
c. A i ude owa ds
gene ic subs i u ion 0.48 <0.001 Signi ican Posi i e
Co ela ion
A i ude a. Age 0.017 0.843 No signi ican co ela ion
No signi ican co ela ion
b. Yea s in p ac ice 0.126 0.136
56 M.L.C. Fiangaan, G.P. Kibi en, J.T. Ballena IV, & R.S. Lumang-ay
o he doc o s. As o why his basic p o ision is
no ye a common knowledge among Filipino
physicians e en up un il his ime emains a
ques ion.
The second gap es s on he physicians’ lack
o awa eness on he he apeu ic equi alence
o gene ic medicines wi h b anded medicines.
This s ikes a he hea o he Gene ics Ac
because he basic assump ion why gene ic
medicines a e being p omo ed is ha hese a e
supposed o be he apeu ically equi alen o
inno a o medicines (La wal & Chand a, 2020;
WHO, 2016; Gene ics Ac , 1998; U.S.F.D.A,
n.d.). The physicians’ lack o knowledge on his
undamen al cha ac e o gene ic medicines
may shed ligh pa ly on hei o e all nega i e
pe cep ion o gene ic medicines. As he esul s
show, majo i y o he physicians do no ag ee
ha gene ic medicines ha e he same quali y as
he b anded medicines. Fo ano he , a majo i y
also opine ha he cu en s anda ds o quali y
es ing o gene ic d ugs a e no su icien . These
could hen be he easons why hey likewise
exp essed ha gene ic medicines should no be
used o se ious diseases.
The physicians’ low ega d o gene ic
medicines is echoed in hei disag eemen wi h
he sugges ion ha he go e nmen p o ide
incen i es o doc o s o p esc ibe gene ic
medicines, a s a egy ha has been ecommended
in o he coun ies (Sha ad e al., 2009; Hassali
e al., 2006). F om hei an age poin , i makes
sense ha he s a e should no incen i ize he
p omo ion o an in e io p oduc . Simila ly, he
physicians’ poo es eem o gene ic d ugs shows
up again in he disag eemen o abou hal o
hem wi h he p ac ice o gene ic dispensing o
subs i u ion by pha macis s. No only ha , mo e
han h ee- ou hs e en wan ha pha macis s
should consul he p esc ibing physicians i s
be o e dispensing gene ic al e na i es, a p ac ice
ha has no been en isioned by he Gene ics
Ac a all. This las poin shows ha physicians
a e no eally sold ou o he law’s p o ision on
gene ic dispensing, which ecalls hei opposi ion
o he law as no ed by Dan es back in 1991.
Gi en hei nega i e app aisal o gene ic
medicines and he quali y assu ance mechanisms
o hese, i does no su p ise why only 28.67% o
he physicians claimed ha hey always p ac iced
gene ic p esc ibing o ha hey did so only
when eques ed by he pa ien (30.82%). These
igu es indica e e y low compliance, as he law
manda es gene ic p esc ibing a all imes and
wi hou excep ions. Wo se, wel e pe cen (12%)
e en admi ed ha hey did no p ac ice gene ic
p esc ibing a all, which is in clea iola ion o
he law.
The physicians’ nega i e pe cep ions o
gene ic medicines and hei lack o us in hei
quali y es ing and egula ion a e no new, as
hese ha e al eady been aised in ea lie s udies
(Wong e al., 2013; Dan es, 1991). Tha his
s udy i e a es he same esul s sugges s ha
no hing much has changed o e he pas h ee
decades, no wi hs anding he in e en ions done
all along by he Depa men o Heal h. This is
wo ying and hus wo h in e oga ing u he .
Whe e is his nega i e ega d coming om? To
he au ho s’ knowledge, he e a e no documen ed
and pee - e iewed e idences showing ha
gene ic medicines in he coun y a e indeed o low
quali y, o ha he cu en s anda ds o quali y
es ing and egis a ion o gene ic medicines a e
ques ionable, o ha gene ic medicines a e less
e ec i e in ea ing se ious diseases. I so, his
poin comes a he su p ising, as by aining,
physicians a e supposed o abide by e idence-
based p ac ice.
In he Philippines, gene ic medicines – jus
like hei b anded coun e pa s – pass h ough
he sc u iny and app o al o he Food and D ug
Au ho i y (FDA) be o e hese a e olled ou o
he ma ke (FDA, 2013). Ea ly on, he Bu eau o
Foods and D ugs (since eplaced by he FDA in
2009) has a es ed o he con o mi y o app o ed
gene ic medicines wi h he agency’s s anda ds,
and ha he e is no much di e ence obse ed
be ween hese and he b anded medicines
(Pabico, 2006b). In 2016, he FDA ully equi ed
bioequi alence e idence o he egis a ion and
app o al o pha maceu icals (FDA, 2016), which
would ha e add essed he linge ing conce n
on he quali y o gene ic d ugs on he ma ke .
And he doc o s a e ully awa e o his la es
equi emen , as e ealed in his s udy.
Thus, i appea s ha his pe sis en nega i e
pe cep ion o gene ic medicines as well as on hei
quali y con ol p ocesses does no es squa ely
on scien i ic e idence. Fu he suppo o his
57
Philippine e-Jou nal o Applied Resea ch and De elopmen
Websi e: peja d.slu.edu.ph ISSN 2449-3694 (Online)
Philippine e-Jou nal o Applied Resea ch and De elopmen 10(2020), 50-60
con en ion is no ed in he physicians’ esponses
o wo o he i ems in his s udy. Fi s , nea ly wo-
hi ds o hem ag ee ha he ou come o he apy
will no change when swi ching medica ions om
b anded o gene ics. Second, he same pe cen age
hough ha b anded gene ics a e less e ec i e
han he inno a o b ands. In u h he b anded
gene ics may also be p oduced by he same
companies manu ac u ing he inno a o d ugs
hemsel es (La wal & Chand a, 2020; Be ge ,
2017). Bu simply because hey a e gene ics,
hen hey a e ega ded as less e ec i e.
These wo inconsis encies appea o lend
c edence o he claim ha he physicians’ nega i e
pe cep ions on he quali y o gene ic medicines
and hei s anda d o quali y es ing a e no
emana ing om ha d e idences bu elsewhe e.
Speci ically, blame has been laid on he undue
in luence o mul ina ional d ug co po a ions, who
om he s a , ha e agg essi ely been peddling
he idea ha gene ic d ugs a e o low quali y (Tan,
2013; Co, 1998; Yadao-Guno, 1991), while a he
same ime con inuously doling ou a ious pe ks
o physicians o he la e o keep on endo sing
b anded medicines (Pabico, 2006b; Ha igan-Go,
2001). Ou side he coun y, he e is e idence ha
doc o s a e indeed in luenced by he p omo ional
ac i i ies and pe ks p o ided by pha maceu ical
companies wi hou hem ealizing o admi ing i
hemsel es (Sah e al., 2013; Boumil e al., 2012;
Fische e al., 2009; Ch en & Lande eld, 1994).
I so, he ma e should also be in es iga ed
locally, especially gi en i s epe cussions on
he implemen a ion o he gene ics law in
he coun y. Elsewhe e, measu es ha e been
ins i u ed o limi he imp ope in luence
o pha maceu ical companies on physicians
(Nissanhol z-Ganno & Yankelle ich, 2017;
Alkhaled e al., 2014; G ande, 2010; Kowalczyk,
2007), and he Philippines should do no less once
he same pa e n is es ablished he e.
In ligh o he pe sis ence o bias agains
gene ic medicines among Filipino physicians,
he Depa men o Heal h (DOH) should adop
mo e agg essi e measu es o de end and p omo e
gene ic medicines. Fi s , he e is a need o
he con inuing in o ma ion and educa ion o
physicians o add ess he gaps in hei knowledge
abou he gene ics law and he quali y con ol
mechanisms o gene ic d ugs in he coun y.
As he s udy’s esul s show, he highe he
physicians’ le el o knowledge is, he highe is
hei ex en o p ac ice in p esc ibing gene ics.
Bu , as he indings also sugges ha he
physicians’ pe cep ions on gene ic medicines ge
be e as hey ad ance in hei yea s o p ac ice,
his con inuing educa ion and in o ma ion migh
be be e o being di ec ed o he new physicians.
In ac , a mo e p oac i e mo e can be aken he e,
ha is, by ensu ing ha p ope in o ma ion on
gene ic d ugs is included in he doc o s’ medical
aining e en be o e hey ge in o ac ual p ac ice.
This s a egy has also been ecommended in o he
coun ies whe e simila issues on he physicians’
knowledge and pe cep ion o gene ic d ugs ha e
been obse ed (Za e bhai e al., 2017; Jamshed
e al., 2011; Chua e al., 2010).
Ano he ack o conside a ion is a s ic e
moni o ing o he physicians’ p esc ibing p ac ice,
gi en he no ed low o e en non-compliance
wi h he basic p o ision o he law on gene ic
p esc ibing. As ea ly as 1996, an in es iga i e
a icle (Pabico, 1996b) has al eady poin ed ou
his p oblem, a ibu ing i o he weak moni o ing
o physicians’ p ac ice, alongside he pe cep ion
ha no one is e e caugh and penalized o
iola ions. The DOH o icials in e iewed in
he same a icle ha e hemsel es admi ed
ha he a e o compliance depends much on
he le el o he Depa men ’s moni o ing o he
implemen a ion o he law. This is con i med
in Wong e al. (2013) which ound ou ha ea
o ge ing caugh and punished was one majo
eason why doc o s ollowed gene ic p esc ibing.
Hence, s ic and consis en moni o ing ha
esul s in ac ual app ehensions and penal ies
o iola o s is c i ical in ensu ing he success ul
implemen a ion o his key p o ision.
In closing, some cau ion should be aken
when in e p e ing he esul s o he s udy. Fi s ,
he esponden s we e limi ed o physicians
in he ci y o Baguio, and speci ically among
hose se ing in hospi als; hus he indings
may no be gene alizable o all physicians in
he Philippines. None heless, he indings poin
ou speci ic di ec ions ha can be picked up
and con i med in he e en ha a na ionally
ep esen a i e s udy is pu sued. Second, he
da a ga he ing was conduc ed in 2017. While
he e a e no indica ions ha changes may ha e
58 M.L.C. Fiangaan, G.P. Kibi en, J.T. Ballena IV, & R.S. Lumang-ay
occu ed in he esponden s’ answe s, as he e
had been no simila s udies conduc ed since hen,
i is s ill impo an o ead he esul s wi hin his
con ex .
Conclusion
Aside om poin ing ou cu en gaps in
he physicians’ knowledge o gene ic medicines
and he Gene ic Ac , his s udy unde sco es he
pe sis ence o nega i e pe cep ions o gene ic
d ugs and hei quali y assu ance s anda ds,
and he opposi ion o he p o ision on gene ic
dispensing. Tha no much change has aken
place along hese lines despi e he leng h o
ime in ol ed, as well as he ini ia i es o he
Depa men o Heal h o p omo e gene ics
medicine, emains a big ques ion. One plausible
di ec ion poin ed ou is he ole o d ug
companies in abe ing he Filipino physicians’
nega i e pe cep ions. Thus, in addi ion o
ecommenda ions on how o add ess he
physicians’ knowledge gaps and hei no ed
low o e en non-compliance o he p o ision on
gene ic p esc ibing, he s udy also calls a en ion
o he need o look u he in o he in luence o
d ug companies on Filipino physicians’ nega i e
pe cep ions and how his can possibly be
mi iga ed.
Acknowledgmen s
The au ho s hank he physicians who ook
pa in he s udy, ei he in he alida ion and
pilo es ing o he ins umen o he ac ual da a
ga he ing. App ecia ion is likewise ex ended o
Ma y G ace S. Ma in o he con ibu ion du ing
he concep ualiza ion o he s udy.
Funding
The s udy was unded by Sain Louis
Uni e si y unde i s Resea ch Facul y Men o ing
G an .
Con lic o in e es : None.
E hics app o al
The s udy p o ocol was app o ed by he Sain
Louis Uni e si y Resea ch E hics Commi ee
(SLU-REC/App o al/ No 29, 2016).
Re e ences
Alkhaled, L., Kahale, L., Nass, H., B ax,
H., Fadlallah, R., Bad , K., Akl, E. A.
(2014). Legisla i e, educa ional, policy
and o he in e en ions a ge ing
physicians' in e ac ion wi h pha maceu ical
companies: a sys ema ic e iew. BMJ Open,
4(7):e004880. h ps://bmjopen.bmj.com/
con en /bmjopen/4/7/e004880. ull.pd
Be ge , K. (2018, May 17). The FDA, gene ics
and di e en ia ing au ho ized om
b anded ypes. Pha macy Times. www.
pha macy imes.com/con ibu o /ka en-
be ge /2018/05/ he- da-gene ics-and-
di e en ia ing-au ho ized- om-b anded-
ypes
Boumil, M. M., Cu ell, E. S., Lowney, K.E.,
& Be man, H. A. 2012. Pha maceu ical
speake s’ bu eaus, academic eedom, and
he managemen o p omo ional speaking
a academic medical cen e s. The Jou nal o
Law, Medicine and E hics, 40, 311–325.
Ch en, M. M., & Lande eld, C. S. (1994). Physicians’
beha io and hei in e ac ions wi h d ug
companies. A con olled s udy o physicians
who eques ed addi ions o a hospi al d ug
o mula y. Jou nal o he Ame ican Medical
Associa ion, 271, 684–689.
Chua, G.N., Hassali, M.A., Sha ie, A.A., & Awaisu,
A. (2010). A su ey explo ing knowledge and
pe cep ions o gene al p ac i ione s owa ds
he use o gene ic medicines in he no he n
s a e o Malaysia. Heal h Policy, 95(2–3),
229–235.
Co, E. E. (1998). Managemen o Policy
Fo mula ion: The Gene ics Ac o 1988.
Philippine Jou nal o Public Adminis a ion,
42(3 & 4), 291-320.
Dan es, R. B. (1991). The new Philippine gene ic
d ugs ac : A physician’s iewpoin . Jou nal
