In the past weeks doctors chat groups have been abuzz with accusations leveled against the pharmaceutical company, Bell-Kenz Pharma Inc., and its  incorporators and management who are mostly physicians. The accusations come from a variety of sources, but the most credible source may be a recent hearing held by the Senate Committee on Health and Demography.

The accusations are alarming. Most egregious is that Bell-Kenz engages in a multi-level marketing scheme that gives doctors rebates that can be substantial, especially for those higher up in the pyramidal chain of doctor/prescribers. Proof of the said paybacks are said to be bank checks, held by Senator Raffy Tulfo, who first denounced the scheme.

Also circulating in doctor chat groups are brochures, allegedly produced by Bell-Kenz, with diagrams that illustrate the rebate scheme. The brochures, the providence of which I cannot ascertain, talk of jedi and padawans in the hierarchy of investors and sellers.

A second accusation relates to the gifts that Bell-Kenz Pharma apparently gives to the doctors who manage to “sell” through their prescriptions. These include luxury cars and watches and lavish foreign trips. Senator Jinggoy Estrada named doctors who, he implied, received luxury cars with brand names like Maserati, BMW, Audi and Mercedes Benz.

Last, but sufficiently grave, is the accusation of conflict of interest. The Senate hearing brought up issues ranging from the over-prescription of drug products of Bell-Kenz, to doctors associated with Bell-Kenz encouraging patients not just to buy the company’s products but directing them to buy these from certain pharmacies which they also owned. The very existence of a drug company incorporated by doctors raises red flags. Senator Tulfo has revealed during the hearing that he has a list of doctors involved with Bell-Kenz. 

Chaotic hearing

My difficulty with the Senate held last April 30 was it was a bit chaotic. 

Issues and accusations were made by the senators against Bell-Kenz and were outright denied by its chairman and CEO Luis Go. Relevant government agencies like the Board of Medicine and the Department of Health were also accused of negligence. They often rambled on about peripheral topics and then were cut short.  

Follow-ups and exchanges were not allowed much time by the committee chair, Senator Bong Go, whose issue was the non-payment of the health emergency allowance to our COVID frontliners. He wanted to have time for that. Senators were lining up to get in their points, and given the limited time nothing got a thorough airing. 

The Senate hearing could have accomplished far more.

CEO Dr. Go was able to deny or explain away the alleged checks and car sales. As one who wants to come to an appreciation of the veracity of the accusations, I am frustrated that the list of names, the checks, and car sale receipts never really saw the light of the Senate meeting room. What I witnessed were plausible accusations and plausible denials.

I also did not hear a sober and nuanced discussion of the state of enmeshment of medical doctors with pharmaceutical companies. If you ask me, the profession as a whole stands condemned, the innocent as well as the guilty. This means that we understand why the guilty need to be punished, and what are the levels of guilt and appropriate punishment. It also involves asking why the innocent find it so hard not to be enmeshed. We must also ask how those of us who are innocent can help set up safeguards, voluntary and through new laws, so that we may become more ethical.

Investigate and prosecute

And, yes, I do want cases to be filed and to begin with Bell Kenz Pharma. Because until we see the profession and its regulators working to uphold ethical standards, the profession is under reputational  threat.

The fundamental trust that we and our patients need in order for us to work together towards health has suffered a blow. At this point, years of missteps and under-the-radar, gray area practices have finally come to fruition. It is not enough for us to say that not all of us are like that. We need to stop the assault now and take this as an opportunity to reset.

I have noticed an opinion writer in one of our broadsheets defending Bell-Kenz Pharma, Inc. The main argument seems to be that it is being singled out and that these charges are being made by a competitor. This is a morally bankrupt argument. The fact that others are doing this is not an excuse for Bell-Kenz’s alleged wrongdoing. Furthermore, if these accusations are proven true, this is the most egregious case. So let’s begin with them, shall we?

But investigations and due process must happen prior to the filing of cases.

Next steps

I suggest therefore that another Senate hearing be called to focus on this issue and that each accusation be given enough time to be discussed. I would be happy for the senators to show the checks they have in hand, the car sale receipts, and other documents, as well as to discuss their provenance. Whistleblowers should also be presented. After this the evidence revealed at the Senate may be sent to the proper regulatory bodies. 

The Board of Medicine may suspend or revoke physicians’ licenses. If there is one thing I have concluded, many of the doctors associated with Bell-Kenz Pharma did not disclose fully their conflict of interest to the necessary parties. They did not disclose this to their patients, their hospital administrators or the Board of Medicine. It is enough for me that the term used by CEO Dr. Go was that they were in “partial compliance” with disclosure regulations.

We must also consider that what is in the law is a minimal ethical floor – not the ceiling. And, if there is one professional who must reach for the ceiling, it is the physician. Hence our ancient and famous Hippocratic oath. And so, on the basis of ideal ethics, I ask Bell-Kenz Pharma doctor incorporators: what were you thinking? 

As to Senator Tulfo’s distrust of the Board of Medicine, he is welcome to ask the Board to constitute a fact finding group of morally tough, knowledgeable and respected doctors to look into it.

The Food and Drug Administration may decide not to renew Bell-Kenz license to operate. Also the Securities and Exchange Commission may refuse registration. Government doctors who have received extravagant gifts may be made to face the Ombudsman. I wonder if a tax audit is in order.

All this must lead to the enactment of a new law that prohibits doctors from prescribing medications and services provided by entities that have a financial relationship to the doctor or their close relatives.

Physician, heal thyself

I call on fellow doctors to begin a long road towards ending our co-dependency on drug companies. We need to stop the smooching. In the short term I think we can refuse those environmentally unfriendly give-aways.

Do you really need another ball pen, baseball cap or paper weight? As a project that will take more time, we should turn our backs on conferences in fancy places, dinners in fancy restaurants, and similar entertainments masquerading as “continuing medical education.” Spending time on those things is less time spent going to the theater, eating out or traveling with friends and families on our own funds. These are far more rewarding and are the kind of social relations shown to contribute greatly to better health outcomes anyway.

We must also strengthen our discipline in bringing critical thinking to what the drug representatives tell us. Our medical training tells us that we must go to peer-reviewed journals and other reputable sources as our main source for guidance. Drug company information and learning activities are to be considered third-class knowledge products.

With regards to Bell-Kenz Pharma, all doctors should stop prescribing their products. We are ethically obliged to prescribe only the cheapest of all the generic formulations. This would essentially mean not prescribing most Bell-Kenz products. I think doctors who  are investors in the company should divest now. It’s probably good financial advice, but I am more interested in the ethical aspects of divesting now.

The best whistleblowers on Bell-Kenz Pharma are likely to be doctors themselves. Please come forward. I suggest to the Senate and the government agency to give these whistleblowers confidentiality and immunity.

Lastly I call on the public to help their doctors now. Please remain vigilant about this issue. If you have encountered or know of any violations in relation to Bell-Kenz Pharma, do report it. But also let us not let the issue die down without resolution, as so many other scandals have died down before. – Rappler.com

Sylvia Estrada Claudio is a doctor of medicine who also has a PhD in psychology. She is Professor Emerita of the University of the Philippines, Diliman.