Interview with Juan Francisco Millan Soberanes, Director General, CETIFARMA

The Mexican government has been fairly pro-active about promoting good practice such as the new drug registration process that helped eliminate drugs from the Mexican market that didn’t fulfill regulatory therapeutic efficiency. In this context, what is left to do for CETIFARMA?
In my opinion when the authorities take a decision to promote transparency on any subject, and increase the efficiency of regulatory processes, it’s good for society, for the pharmaceutical companies and great for us at CETIFARMA. Our code of ethics express that it’s important for all pharmaceutical companies to commit to their duties and obligations within the realm of law and if the government works with us on ensuring things are in place, then it makes things clearer for the pharmaceutical companies about what is expected. If the companies and the government move in the same direction, then at some point they will meet!

Since the opening of CANIFARMA in 2005, how have you seen the Mexican pharmaceutical industry develop in terms of good practice and transparency?
The job of CETIFARMA implies a real cultural change in the industry: the adoption of new values and new rules, particularly with regards to self-regulation. As you know, cultural changes take a long time and can be very challenging for companies. If we compare pre-2005 to how we work today, you will see that companies have started to work, for example, with new promotional and advertising practices, and working in closer co-ordination with healthcare professionals. Despite this, it’s very important to adhere to global standards too- we are not a special case in Mexico, and we should all adhere to the deontological practices based on universal ethical principles. The challenge is that each country is particular, and deep cultural changes are not easy. In Mexico we might have to spend more time so that all stakeholders can not only understand these changes, but act on them.

Over the last 10 years, the global pharmaceutical industry as a whole has not maintained an entirely positive reputation. What do you think can be done about this, and what have you seen organizations including CETIFARMA do to shed this negative image?
I can’t deny that it’s a challenge. In the 1980’s the World Health Organization initiated a programme to work with world governments and the global pharmaceutical industry to promote good practices in pharmaceutical advertising. Since then, world medical associations have been pointing their ethical codes in the same direction. Unfortunately, I believe the negative side of the pharmaceutical industry’s reputation can be attributed to certain practices that only a few companies have performed in the past, and once a company has lost their good reputation it’s extremely difficult to recover, and this might have had a knock-on effect for the entire industry.
When the IFPMA and other international associations adopted a decision in 2005 to promote a global good practice code of advertising and promotion, I think these types of decisions and actions are helping to build a new reputation for the pharmaceutical industry. Although despite this, it’s not enough because I feel everyone in the process needs to move together, including doctors and practitioners, in order to change public opinion.
In our experience, we’ve also seen mixed feelings in terms of reputation. On one hand people can see the good practices put into action, but they also ask “what about the price?” We need to balance both points, because the issue of drug prices has also had a negative impact on the reputation of the industry. At the end of the day, in my experience as a practitioner, the public feel comfortable when they are given a prescription, and feel they are recovering their health, which indicates trust in both the medicine, and the doctors’ judgment. Having said that, I think there is a long way to go yet.

Historically there has been a problem of counterfeit medicines and self-administration in Mexico. What do see as the most effective way of resolving this problem and gradually changing habits?
I think that the Mexican Health Minister and other key figures are really making an effort to shut down the production and sale of counterfeit drugs. It’s also extremely important that health authorities, manufacturers, and wholesalers co-operate fully on this issue and move together in the right direction. At the moment I feel the public health system has good control over medicines purchased for, and used in, public institutions. Obviously counterfeit drugs exist in Mexico but I don’t think it’s a big problem that can’t be overcome with just a little more collaboration between the public and private sector.
Regarding self-administration, we need to look at what kind of health education people have here in Mexico. What do people actually know about their prescriptions? I would say that there is very little public knowledge about these things in Mexico, and part of the reason might be because we don’t have many professionally trained pharmacists within the drugstore, like they do in lots of other countries. I believe there is a need to develop special training programmes to improve the quality of information given by those working in drug stores across Mexico, to their customers.
The other significant problem is that patients in Mexico don’t always follow their doctor’s instructions and often abandon their course of treatment. Part of the reason for this is lack of health education, but also due to the kind of relationship between doctor and patient. How much time does a doctor spend with his patients explaining why they are prescribing a certain medicine rather than another one? It’s essential that the public are educated on in importance of completing a full course of treatment, and the risks involved to the contrary, and if doctor’s are a good source of education for the public, perhaps we don’t incentivize them enough to spend more time with patients to explain things. On top of all that, some people in Mexico cannot afford to go to a doctor in the first place, or they don’t want to spend the time, so it’s a complex problem.

What are the new initiatives and activities that CETIFARMA has planned for the next 24 months?
One initiative is to promote the monitoring of best-practice compliance in pharmaceutical companies. We need to have evidence that there is compliance with ethical rules, and if we don’t have evidence or we can’t see the outcomes, it’s very difficult to understand how a company is complying with standards. The second initiative is to continue the sustainable work with best-practice advertising and promotion, particularly advertising to the general public. It’s very important for us that companies fully comply with global standards and avoid all kinds of activities that could be construed as misleading.

You’ve been intricately involved in education and medicine for almost your whole career and Director of CETIFARMA since 2008, when it was started. What is it that keeps you coming to the office every morning and what is it that you want to achieve in the coming years?
Every morning I get up and go to work with one motivating thought- that what I do helps society. It helps pharmaceutical companies to do things in the right way, and to perform actions based on global ethical principles. That’s my motivation. If not, I can’t really explain what I’m doing here.

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