(1st District, Davao) yesterday during the period of interpellation on HB 4244.
It was a well-executed set-up. RH Bill co-author Rep. Kaka Bag-ao (Akbayan
Party List) ended up backpedalling on side effects acknowledged by the birth
control pill manufacturers themselves.
Bag-ao had no idea what hit her, leaving her fellow RH Bill co-authors stunned.
Read all about it. But do not by any means assume that we have won the bout.
We just won another round. That's all.
TRUTH WILL OUT!
Z
EXCERPTS FROM
UNOFFICIAL TRANSCRIPT OF
PERIOD OF INTERPELLATION
ON HOUSE BILL No. 4244
01 June 2011
Rep. Fariñas presiding
Rep. Bag-Ao sponsoring
Rep. Nograles interpellating
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
THE PRESIDING OFFICER (Rep. Fariñas). ... for
continuation of sponsorship and the Honorable Nograles for
his interpellation.
REP. NOGRALES. Good afternoon, Mr. Speaker, dear
colleagues.
Mr. Speaker, I would like to ask if the distinguished Sponsor
is willing to answer several questions from this
Representation.
REP. BAG-AO. Gladly, Mr. Speaker.
REP. NOGRALES. Thank you very much, Mr. Speaker.
Let me first go to Section 2 of the proposed bill. Under
Section 2, it states very clearly that, “The state likewise
guarantees universal access to medically safe, legal,
affordable, effective and quality reproductive health care
services, methods, devices, supplies and relevant information
and education thereon even as it prioritizes the needs of
women and children, among other underprivileged sectors.”
Mr. Speaker, I’d like to ask, does this includes state
guaranteed access to birth control pills or oral contraceptives?
REP. BAG-AO. Yes, Mr. Speaker. In fact, I invite the
Honorable Congressman from Davao to look at Section 10 of
the bill, House Bill No. 4244, which says that;
“Family Planning Supplies as Essential Medicines. –
Products and supplies for modern family planning methods
shall be part of the National Drug Formulary and the same
shall be included in the regular purchase of essential
medicines and supplies of all national and local hospitals and
other government health units.”
Also there is a provision on Section 11 on the Procurement
and Distribution of Family Planning Supplies, which says
that;
“The DOH shall spearhead the efficient procurement,
distribution to LGUs and usage-monitoring of family
planning supplies for the whole country. The DOH shall
coordinate with all appropriate LGUs to plan and implement
this procurement and distribution program. The supply and
the budget allotment shall be based on, among others, the
current levels and projections of the following:
(a)
number of women or reproductive age and couples who
want to space or limit their children;
(b)
contraceptive prevalence rate, by type of method used;
and
(c)
cost of family planning supplies.”
REP. NOGRALES. Thank you very much, Mr. Speaker.
We will go to those provisions later on. But since the
distinguished Sponsor and the authors of the bill have agreed
that this includes birth control pills, I would like to ask, Mr.
Speaker, if the authors of this bill and the distinguished
Sponsor is very much aware of the dangers of the birth
control pill. For instance, Mr. Speaker, are the authors of the
bill aware that at the University of Udine in Italy, Department
of Biomedical Sciences and Technologies have reported in
their study in 2008, that women on the pill were four times
more likely to have high levels of C-reactive protein enough
to cause intermediate risk for heart disease. This is reported
by the University of Udine in Italy. So, therefore, four times
more chances to have high levels of C-reactive protein or
CRP that causes heart disease.
REP. BAG-AO. Marami pong salamat sa tanong. Unanguna,
po kagaya po ng napag-usapan noong ang bill na ito ay
pending pa lang sa committee, iyong tanong po na iyan ay
natalakay na at na-raise na. At babanggitin ko lang po ang
records ng committee hearing noong December 15, 2010,
noong pinag-usapan din ang tanong na iyan. At nasagot na
din po iyan ng mga eksperto natin. At sabi po ni Mr.
Misiteros, halimbawa, sabi nya, “While some would argue
that contraceptives are carcinogenic, we can always say, any
doctor can always say that almost all drugs, whether it be for
contraception or not, are carcinogenic. In fact, not just drugs
but the food we eat, the fertilizers we put on them. And it is
always when you are faced with something that you are
confronted with the question because drugs are double-edged
swords including contraception. At iyan pong tanong na iyan
ay natalakay at nasagot na.
Pangalawa, kung babasehan po natin ang documentations at
documents na ni-release ng World Health Organization,
2007, page 109, ang sabi po nila, “Almost all modern
contraceptives are in the World Health Organization’s model
list of essential medicines. Ano iyong basehan na pagkasabi
na ito ay essential medicines? Sabi nila, nilagay ito ng World
Health Organization on the basis of priority healthcare need,
efficacy, safety and cost effectiveness. In fact, naglagay sila
ng hiwalay na box para sa mga drugs na kinokonsider nilang
abortifacient.
Ang sabi lang nila, clearly marked with a box note stating,
“Where permitted under national law and where culturally
acceptable.” Kung sabihin natin na lahat ng—ang mga pills
na may kinalaman sa contraceptives ay may carcinogenic
effect at sinasabi ko nga na ito ay nasagot na ng paulit-ulit
doon sa committee hearing, ay lahat po talaga ay pwede
nating ipagbawal, ‘no? Kahit iyong sinasabi nila na
carcinogenic ang kumain ng barbecue dahil ito ay may
nasusunog at dahil niluluto sa uling, eh, ibig sabihin ay hindi
na tayo dapat kumain ng mga litsong manok kasi ito ay
carcinogenic.
Kaya—at panghuli, ang gusto ko lang i-point out, tingin ko
hindi para sa atin, kaya gusto ko rin kayong imbitahin na
wala namang enumeration ng drugs sa Section 10, Family
Planning Supplies as Essential Medicines. Kaya ang talagang
pwedeng ekspertong magtakda ng listahan kung ano ang mga
medisinang dapat ituring na abortifacient o contraceptives ay
dapat i-declare, o carcinogenic, ay dapat lamang i-declare ng
Food and Drugs Administration.
Iyong birth control pills, as well as all contraceptives, which
will be provided under the bill, are subject to the approval of
the FDA. Hindi po ito ang tamang venue para pag-usapan
kung ano ang particular na gamot ang carcinogenic o kaya ay
abortifacient. What we need is an authoritative
documentation of the contraceptives which are safe and
healthy. And as of now, we depend on the World Health
Organization list, model list of essential medicines, which
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
were listed on the basis of priority healthcare need, efficacy,
safety, I repeat, safety and cost effectiveness.
REP. NOGRALES. But are we safe to assume, Mr. Speaker,
that the drugs that are being sold in the market were most
probably and is probably the same drugs, birth control pills
that we are giving to our women given by the government,
eh, sinasabi ninyo, subject to the regulation pa ng FDA. Pero
sa ngayon, etong mga pills that are readily available in the
market are the pills that we will be giving to our women.
REP. BAG-AO. Tama.
REP. NOGRALES. Correct?
REP. BAG-AO. Tama. In fact—at dahil ito, ang mga pills
na ito ay certified din ng FDA based sa kanilang pag-aaral na
safe para gamitin ng mga kababaihan. Sa ngayon, iyon ang
ating magiging basehan para sabihin kung ano iyong mga
contraceptives na dapat magiging bahagi ng list of essential
medicines na nakalagay sa Section 10 at Section 11.
REP. NOGRALES. Pero ang pagkakaiba kasi, Mr. Speaker,
is that, these drugs, if you want to take them, you take them at
your own risk. Pero iba naman ang pinag-uusapan natin kung
ang gobyerno ngayon ang bibili ng mga medicines na ito na
nakasasama sa mga katawan ng ating mga kababaihan at
ibinibigay ito ng libre. There is a big difference because if
you want to take those medicines, knowing that you have the
risk and you are willing to pay for that, that is a big difference
from government knowing all of these risks, purchasing all of
these medicines, giving it for free to all of our women, asking
them to take it so that they can control the population, and
then, eventually, these women dying because of all of these
diseases.
REP. BAG-AO. Pero mayroon po tayong government
agency, ang Food and Drug Administration, na siyang may
mandato para siguraduhin na ang ating mga gamot ay safe sa
lahat ng mamamayan, hindi man ito contraceptives o gamot
man ito para sa ibang sakit; at sa kasalukuyan, ang Philippine
Food and Drug Administration currently allows all types of
contraceptives, which is consistent with the World Health
Organization’s list of essential medicines.
REP. NOGRALES. Of course, Mr. Speaker, our
distinguished Sponsor, …
REP. ROMULO. Mr. Speaker.
THE PRESIDING OFFICER (Rep. Fariñas). Majority
Leader.
REP. ROMULO. Mr. Speaker, with the permission of the
Honorable Bag-ao and the Honorable Nograles, and all
Members present, may we be allowed to interrupt the debate
for the moment in order to welcome guests of the House of
Representatives, the parliamentarians …
THE PRESIDING OFFICER (Rep. Fariñas). The debate is
temporary suspended to …
REP. ROMULO. The parliamentarians and delegates
attending the 3rd ASEAN Inter-Parliamentary Assembly
(AIPA) Caucus
RESUMPTION OF SESSION
At 5:20 p.m., the session was resumed.
THE PRESIDING OFFICER (Rep. Fariñas). Session is
resumed.
REP. ROMULO. Mr. Speaker, I move that we resume the
period of interpellation with the Honorable Kaka Bag-ao and
the Honorable Karlo Nograles.
THE PRESIDING OFFICER (Rep. Fariñas). Please
proceed.
REP. NOGRALES. Thank you very much, Mr. Speaker.
Allow me to go to another study. Is the distinguished
Sponsor aware that the British Medical Journal reported that
women using the pill is 1.9 times more likely to die from
cerebrovascular disease and 2.5 times more likely to die from
cervical cancer? That is 1.9 times higher chances of
developing cerebrovascular disease and 2.5 times higher
chances of developing cervical cancer.
REP. BAG-AO. Alam mo, pwede talaga tayo magpalitan ng
mga study. Bibigyan din kita ng ng isa. “Society of
obstetricians and gynecologists of Canada: Compared to
other reproductive tract and lifestyle factors that affect breast
cancer risk, example, one alcoholic drink per day, failure to
breastfeed, first child after 35, the increase in risk associated
with oral contraceptive is very small.”
Isa pang study. Bale pwede tayong magpalitan ng mga
studies e. J. Trussell, Contraceptive Technology, Chapter 3,
18th
Edition, “However, there is a great uncertainty regarding
the causal link, if any, between combined OC use and liver
and colorectal cancer, and recent evidence suggests no
association between current or former combined OC use and
breast cancer. Regardless, the net effect of combined pill use
on cancer is negligible.”
Ang punto ko lang, Mr. Speaker, una, lahat po ng studies na
ito ay isolated studies at wala pong consensus among medical
practitioners na mayroong direct relation, at talagang
sasabihin natin na hindi natin gagamitin ang mga pills na ito
kasi carcinogenic.
Pangalawa, kaya nga po ang mga gamot ay may
contraindication para malaman natin na hindi lahat ng gamot
ay pwede sa lahat ng populasyon. Kaya nga po mayroon
tayong Food and Drugs Administration, ang government
agency na may mandato, may expertise at nagko-conduct ng
research para alamin kung ano ang mga tamang gamot para
sa atin.
Panghuli, kung sasabihin natin na lahat ng mga gamot ay
carcinogenic, e huwag na ho tayo uminom ng gamot. Lately,
alam ko, ‘pag gumamit ng cellphone, carcinogenic. Baka
hindi na tayo dapat mag-cellphone.
Ang sinasabi ko lang, pwede talaga tayong umabot sa isang
absurd na application kapag tayo po ay maggagawa ng
assumption na ang mga basehan natin ay napakaraming
study, kaliwa’t kanan, na conflicting with each other.
Ang point ko po, ang sinasabi natin, sa ngayon, at ako po ay
naniniwala sa World Health Organization list of essential
medicine at sa Food and Drugs Administration competency,
to declare ano po ang mga gamot na makakabuti sa atin,
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
whether ito po ay pang-araw-araw nating kailangan kagaya
ng paracetamol or para sa maternal health care at para sa
reproductive health and family planning.
Iyon po ang gusto sana nating i-emphasize sa batas na ito.
And in the end, ang mamimili po ay iyon pong gagamit.
Kung pong tingin niya, sa pagbasa niya ng contraindication,
sa pagkonsulta niya sa FDA, sa pagkonsulta niya sa midwife,
sa barangay health worker, na ang batas na ito ay
sumusuporta na dapat maraming skilled barangay health
worker at midwife, pagkatapos niyang mangunsulta,
pagkatapos niyang humingi ng impormasyon, pagkatapos
niyang magnilay, konsultahin ang kanyang asawa at mag-
decide siya na itong pill na ito ang tama para sa akin, itong
partikular na family health method ang tama para sa akin,
hindi ba dapat suportahan natin siya, lalo na kung siya ay
kabilang sa mahihirap na komunidad.
Kasi alam naman natin, iyong lower strata ng ating lipunan,
iyong mga mahihirap kung saan mas marami rin ang kanilang
mga anak, sila rin ay walang kakayahang magsubi ng pera
para bumili ng gamot.
Ang unang-unang pangangailangang uunahin niyang gastusin
ay pagkain. Kaya nga mahalaga na bahagi ng programa natin
ay i-inform ang bawat pamilya ano ang iba’t ibang
pamamaraan, ibigay sa kanila ang tamang information,
huwag nating itago para magkaroon sila ng kakayahan at
kapangyarihang mamili. At kapag namili na po sila, bigyan
po natin po sila ng pagkakataong mabigyan ng suporta ang
desisyon na kanilang gagawin. Iyon lang po ang ibig sabihin
ng bill na ito.
REP. NOGRALES. Iyon nga ang punto, Mr. Speaker. Kasi
gagamit po tayo ng pera ng bayan para bumili ng mga
contraceptive pills para ipamigay ng libre sa ating mga
kababaihan. Iyan po ang punto na gusto nating i-emphasize.
Why spend government money to purchase medicines that
may be hazardous to your health? Kahit na sabihin natin may
tsansa na hindi, may tsansa na meron, ang mangyayari ba
nito, Mr. Speaker, pag punta ng barangay health worker doon
sa mga kababaihan natin para ialok sila na gumamit o mag-
testing nitong contraceptive pills, hindi ba parang ang
mangyayari nito iyong parang debate naming dalawa ng ating
distinguished Sponsor? Sasabihin ng health worker, “O, itong
pill, may nagsasabi may kanser, may nagsasabi hindi rin
kanser, bahala ka na.”
REP. BAG-AO. Alam mo problema...
REP. NOGRALES. Ganoon po ba ang nafo-foresee nating
mangyayari dito?
REP. BAG-AO. Ang problema, ang sinasabi kasi natin ay
may be hazardous to your health, may be. Ni hindi tayo
eksperto para sabihin na ang “may be” na ito ay talagang
nakaka-cause ng kanser. Ang tingin ko nga, ang mas may
awtoridad para maitakda ano ba iyong mga essential
medicines sa ating bayan ay ang gobyerno, ang ahensiya ng
gobyerno, iyong Food and Drug Administration. Ngayon,
dumaan iyan sa mahabang pag-aaral, bawat pakete, sa
pagkakaalala ko, hindi man ho ako drug user, bawat pakete
nakalista contraindication, kailan ito pwedeng gamitin, ano
iyong—ibig sabihin, ito ay applicable sa bawat sakit. I am
sure nag-take ng responsibility ang ating gobyerno na ang
mga gamot na tingin nila ay carcinogenic ay hindi na po inaapprove
at hindi din pinapa-distribute. Ang punto ko lang
hindi natin pwedeng i-legislate ang ating mga “may bes” kasi
hindi tayo sigurado doon. Ang sigurado tayo ay kailangang
masuportahan ang pangangailangan ng family planning ng
mga taong kagaya halimbawa ni Aling Salve Paa ng
Valenzuela, na sinabi niya mayroon siyang 12 anak, buntis
siya sa panglabingtatlo, namatay ang apat dahil sa
kumplikasyon ng maruming tubig, mga sakit na madali
sanang gamutin. Anong sabi niya noong ininterbyu siya ng
Inquirer? “Kung alam ko lang ho ang family planning, hindi
ko sana gagawin ito, alam ko sana mag-space ng birth, alam
ko sana kailan ako dapat manganak, ilan dapat ang anak ko,
iyong kaya ko lang buhayin.” Iyon ho ang gusto nating
balikan na esensiya ng batas na ito, hindi mag-legislate ng
mga may be kasi hindi tayo sigurado pa.
REP. NOGRALES. Ang problema, Mr. Speaker, hindi
naman po may be ito dahil nakasulat nga sa kanilang mga
studies, very clear ang sinabi dito, University of Udine – 3.9
times, four times more likely to cause heart disease; British
Medical Journal – 1.9 times more likely to die from
cerebrovascular disease, 2.5 times more likely to die from
cervical cancer; University of Kent in Belgium – every 10
years of oral contraceptive use was correlated to 20-30%
increase in atherosclerotic plaque that may cause build up in
your arteries. UK’s Epidemiology Unit in Oxford, researches
from the cancer research says, 10% increased risk in cervical
cancer if the woman is taking the pill for five years or less,
sixty percent increased risk of developing cervical cancer if
the woman is taking the pill for five to nine years use, one
hundred percent greater risk if taken for at least 10 years.
These are very conclusive studies.
Ngayon, nabanggit naman ang FDA. FDA, sila ang
magsasabi ano iyong dapat, ano iyong tama, e bakit pa tayo
magle-legislate dito kung FDA naman pala ang magsasabi.
Why is there a need to provide legislation that classifies these
carcinogens as essential medicines, e kung andiyan naman
ang FDA para gawin iyan? Hindi ko naman sinasabi na ang
FDA will now classify these as essential medicines knowing
that all of these ay nakakabigay pala ng sakit sa ating mga
kababaihan e.
REP. BAG-AO. Okay, balik na naman tayo sa mga studies,
meron pa akong baon diyan...
Ito naman iyong studies ko para pantapat sa studies mo.
Puwede talaga tayong magpalitan ng studies.
Una, after more than 50 studies – ito naman iyong studies na
mayroon ako – most experts believe that pills have little, if
any, effect on the risk of developing breast cancer.
The following are excerpts of some of these studies:
The Women’s CARE study of 4,575 women with breast
cancer and 4,682 controls found no increased risk of breast
cancer among women currently using pills. Use of pills by
women with a family history of breast cancer was not
associated with an increased risk of breast cancer nor was the
initiation of pill use at a young age – Marchbanks 2002.
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
However, several studies have shown that current users of
pills are slightly more likely to be diagnosed with breast
cancer, relative risk, 1.2 – Lancet 1996.
Two factors may explain this. Number one, a detection bias.
Pills users undergo more breast examinations and
mammograms, or two, promotion of an already present nidus
of cancer cells.
Ten years after discontinuing pills, women who have taken
pills in the past are at no increased risk of having breast
cancer diagnosed – collaborative group, Lancet 1996.
Breast cancer diagnosed in women currently on pills or
women who have taken pills in the past are more likely to be
localized or less likely to be metastatic – collaborative group,
Lancet 1996.
By age 55, the risk of having had breast cancer diagnosed is
the same for women who have used pills and those who have
not. The conclusion of the largest collaborative study of the
risk of breast cancer is that women with strong family history
of breast cancer do not further increase their breast cancer
risk by taking pills.
This was also the conclusion of the Nurses’ Health Study,
Lipnick 1986, Colditz 1996, and the Cancer and Steroid
Hormone Study – Murray 1989, the Centers for Disease
Control, Cancer and Steroid Hormone Study, 1983.
The overall conclusion of these studies is that, pills do not
cause breast cancer. Many years after stopping oral
contraceptive use, the main effect may be protection against
metastatic disease—Speroff and Darney 2001, collaborative
group, Lancet 1996.
Mayroon pa po pa rin ako diyan kung mayroon ka pa ring
study.
Pangalawa, hindi po natin nile-legislate na bigyan ng
kapangyarihan ang FDA kasi mayroon na siya. Ang sinasabi
lang natin, iyong products and supplies for modern family
planning method, shall be part of the national drug formulary
and the same shall be included in the regular purchase of
essential medicines and supplies of all national and local
hospitals and other government health units.
Ngayon, anong mga gamot iyon? Anong mga contraceptives
iyon? Iyon iyong mga contraceptives na approved ng Food
and Drug Administration based doon sa list of essential
medicine na ang puwedeng maging basehan ay ang World
Health Organization na tingin ko ay may credibility, may
expertise para itakda na itong mga ito ay safe at puwedeng
ilista bilang essential medicine.
REP. NOGRALES. Of course, Mr. Speaker, maaari din
pong magkamali ang ating mga government agencies. Let
me cite one fact. Before, Johnson&Johnson, a
pharmaceutical company, recalled the drug Ortho Evra birth
control patch, after lawsuits revealed definitive proof that
women on the patch were dying of stokes and blood clots
three times more frequently than the general population.
This, after the patches were distributed and used by the
women. Pagkatapos ma-distribute, ginamit ng mga
kababaihan natin, doon lang nalaman na nakaka-cause pala
ito ng blood clot and stroke.
And then, just recently, Mr. Speaker, published by
Bloomberg News, May 31, 2011. Bayer’s birth control pills
will be reviewed by regulators after some studies suggested
that they may cause more blood clots than competing
medicines. Two recent reports in the British Medical Journal
found a two-fold to three-fold greater risk of blood clots in
women taking pills like Bayer’s Yaz, the Food and Drug
Administration said in a statement. While all birth control
pills—all, mind you—all birth control pills pose a risk of
blood clots, the FDA review focuses on the hormone
drospirenone found in Bayer’s Yaz, Yasmin, Beyaz and
Safyral. The agency expects to have results later this
summer, etc., etc. The Yaz family of products generated
$1.47 billion in sales last year for Bayer or 3.3% of the
company’s revenue.
In other words, Mr. Speaker, $1.47 billion worth of Bayer’s
Yaz have been distributed, bought and used by women all
over the world including the Philippines, only to find out later
on that it can cause blood clot. In the meantime, regulators
said doctors and patients should watch for symptoms of blood
clots including leg or chest pains.
Too late the hero, Mr. Speaker. Ipinamigay na natin – worse,
if this bill had been passed earlier on and our government had
purchased so many boxes of this Yaz medicine, given it to
our women for them to use, and then suddenly only to be
recalled, kasi nga, uy, nagkamali tayo, nakakapatay pala ito.
How much more and how many more pills out there in the
market ang may ganyang klaseng findings? And medical
journals have already warned us and I think the Members of
this House should be well-informed of the risk before putting
this to a vote.
REP. BAG-AO. Tama iyan. Pero gusto ko lang ipaalala sa
iyo, pareho tayong abogado, meron tayong presumption of
regularity sa mga government agencies. Ibig sabihin, ang una
nating kaisipan ay tama, may competence at may kakayahan
ang government agency na ito. Ngayon, kung lahat ng gamot
na-re-release ng Food and Drug Administration ay
pagdududahan natin na hindi tama sa atin, ay talagang gusto
nating – sina-suggest mo ba na huwag tayong magtiwala sa
ating gobyerno?
REP. NOGRALES. Ang sina-suggest ko huwag po tayong
bumili ng birth control pills.
REP. BAG-AO. Huwag tayong magtiwala sa Food and
Drug Administration? Na halimbawa ang sasabihin ng FDA
na ito ay bahagi ng list of essential medicines.
REP. NOGRALES. Huwag nating gamitin ang pera ng
taumbayan para bumili ng birth control pills.
THE PRESIDING OFFICER (Rep. Fariñas). Hold it, hold
it, hold it, hold it. Please speak one after the other and
address all your answers to the Chair.
REP. BAG-AO. Mr. Speaker.
THE PRESIDING OFFICER (Rep. Fariñas). Please
proceed.
REP. BAG-AO. Mr. Speaker, ang pinupunto ko lang po,
unang-una ay mayroon pong presumption of regularity.
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
REP. CAGAS. Mr. Speaker. Mr. Speaker.
THE PRESIDING OFFICER (Rep. Fariñas). The
Gentleman from Davao del Sur.
REP. CAGAS. Yes. I just want to ask the two distinguished
Congressman and Congresswoman, in what language is the
title of the bill written? Was it written in Bagobo, in Ilocano?
REP. NOGRALES. In English, Mr. Speaker.
REP. CAGAS. Thank you.
Mr. Speaker, I am just curious, is there any Rule that...
THE PRESIDING OFFICER (Rep. Fariñas). Hold it. What
is your—is there a point of order or?
REP. CAGAS. I am asking this, Mr. Speaker, because I
have been listening to Tagalog debates. I would rather listen
for the two Congressmen to debate in English or in Bisaya
because the two of them are from Visayas.
REP. BAG-AO. Sakto man, bay. Pwede man kini mag
istorya sa Bisaya. Pero ang punto ko po, ako po ay
nagsasalita sa official language ng Pilipinas. Hindi ko po
alam kung ano po ang bina-violate kong Rule.
REP. CAGAS. Let us speak in English.
THE PRESIDING OFFICER (Rep. Fariñas). Hold it. The
point of the Gentleman from Davao del Sur is, if you could
debate in English. But you have the choice to debate in
Pilipino, if that is your wish.
REP. BAG-AO. Hindi ko po maunawaan kung bakit po
kailangan akong piliting mag-Ingles kung pwede naman po
akong magsalita ng Pilipino.
THE PRESIDING OFFICER (Rep. Fariñas). Pwede kang
mag-Pilipino.
REP. BAG-AO. Naiintindihan naman po ako siguro ng
lahat.
THE PRESIDING OFFICER (Rep. Fariñas). Ipagpatuloy po
ninyo. (Laughter)
REP. BAG-AO. Pero sasagutin na kita, ha?
REP. NOGRALES. Thank you very much, Mr. Speaker.
REP. BAG-AO. Salamat po, Mr. Speaker.
Ulit, sasabihin ko po, may presumption of regularity ang
ating government agency at ang Food and Drug
Administration ay mayroong presumption na may
competency at may kakayahang magbigay sa atin ng tamang
pagsusuri at paglalagay ng contraindications ng mga gamot
na dapat nating i-take. Pero gusto pa natin ng study at maguusap
tayo ng risk, meron din po ako.
Comparative risks of dying, of different activities versus use
of contraceptives. Sa U.S. po, mula kay Trussell: from an
accident, 1:2,900; from being struck by lightning,
1:2,000,000; non-smokers, 35 to 44 using combined
contraceptives, 1:33,000; smoker, 35 to 44, using combined
contraceptives, 1:2,500; undergoing sterilization, 1:66,700;
pregnancy, 1:8,700. Iyon po ang ilang studies na meron ako
kung pag-uusapan po natin ang risks.
REP. NOGRALES. I find it quite disturbing, Mr. Speaker,
that after revealing all of these studies that we could just turn
a blind eye or not look at the studies and see the warnings on
the label. But because we are going to studies, let me go
further to more studies. And this was already brought up by
previous interpellators. The International Agency for
Research Center of the U.N.’s World Health Organization
classified hormonal contraceptives as group one carcinogens
for breast, cervical and liver cancers. ‘Yan, galing na sa U.N.
World Health Organization. This is interesting, Mr. Speaker,
lalung-lalo na sa mga kalalakihan.
Scientists at the University of Missouri found that hormonal
birth control pill has also been associated with prostate cancer
in male children of mothers who take the pill because it has
been found that the oral contraceptive could deform the
prostate gland of the human embryo, and deformities in the
prostate gland have been linked to prostate cancer and
bladder disease in later life.
Ibig pong sabihin nito, isang nanay, umiinom ng birth control
pill, eh hindi niya alam na-miss niya siguro ang isang day,
buntis na pala siya, still taking the oral contraceptive, eh
meron na pala siyang lalaking anak sa loob ng kanyang
womb. Iyong lalaking anak puwede pong magkaroon ng
prostate cancer paglaki po niya.
Also, 2006, the Mayo Clinic Foundation reported that premenopausal
and post-menopausal women who use birth
control pills before the first full-term pregnancy has at least
40% increased risk of developing breast cancer. And women
younger than 46 years old who use the birth control pill for
four or more years prior to the birth of her first child has a 72,
note, 72% risk of developing breast cancer.
Other side effects: venous thromboembolism, the medical
term for blood clots; elevated bad cholesterol;
arteriosclerosis; heart attack; stroke; hypertension; liver
cancer; liver tumors; deep vein thrombosis; heart attacks;
pulmonary embolism; pelvic inflammatory disease;
hypertensive disease; blood pressure rise; liver tumors.
In fact, after reading all of these medical journals, Mr.
Speaker, hindi na po ako nakatiis. Eh kailangan – I need to
find out myself. Huwag po kayong mag-alala, hindi ko po ito
binili sa souvenir shop ng Kongreso. Iyong bag lang po.
Pero pumunta ako sa isang pharmacy.
Pumunta ako sa pharmacy, sinabi ko doon sa pharmacist,
“Bibilhin ko lahat ng mga birth control pills na mayroon kayo
available dito sa pharmacy ninyo.” And so I bought it to find
out what really are we talking about, Mr. Speaker.
Let me start with the first birth control pill na binenta po sa
akin. For the information of everyone in this Congress, I
bought this pill and actually, nabigla po ako sa presyo. Kasi
pagbili ko nito, ang presyo pala nito P729.75. P729.75 for
this pill, eh good for one month lang ito kasi 20-30 tablets
lang ito eh.
So, sinabi ko sa pharmacist, “Bakit napakamahal naman po
niyan, P729? Ibig sabihin, bibili tayo P729 per month?”
Sabi niya, “Eh, Sir, itong birth control pill, hindi po ito birth
control pill lamang kundi nagpapaganda rin po ito ng kutis.”
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
Sabi ko, “Talaga, nagpapaganda ng kutis? Bakit?”
“Kasi, nakalagay po dito, ‘Indication: This pill is indicated
for use as oral contraceptive and treatment of moderate
acne.’” So, hindi lang ito oral contraceptive kundi
pampawala rin ng acne. Eh, ang nakakabigla rito, Mr.
Speaker, binili ko ito, readily available sa anong pharmacy
diyan. Ano po ang tatak nito? “Yaz.”
Ito iyong Yaz na ngayong May 31, 2011, sinabi ng
Bloomberg News that “US orders review of risk of some
birth control pills,” suggesting na itong Bayer’s Yaz, ito ang
nakakabigay ng two-fold to three-fold greater risk of blood
clots in women. And anyone can purchase this. At baka ito
rin ang ipamimigay natin sa mga kababaihan natin. Ito po
iyong Bayer’s Yaz. Mayroon ding Yasmin, nadito rin iyan,
pareho po na ibinebenta.
REP. BAG-AO. Ang tingin ko kung mayroon po tayong
usapin tungkol sa kakayahan ng Food and Drug
Administration ay ibang issue ito at hindi ito reproductive
health question kasi ang ina-assume nga natin ay may
regularity ang pagganap ng mga gawain ng mga government
agency.
Pangalawa, iyang mga sinasabi mong maling paggamit ng
mga contraceptives ay talagang dulot ng kakulangan sa
impormasyon. Kaya, napakahalaga ng Reproductive Health
Bill, Mr. Speaker, dahil bahagi ng batas na ito ay hindi lang
iyong usaping contraceptives. Bahagi rin po ng batas na ito
ang pagbibigay ng tamang impormasyon, ang pagbibigay ng
tamang contra-indication, at pagbibigay ng tamang pag-aaral
sa lahat ng mga pamilya para hindi maging iresponsable ang
paggamit nila o pag-adopt ng isang partikular na reproductive
health o family planning method.
Pero para sagutin ko ng konkreto iyong mga studies na nireraise
mo, iyong sinasabi mong study mismo ay mayroon ding
tugon. Tapusin natin iyong study na iyan. At ito ay mula
doon sa UNDP, UNFPA, WHO, World Bank Report,
September, 2005.
Sabi nila: “It is important to note that IARC do not
evaluate the overall risk-benefit profile of compounds in
public health terms even in terms of overall cancer risk
for compounds that have a protective effect on some
cancers and increase the risk of some others. As stated on
IARC’s review, the use of COCs modifies slightly the risk
of cancer, increasing it in some sites – cervix, breast, liver,
decreasing it in others – endometrium, ovaries. Some of
this data refer to older higher-dose COC preparations.
Assessments based on the risk benefit calculations are
carried out by different teams within the World Health
Organization. Several WHO committees work on
creating evidence-based family planning guidelines and
on keeping them up-to-date on a continuous basis. They
regularly review the safety of COCs and assess the
balance of risks and benefit of COC use and they have
determined that for most health women, the health
benefits clearly exceed the health risks.”
Ibig sabihin, kapag nag-usap tayo ng mga studies, talagang
iyong posibilidad, iyong risk, iyong may be, iyong
possibilities ng anumang gamot ay laging nandiyan. Pero,
sinasabi nga nila, mayroon ding mga study na mas naaoutweigh
ng benefit ang health risk. Kaya ang sinasabi natin,
and in the end, Mr. Speaker, ang mahalaga sa diskusyon at sa
debate natin ngayon ay maunawaan na bahagi ng
Reproductive Health Bill at puwede po talaga—kahapon ay
napakahaba ng diskusyon sa medical issues behind
reproductive health—pero in the end, sa akin pong pagunawa,
iyon po ang kahalagahan ng batas na ito, ang
maunawaan ito ng lahat ng mamamayan sa Pilipinas na
gustong magkaroon ng tamang impormasyon sa pagpaplano
ng kanilang pamilya. Alam ninyo ho, bago ako nag law
school, ako po ay community organizer ng isang urban poor
community sa Commonwealth, at ito rin po ang dahilan kung
bakit ako ay nagtatanong kung bakit mahalaga ang batas na
ito. Sa isang taon ko pong pagiging community organizer sa
urban poor community ng Commonwealth, hindi lang po
sampu ang batang nakita kong itinapon sa kanal na bagong
panganak at namatay. Ang tanong ko ho sa sarili ko, bakit
nangyayari iyon?
Kinausap ko ho iyong mga nanay at sabi nila, kasi hindi na
nila kayang alagaan, kasi hindi nila alam kung paano
sisiguraduhin na pwede pala nilang planuhin ang kanilang
pamilya. At kagaya nga po ng sinasabi kong kaso ni Aing
Salve, hindi po siya fiction, siya po ay totoong nanay na may
12 anak at apat na ang namamatay. Ano ang mali sa nangyari
sa kanya? Siya mismo ang nagsabi, “Dahil wala akong
tamang inpormasyon para planuhin ang aking pamilya.” Iyon
po ang isang klarong objective ng batas na ito.
At para po sa mga mahihirap na nanay kagaya ni Aling Salve,
Mr. Speaker, at sa mga kapitbahay niyang urban poor ng
Valenzuela, tingin ko ho obligasyon natin na i-provide ang
batas na ito para siguraduhin na alam nila ang mga
pagpapasyang gagawin nila. Kagaya ng anong gamot ang
tama para sa kanila sa pagpaplano ng kanilang pamilya, ano
ang contra-indications, ano ang ibig sabihin noon at meron
silang magiging basihan para magnilay, mag-aral, intindihin
ang lahat ng mga pamamaraan ng family planning. Ngayon,
hindi naman sila pipilitin ng gobyerno na bumili ng isang
partikular na gamot, Mr. Speaker. In fact, bahagi ng
Reproductive Health Bill na ito ay respetuhin ang kanilang
pagpapasya kung gusto po ng mga pamilya na mag-adopt ng
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
natural family planning method, sila din po ay susuportahan
ng gobyerno.
Ang punto lang po natin, hindi po natin pipilitin na mag-
adopt ng isang partikular na pill, mag-adopt ng isang
partikular na metodo, mag-adopt na isang partikular na
pamamaraan ang bawat pamilya kung gusto nilang planuhin
ito. Kung ano po ang kanilang napagpasyahan, ang
responsibilidad nating Mambabatas ngayon ay siguraduhing
bigyan ng kapangyarihan ang gobyernong masuportahan ang
pagpapasyang ito.
REP. NOGRALES. Pero, Mr. Speaker, napakalaki kasi ng
temptation na pills ang kukunin dahil nga binibigay ng libre
ng gobyerno.
Ngayon, let’s go to another type of oral contraceptive pill,
this is Lynestrinol. And here, I mentioned medical studies,
the distinguished
Sponsor also mentioned
medical studies, to
combat iyong medical
studies na inilabas ko.
Pero ito klarong-klaro.
Nakalagay po dito sa
literature ng gamot na ito, “Breast cancer has been found
more often in women who take the pill than in those who
do not take the pill. The risk increases as the woman gets
older. In every 10,000 women who take the pill for up to
five years but stop taking it by age 20, there would be less
than one extra case of breast cancer.” Malas mo na lang
kung ikaw iyong one out of the 10,000.
“In 10,000 women who take the pill for up to five years
but stop taking it by the age of 30, there would be five
extra cases of breast cancer.” Malas mo naman kung sa
10,000, ikaw iyong isa sa limang babae.
And it says here, “In 10,000 women who take the pill for
up to five years but stop by the age of 40, there would be
20 extra cases of women with breast cancer.” Again,
malas mo na lang, cost-benefit ratio, malas mo na lang kung
isa ka sa 20 out of the 10,000 na nagkaroon ng breast cancer
because of the pill. Ang pinag-uusapan naman natin dito is
chance. There’s the chance, 20 out of 10,000.
Thrombosis is the formation of a blood clot which may block
a blood vessel. If this clot breaks away from the veins, it may
reach and block the arteries of the lungs causing a so-called
pulmonary embolism. The risk of thrombosis is higher in pill
users.
Ovarian cyst, small fluid-filled sacs may develop in the
ovaries, these are called ovarian cysts. So, women using the
pill may also develop ovarian cysts. Nasa pangalawang birth
control pill lang po ako. Marami pa po dito. Iba-iba kasi ang
generic name. Eto.
REP. BAG-AO. Maraming salamat, Mr. Speaker. Una,
gusto ko lang po talagang patunayan at gusto ko siyang
pasalamatan ng pagbibigay sa atin ng tamang ebidensiya, ng
tamang inpormasyon kung bakit talaga kailangan na
mayroong RH Bill kasi kailangang-kailangan talaga natin ng
ganyang klase ng information. In fact, iyon pong ini
enumerate, Mr. Speaker, ng kagalang-galang na Kongresman
mula sa Davao ay kailangang-kailangan po natin pagkatapos
nating maipasa ang bill na ito, sapagkat pagkatapos pong
maipasa ang bill na ito, kailangan natin mag-identify ng
products and supplies for modern family planning method,
which shall be part of the national drug formulary and the
same time shall be included in the regular purchase of
essential medicines and supplies of all national and local
hospitals and other government health units.
Mr. Speaker, iyon pong kinukwento ngayon at enumeration
ng mga gamot na mayroong probability at risk ng iba’t ibang
types ng cancer ay mahalagang-mahalagang information,
mahalagang-mahalagang information pagkatapos nating
maipasa ang batas, sapagkat bahagi ng implementasyon ay
ang paga-identify ng mga tamang gamot para maging bahagi
ng essential medicines na kakailanganin natin para
maipatupad ang batas ng reproductive health. Pero isa na
lang study para din na masagot ko ng diretso iyong study na
ipini-present din, ‘no?
Like all drugs and medical devices, contraceptives have
associated risks and side effects. This way, it is not unlike
paracetamol, one of the most effective pain and fever
lowering drugs that no home should be without, or
ampicicillin, the most widely prescribed antibiotic. Yet, the
complete drug literature for paracetamol includes the
information that one can have skin rashes, blood disorder,
swollen pancreas, and severe liver damage that can be fatal.
The same with the literature on ampicicillin, which warns
about nausea, vomiting, loss of appetite, diarrhea, abdominal
pain, allergic reaction, shock and even death.
Iyang mga ganitong information, importanteng-importante
ito. Kaya dapat huwag kakalimutan, Mr. Speaker, ng
kagalang-galang na Kongresman mula sa Davao iyong
kanyang mga literature kasi po kapagka gumawa na po ng
implementing guidelines ang DOH, kapag po gumawa na ng
rules at kapag po nag-identify na tayo ng mga products and
supplies na magiging bahagi ng national drug formulary,
kakailanganin po natin ang mga inpormasyon at ebidensiyang
iyan para siguraduhin na ang mga pamilya na papasok at
pipili ng karapat-dapat na family planning method sa kanila
ay well-informed, may ebidensiyang binatayan ang kanilang
kaalaman, may kakayahan silang magnilay at mamimili sila
ng angkop at tamang gamot para sa kanila. Kaya maraming
salamat po sa information.
REP. NOGRALES. That is why I was asking and I
premised, my line of questioning, Mr. Speaker, on the first
question that I asked. And the first question that I asked: Are
birth control pills part of the policy of this bill? In other
words, if this bill becomes law, then, we will be giving out
birth control pills to our women, which brings us back now to
our original position, which is, we don’t need this law.
And in fact, it will open up, you know, our women to the
possibility of developing so many diseases, so many
sicknesses because we’ll be giving these for free. Iyon nga
iyong point na sinasabi ko. Hindi na natin kailangan gawing
batas ito because right now, as I expose this, as we talk about
the risks, each and every Congressman here now and
Congresswoman is well-informed of the risk.
EXCERPTS FROM UNOFFICIAL TRANSCRIPT OF PERIOD OF INTERPELLATION ON HOUSE BILL No. 4244 – 01 JUNE 2011
That’s put on record, Mr. Speaker. And if you cast your vote
for this bill that means that in your conscience, you are
looking at the risk-benefit ratio, knowing all of these
literatures, knowing all of these studies, alam natin
makakabigay ng sakit sa ating mga kababaihan and yet we
pass this bill. Are we not now saying to our fellow-Filipino
people, that it’s okay to use the pill kasi pinasa natin iyan?
As Representatives of the people, we are now saying,
gumamit ka ng pill kasi kahit na may mga studies na
nagsasabing ito ay nakakasama, ito ay nakaka-cause ng
cancer, ay may mga studies naman na nagsasabing hindi.
So, we are putting our stamp of approval in giving this
government the free rein of giving out these dangerous,
hazardous products, to our women for them to consume and
probably die because of it.
REP. BAG-AO. Mr. Speaker, gusto ko lang pong i-
emphasize na ang national Food and Drug Administration all
over the world, maging sa US at sa Europe, have taken these
life risks into consideration, and have consistently judged that
most of these contraceptive pills are safe. Kaya nga ang
sinasabi po natin, mahalagang-mahalaga ang batas na ito.
Hindi po natin puwedeng sabihin na hindi ito mahalaga.
Kasi, sinasabi natin, ito ay bahagi. At tama, maniniwala ako
na dapat puwede akong mag-take ng gamot. Kasi po – oo.
Kasi po, bahagi ng Reproductive Health Bill, Mr. Speaker, ay
pagbibigay ng kasanayan sa ating mga barangay health
workers, sa ating mga midwives, sa mga ospital, para may
kakayahan silang magbigay ng medical advice, expert
medical advice, sa mga gustong gumamit ng pills na ito. At
magtitiwala po ba ako? Oo, magtitiwala po ako. Kasi bahagi
po ng bill na ito ay pag-angat ng kanilang kasanayan at
pagtitiwala sa gobyerno na sisiguraduhin niyang
susuportahan niya ang anumang pasya ko sa pagpaplano ng
aking pamilya.
Magtitiwala po ba ako sa batas na ito? Kailangan, kasi,
kagaya po ng maraming komunidad na walang access, at ito
po ang isang objective din ng Reproductive Health Bill,
access to family planning services. Ang sinasabi po natin,
kapag po sila ay nabigyan ng tamang impormasyon, may
contraindication: itong gamot na ito ay hindi puwedeng
gamitin kung ikaw ay hypertensive, itong gamot na ito ay
hindi mo puwedeng gamitin kapag ikaw ay may sakit sa atay,
itong gamot na ito ay hindi mo puwedeng gamitin kapag
makaka-cause ito ng sakit sa tiyan. Sasabihin po iyon.
Kapag sinabi po ba ng doctor sa akin, magtitiwala po ba ako?
Opo, kasi ang alam ko po, ang trabaho nila ay siguraduhing
ako ay mabibigyan ng tamang guidance sa pagpipili ng
tamang gamot para sa akin. Kaya, ang sinasabi ko, kung
lahat po ng gamot ay may risks, totoo po iyon. Kaya nga po
may contraindications na nakalagay at bibigyan po tayo ng
tamang advice.
Ang punto po natin, iyon po ang kahalagahan ng
Roproductive Health Bill na ito, ang mabigyan ng tamang
impormasyon ang lahat ng pamilya. Pero ganoon din ang
pagtitiwala na kapag ang mga gamot na ito ay na-determine
at na-identify na safe at essential, at marami din pong mga
organisasyon sa buong mundo, kasama ang World Health
Organization, na nagse-certify ng mga gamot na ito bilang
essential medicine, at magtitiwala po ako sa ganoong klase ng
pagsisiyasat at pagtatakda na ito ay maaaring gamitin, kung
halimbawa, ay bagay ito sa bawat pamilya ang mag-a-adopt
ng isang particular na family planning method. Kasi, nakaindicate
naman po sa gamot ang mga contraindications ng
bawat pill na isa-suggest at ire-recommend ng mga medical
experts sa mga pamilya. Kaya mahalagang-mahalaga ang
batas na ito, Mr. Speaker.
That’s
put
on
record,
Mr.
Speaker.
And
if
you
cast
your
vote
for
this
bill,
that
means
that
in
your
conscience
–
you
are
looking
at
the
risk
benefit
ratio,
knowing
all
of
these
literatures,
knowing
all
of
these
studies
–
alam
nating
makakabigay
ng
sakit
sa
ating
mga
kababaihan,
and
yet
we
pass
this
bill.
Are
we
not
now
saying
to
our
fellow
Filipino
people,
that
it’s
okay
to
use
the
pill
kasi
pinasa
natin
iyan?
~Rep. Karlo Nograles, 1st District, Davao
