“Advocating high-quality, efficient, patient-centered care in the practice of General Internal Medicine”

SECTION OF ADULT MEDICINE Department of Medicine, University of the Philippines, Manila

College of Medicine & Philippine General Hospital Tel. Nos 521-77-93, Telefax: 5679740

November 23, 2012 To the WHO Expert Committee: My name is Antonio L. Dans. I am a professor at the University of the Philippines College of Medicine, and an Academician of our country’s National Academy of Science and Technology. I practice internal medicine at the Philippine General Hospital, a government facility that serves indigent patients from all over the country. My research and publications have ranged from clinical trials on novel drugs for primary and secondary prevention, to epidemiologic studies on burden of illness and causes of cardiovascular disease in my country. With this letter, I am endorsing proposals to include a fixed dose combination (FDC) of cardiovascular drugs in the World Health Organization’s (WHO) Model List of Essential Medicines, specifically for secondary prevention of cardiovascular disease. Although several individual classes of drugs have been proven to reduce CV disease in the secondary prevention setting, access to these drugs in our country has been limited. Because healthcare is paid mostly out-of-pocket, few patients can afford the full range of medications needed after an event. This has led to a situation where the poor suffer the highest deaths from the cardiovascular epidemic [1]. Even amongst those who can afford however, few can adhere to the myriad of drugs that need to be taken – many for the rest of their lives. Because of this, many experts have also pointed out FDCs for CV disease can improve effectiveness of the individual components. As a physician serving indigent patients in a developing country, I believe that FDCs will lower the individual costs of these medications and increase access - not just for individual patients, but also for governments such as ours, that are struggling to attain Universal Health Care. For these reasons, I strongly urge your panel to strongly consider the recommendation to include them in WHO Model List of Essential Medicines for secondary prevention of cardiovascular disease. Sincerely

Antonio L. Dans MD, MSc Professor, University of the Philippines College of Medicine [1] Dans A, Ng N, Varghese C, Tai ES, Firestone R, Bonita R. The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet. 2011 Feb 19; 377 (9766) :680-9. PubMed PMID:21269677.

Section Chief: NEMENCIO A. NICODEMUS JR., MD Deputy Chief for Research ANTONIO MIGUEL L. DANS, MD,MSC. Deputy Chief for Service and Training ALDRIN B. LOYOLA, MD Consultants: MARK EVANS M. ABAT, MD REGINA R. BERBA, MD, MSC HOMER U. CO, MD SHELLEY ANN F. DELA VEGA, MD NORMAN L. MAGHUYOP, MD LIA AILEEN M.PALILEO, MD FRANCISCO P. TRANQUILINO, MD Chief Executive Officer: MARIA VANESSA V. SULIT, RN, MSC