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Turunnya Harga obat terserah kemauan politik
Saco-Indonesia.com - Penderita kanker di negara ini mendapat beban vonis dua kali.
Saco-Indonesia.com - Penderita kanker di negara ini mendapat beban vonis dua kali. Selain usia dipastikan berakhir oleh dokter saat stadium mencapai tahap lanjut, vonis kedua adalah mahalnya ongkos harus dikeluarkan untuk obatnya.
Ambil contoh harga sorafenib, zat kimia penting bagi penderita kanker hati atau ginjal supaya perkembangan sel jahat berkurang. Seorang pasien butuh hingga Rp 50-an juta menebus obat itu buat konsumsi rutin sebulan.
Itu di luar biaya kemoterapi Rp 2-6 juta sekali sesi. Tak salah bila Yayasan Kanker Indonesia melansir kira-kira satu penderita butuh biaya Rp 102 juta per bulan untuk mempertahankan hidupnya.
Komponen obat jadi salah satu paling membebani. Hal itu dibenarkan oleh Marius Widjajarta, dokter masuk tim perumus harga obat Kementerian Kesehatan. "Obat riset itu mencakup 20 persen dari yang beredar di pasaran. Rata-rata memang untuk penyakit-penyakit berat, kanker, HIV, flu burung, dan semacamnya. Harganya mahal karena ada paten yang harus dibayarkan pada perusahaan sebagai penemunya," ujarnya kepada merdeka.com awal bulan ini.
Akan tetapi kondisi ini bukannya tanpa jalan keluar. Khususnya supaya harga obat lebih terjangkau bagi penderita penyakit kronis. Akar dari mahalnya obat paten adalah Trade-Related Aspects of Intellectual Property Rights (TRIPS). Ini beleid perlindungan hak paten produsen obat hasil riset wajib dipatuhi Organisasi Perdagangan Dunia (WTO).
Hal itu disampaikan pengamat isu kesehatan dari lembaga swadaya Indonesia for Global Justice, Rachmi Hertanti. Dia meyakini beban ongkos paten menjerat itu masih bisa dilobi pemerintah.
Itu berkaca pada artikel nomor 31 dari ketentuan WTO mengenai TRIPS. "Setiap anggota bebas menggunakan metode sesuai dalam mengimplementasikan ketentuan terdapat dalam perjanjian sesuai ketentuan hukum mereka miliki."
"Artinya suatu negara dibolehkan memproduksi atau mengimpor obat dari pihak ketiga, tidak harus dari pemegang paten, jika ada suatu situasi-situasi yang dianggap darurat," ujar Rachmi. "Sehingga harganya bisa jadi lebih murah."
Pemerintah bukannya tidak mengetahui celah hukum itu. Terbukti pada Oktober 2012, Susilo Bambang Yudhoyono mengeluarkan keputusan presiden mengesampingkan paten dari tujuh obat HIV/AIDS dan hepatitis C dimiliki oleh Merck & Co, GlaxoSmithKline, Bristol-Myers Squibb, Abbott, dan Gilead.
Dampaknya segera dirasakan pasien karena harga obat paten langsung menjadi lebih murah. Contohnya beban belanja lopinavir dan ritonavir dibutuhkan penderita HIV memperpanjang hidupnya menjadi tak sampai Rp 100 ribu buat kebutuhan sebulan.
Rachmi menyatakan pemerintah bisa mengupayakan harga obat paten lain diturunkan meniru kebijakan buat penderita HIV. "Penyakit kanker atau jantung, sebenarnya hampir 70 persen dari penyebab kematian di negara kita, butuh kebijakan serupa," tuturnya.
Apalagi negara di kawasan sudah menjalankan negosiasi TRIPS. Ambil contoh Thailand pada 2008 menerbitkan lisensi mengabaikan paten buat beberapa jenis obat kanker. Hasilnya, harga docetaxel dan letrozol turun 24 kali lipat dari harga normal. Negeri Gajah Putih ini juga mengabaikan paten buat clopidogrel biasa dikonsumsi penderita kanker paru sehingga harganya turun 91 persen dari pasaran.
India lebih agresif lagi mengabaikan paten. Data Organisasi kemanusiaan medis internasional Medecins Sans Frontieres/Dokter Lintas Batas (MSF) menunjukkan negara itu mengabaikan paten atas sorafenib. Obat kanker itu dari awalnya seharga hampir Rp 50 juta, turun drastis menjadi hanya Rp 1,7 jutaan.
Negeri Sungai Gangga, melalui Mahkamah Agung , memaksa perusahaan obat Bayer asal Jerman pada 2012 melepas hak eksklusif paten atas bermacam obat kanker.
"Thailand dan India nyatanya berani, ini perkara kemauan politik saja," kata Rachmi menegaskan.
Masalahnya, pemerintah akhir tahun lalu justru memperlemah daya saing industri farmasi lokal melalui revisi Daftar Negatif Investasi (DNI) untuk sektor farmasi. Perusahaan luar tadinya hanya boleh menguasai 75 persen saham, kini diperbesar jatahnya menjadi 85 persen.
Situasi ini akan membuat mereka semakin dominan dibanding pabrik obat lokal. Sebab, 24 perusahaan asing beroperasi di Indonesia menguasai 80 persen pasar obat paten.
Rachmi mengingatkan kesuksesan India dan Thailand disokong oleh kesiapan farmasi lokalnya memproduksi obat tersebut. Artinya, tanpa ada industri dalam negeri kuat, pengabaian TRIPS jadi percuma. "Kalau asing semakin diperlonggar masuk ke Indonesia, dia harus diwajibkan kerja sama transfer teknologi dengan BUMN farmasi," usulnya.
Marius punya gagasan lain lagi. Dia melihat beberapa obat bermerek dikuasai farmasi asing patennya sudah kadaluarsa. Artinya, status mereka hanyalah generik bermerek. Obat-obat semacam itu, misalnya Topamax, dibutuhkan penderita epilepsi, wajib dikontrol Kementerian Kesehatan.
Dia mengaku punya data generik bermerek adalah satu satu sektor harganya gila-gilaan tanpa pernah dikontrol. "Obat merek itu harganya dilepas begitu saja. Data saya ada yang 40-60 kali lipat dari harga generiknya," kata Marius.
Ini juga perkara kemauan politik. Kenyataannya, Marius melihat data harga obat dipasok industri untuk program pemerintah dilepas hanya 3-4 kali dari biaya produksi. "Mekanisme pengendalian harga jual harus dibuat," kata Ketua Yayasan Pemberdayaan Konsumen Kesehatan Indonesia ini.
Editor : Maulana Lee
Sumber : Merdeka.com
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Editor : Dian Sukmawati
Ghostly Voices From Thomas Edisonís Dolls Can Now Be Heard
Though Robin and Joan Rolfs owned two rare talking dolls manufactured by Thomas Edison’s phonograph company in 1890, they did not dare play the wax cylinder records tucked inside each one.
The Rolfses, longtime collectors of Edison phonographs, knew that if they turned the cranks on the dolls’ backs, the steel phonograph needle might damage or destroy the grooves of the hollow, ring-shaped cylinder. And so for years, the dolls sat side by side inside a display cabinet, bearers of a message from the dawn of sound recording that nobody could hear.
In 1890, Edison’s dolls were a flop; production lasted only six weeks. Children found them difficult to operate and more scary than cuddly. The recordings inside, which featured snippets of nursery rhymes, wore out quickly.
Yet sound historians say the cylinders were the first entertainment records ever made, and the young girls hired to recite the rhymes were the world’s first recording artists.
Year after year, the Rolfses asked experts if there might be a safe way to play the recordings. Then a government laboratory developed a method to play fragile records without touching them.
The technique relies on a microscope to create images of the grooves in exquisite detail. A computer approximates — with great accuracy — the sounds that would have been created by a needle moving through those grooves.
In 2014, the technology was made available for the first time outside the laboratory.
“The fear all along is that we don’t want to damage these records. We don’t want to put a stylus on them,” said Jerry Fabris, the curator of the Thomas Edison Historical Park in West Orange, N.J. “Now we have the technology to play them safely.”
Last month, the Historical Park posted online three never-before-heard Edison doll recordings, including the two from the Rolfses’ collection. “There are probably more out there, and we’re hoping people will now get them digitized,” Mr. Fabris said.
The technology, which is known as Irene (Image, Reconstruct, Erase Noise, Etc.), was developed by the particle physicist Carl Haber and the engineer Earl Cornell at Lawrence Berkeley. Irene extracts sound from cylinder and disk records. It can also reconstruct audio from recordings so badly damaged they were deemed unplayable.
“We are now hearing sounds from history that I did not expect to hear in my lifetime,” Mr. Fabris said.
The Rolfses said they were not sure what to expect in August when they carefully packed their two Edison doll cylinders, still attached to their motors, and drove from their home in Hortonville, Wis., to the National Document Conservation Center in Andover, Mass. The center had recently acquired Irene technology.
Cylinders carry sound in a spiral groove cut by a phonograph recording needle that vibrates up and down, creating a surface made of tiny hills and valleys. In the Irene set-up, a microscope perched above the shaft takes thousands of high-resolution images of small sections of the grooves.
Stitched together, the images provide a topographic map of the cylinder’s surface, charting changes in depth as small as one five-hundredth the thickness of a human hair. Pitch, volume and timbre are all encoded in the hills and valleys and the speed at which the record is played.
At the conservation center, the preservation specialist Mason Vander Lugt attached one of the cylinders to the end of a rotating shaft. Huddled around a computer screen, the Rolfses first saw the wiggly waveform generated by Irene. Then came the digital audio. The words were at first indistinct, but as Mr. Lugt filtered out more of the noise, the rhyme became clearer.
Recently, the conservation center turned up another surprise.
In 2010, the Woody Guthrie Foundation received 18 oversize phonograph disks from an anonymous donor. No one knew if any of the dirt-stained recordings featured Guthrie, but Tiffany Colannino, then the foundation’s archivist, had stored them unplayed until she heard about Irene.
Last fall, the center extracted audio from one of the records, labeled “Jam Session 9” and emailed the digital file to Ms. Colannino.
“I was just sitting in my dining room, and the next thing I know, I’m hearing Woody,” she said. In between solo performances of “Ladies Auxiliary,” “Jesus Christ,” and “Dead or Alive,” Guthrie tells jokes, offers some back story, and makes the audience laugh. “It is quintessential Guthrie,” Ms. Colannino said.
The Rolfses’ dolls are back in the display cabinet in Wisconsin. But with audio stored on several computers, they now have a permanent voice.
Dave Goldberg Was Lifelong Womenís Advocate
Even as a high school student, Dave Goldberg was urging female classmates to speak up. As a young dot-com executive, he had one girlfriend after another, but fell hard for a driven friend named Sheryl Sandberg, pining after her for years. After they wed, Mr. Goldberg pushed her to negotiate hard for high compensation and arranged his schedule so that he could be home with their children when she was traveling for work.
Mr. Goldberg, who died unexpectedly on Friday, was a genial, 47-year-old Silicon Valley entrepreneur who built his latest company, SurveyMonkey, from a modest enterprise to one recently valued by investors at $2 billion. But he was also perhaps the signature male feminist of his era: the first major chief executive in memory to spur his wife to become as successful in business as he was, and an essential figure in “Lean In,” Ms. Sandberg’s blockbuster guide to female achievement.
Over the weekend, even strangers were shocked at his death, both because of his relatively young age and because they knew of him as the living, breathing, car-pooling center of a new philosophy of two-career marriage.
“They were very much the role models for what this next generation wants to grapple with,” said Debora L. Spar, the president of Barnard College. In a 2011 commencement speech there, Ms. Sandberg told the graduates that whom they married would be their most important career decision.
In the play “The Heidi Chronicles,” revived on Broadway this spring, a male character who is the founder of a media company says that “I don’t want to come home to an A-plus,” explaining that his ambitions require him to marry an unthreatening helpmeet. Mr. Goldberg grew up to hold the opposite view, starting with his upbringing in progressive Minneapolis circles where “there was woman power in every aspect of our lives,” Jeffrey Dachis, a childhood friend, said in an interview.
The Goldberg parents read “The Feminine Mystique” together — in fact, Mr. Goldberg’s father introduced it to his wife, according to Ms. Sandberg’s book. In 1976, Paula Goldberg helped found a nonprofit to aid children with disabilities. Her husband, Mel, a law professor who taught at night, made the family breakfast at home.
Later, when Dave Goldberg was in high school and his prom date, Jill Chessen, stayed silent in a politics class, he chastised her afterward. He said, “You need to speak up,” Ms. Chessen recalled in an interview. “They need to hear your voice.”
Years later, when Karin Gilford, an early employee at Launch Media, Mr. Goldberg’s digital music company, became a mother, he knew exactly what to do. He kept giving her challenging assignments, she recalled, but also let her work from home one day a week. After Yahoo acquired Launch, Mr. Goldberg became known for distributing roses to all the women in the office on Valentine’s Day.
Ms. Sandberg, who often describes herself as bossy-in-a-good-way, enchanted him when they became friendly in the mid-1990s. He “was smitten with her,” Ms. Chessen remembered. Ms. Sandberg was dating someone else, but Mr. Goldberg still hung around, even helping her and her then-boyfriend move, recalled Bob Roback, a friend and co-founder of Launch. When they finally married in 2004, friends remember thinking how similar the two were, and that the qualities that might have made Ms. Sandberg intimidating to some men drew Mr. Goldberg to her even more.
Over the next decade, Mr. Goldberg and Ms. Sandberg pioneered new ways of capturing information online, had a son and then a daughter, became immensely wealthy, and hashed out their who-does-what-in-this-marriage issues. Mr. Goldberg’s commute from the Bay Area to Los Angeles became a strain, so he relocated, later joking that he “lost the coin flip” of where they would live. He paid the bills, she planned the birthday parties, and both often left their offices at 5:30 so they could eat dinner with their children before resuming work afterward.
Friends in Silicon Valley say they were careful to conduct their careers separately, politely refusing when outsiders would ask one about the other’s work: Ms. Sandberg’s role building Facebook into an information and advertising powerhouse, and Mr. Goldberg at SurveyMonkey, which made polling faster and cheaper. But privately, their work was intertwined. He often began statements to his team with the phrase “Well, Sheryl said” sharing her business advice. He counseled her, too, starting with her salary negotiations with Mark Zuckerberg.
“I wanted Mark to really feel he stretched to get Sheryl, because she was worth it,” Mr. Goldberg explained in a 2013 “60 Minutes” interview, his Minnesota accent and his smile intact as he offered a rare peek of the intersection of marriage and money at the top of corporate life.
While his wife grew increasingly outspoken about women’s advancement, Mr. Goldberg quietly advised the men in the office on family and partnership matters, an associate said. Six out of 16 members of SurveyMonkey’s management team are female, an almost unheard-of ratio among Silicon Valley “unicorns,” or companies valued at over $1 billion.
When Mellody Hobson, a friend and finance executive, wrote a chapter of “Lean In” about women of color for the college edition of the book, Mr. Goldberg gave her feedback on the draft, a clue to his deep involvement. He joked with Ms. Hobson that she was too long-winded, like Ms. Sandberg, but aside from that, he said he loved the chapter, she said in an interview.
By then, Mr. Goldberg was a figure of fascination who inspired a “where can I get one of those?” reaction among many of the women who had read the best seller “Lean In.” Some lamented that Ms. Sandberg’s advice hinged too much on marrying a Dave Goldberg, who was humble enough to plan around his wife, attentive enough to worry about which shoes his young daughter would wear, and rich enough to help pay for the help that made the family’s balancing act manageable.
Now that he is gone, and Ms. Sandberg goes from being half of a celebrated partnership to perhaps the business world’s most prominent single mother, the pages of “Lean In” carry a new sting of loss.
“We are never at 50-50 at any given moment — perfect equality is hard to define or sustain — but we allow the pendulum to swing back and forth between us,” she wrote in 2013, adding that they were looking forward to raising teenagers together.
“Fortunately, I have Dave to figure it out with me,” she wrote.