Bitter Pills:Medicines & The Third World Poor | Page 101

Direct advertising is of course mainly targeted at the privileged minority in poor countries. But it has exerted a strong influence on the poor, such as in encouraging them to bottle-feed their babies and smoke expensive foreign cigarettes. The direct impact of drug advertising is more difficult to gauge. But advertising aimed exclusively at the educated minority clearly has a strong indirect impact on the poor. It conditions the attitudes and prescribing habits of doctors, who in turn influence the retailers who sell drugs to the poor. There are few meaningful controls on advertising standards in developing countries. Some advertising appears to increase dependence on medicines by playing on fear and ignorance. The advertisment for Calcium-Sandoz, reproduced opposite, appeared in a magazine in India - a country that operates more controls on drug marketing than many. Its message is unambiguous. If you do not hurry to start your child on a calcium supplement, it may soon be "too late. No amount of calcium given later can repair the damage.'' By implication, only these calcium tablets can provide enough calcium for a growing child. This type of advertisement is clearly aimed at India's better- nourished middle-class. But it is likely to help persuade drug sellers that these calcium supplements must be essential for the under-nourished poor. Sandoz point out that average calcium-intake is low in India, which it certainly is by comparison with most of Europe and North America.(l0) They argue that their product provides a cheaper source of calcium in India than relatively highpriced dairy products: one litre of cow's milk costing Rupees 4-6 provides a similar amount of calcium to two tablets of Calcium-Sandoz, priced at Rupees 0.18. ( "' But this comparison takes no account of other important nutrients in cow's milk. "2) Cow's milk is costly, but buffalo milk, with almost twice its calcium value, is readily available in Indian villages, and there are other local foods particularly pulses and vegetables - which people could be encouraged to eat more of to boost their calcium- intake. (13) These alternatives to medicines are masked by advertising campaigns. For example, promotion has opened a large market for vitamin and mineral supplements including extra calcium in Mexico, a country where people get plenty of calcium from tortillas which are soaked in lime. 94