Bitter Pills:Medicines & The Third World Poor | Page 104

The problem is that drugs are inherently 'unsafe'. According to the British National
Formulary, "Almost any drug may produce unwanted or unexpected adverse
reactions". "6> A professor of clinical pharmacy explains that "a drug's effects
are like shot-gun pellets - some land on target, others do not", so "any drug
produces some undesired effects along with the desired effects ..." (17)
Consequently there are risks to be balanced against possible benefits in the use
of any drug. In Britain, where the use of drugs is controlled by strict 'precription
only' regulations, as many as one patient in ten is reported to suffer some adverse
reaction to a prescription. Furthermore, a Cambridge Regius Professor of
Medicine considers that the estimate of 6,000 deaths each year "associated with
National Health Service prescriptions" is "unlikely to be an under-estimate".(18)
In developing countries where drug use is uncontrolled, the extent of drug-induced
illness is impossible to measure. According to Dr. Silverman, "Among Latin
American medical authorities - especially haematologists, pathologists and other
experts - the damage caused by drugs is believed to be shockingly high".(19) But
most people who take drugs in developing countries are not seen by doctors, let
alone haematologists. In fact hardly any of the people prescribing and selling
medicines in poor countries have any inkling of their possible dangerous sideeffects and interactions with other drugs.
A French pharmacist round that 90% of pharmacies she visited in Mexico were
staffed by unqualified sales assistants. All they knew about drugs they had learnt
from visiting sales representatives. <20) They are fairly typical of drug sellers
throughout the Third World, such as those observed by an anthropologist in El
Salvador. "Pharmacy personnel in small towns have rarely received any formal
training in the use of the products they sell. Some are skilful, but it is not uncommon
for illiterate or semi-literate clerks or children to prescribe and dispense medications
to customers seeking advice." <21)
The hazards are all too obvious. In Mitford market in Dacca, capital of
Bangladesh, we bought one of the latest anti-cancer drugs over the counter. This
drug which is used to treat lethal brain tumours, can have fatal side- effects.(22)
The salesman assured us not only that it was "safe" but. that it "cured all cancers".<23)

'PROBLEM' DRUGS
Manufacturers that we have approached about cases of misleading drug
information and the marketing of harmful and non-essential products in poor
countries invariably stress the differences in opinions and regulations that exist
from one country to another.(24) For example, within Europe drugs considered
too hazardous for sale in Britain and Scandinavian countries are still marketed
in West Germany, Italy and other countries. Undoubtedly this complicates the
issues as there can be as many opinions on the degree of risk of drugs as there
are experts. (25)
But the 'differences' argument is advanced by companies to 'prove' that they are
doing all that can reasonably be expected of them and that it is up to Third World
governments both to decide which drugs they will allow onto the market, and
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