Bitter Pills:Medicines & The Third World Poor | Page 105

to make sure they are used safely. But the argument needs to be turned on its head.
Third World regulatory agencies rely on manufacturers for information on which
to base their decisions. Inevitably manufacturers are in a position to convince
governments that the advantages offered by their products outweigh possible
hazards. As ^result, drugs with known toxic side- effects are freely available in
Third World countries. They are doled out to the unsuspecting often by illiterate
sales assistants, quacks, even children, who can have no idea of the dangers, or
that there may be 'safer' alternatives.
If anything the 'differences' - poverty and uncontrolled drug sales - put even more
onus on manufacturers not to try to market drugs that can do more harm than
good in developing countries, especially when they are not vital. Manufacturers
are understandably sensitive about any singling out of individual 'problem' drugs
- not least because all drugs carry some risk. But some carry more risk than others
particularly in poor countries.

ANTIDIARRHOEALS
The dangers can readily be seen if we look at a number of antidiarrhoeal drugs
widely sold in poor countries. According to WHO, diarrhoea is the major killer
of children under three, particularly babies. (26) Two kinds of drugs are used to
treat diarrhoea. One attacks the underlying infection causing the diarrhoea, the
other stops only the symptoms of the infection, in other words, just the diarrhoea.
Any number of symptomatic antidiarrhoeals are marketed in the Third World.
Amongst the most widely sold are Lomotil, manufactured by Searle, and the CibaGeigy products, Entero-Vioform and Mexaform. All are sold to treat young
children of even very poor families. But experts, including Professor King and
colleagues who compiled a WHO Primary Child Care manual for health workers,
are adamant that "most children with diarrhoea don't need drugs". (27) They
state that symtomatic drugs including diphenoxylate (the active ingredient of
Lomotil) and Entero-Vioform "do not help children and are not necessary" ...
"These drugs often seem to work with adults, because most adult patients with
diarrhoea cure themselves. Many children have diarrhoea and you can waste much
money giving them drugs which do not help." (28) (original emphasis)
Tragically, poor mothers are not aware of this. They do spend money on Lomotil,
Entero-Vioform and Mexaform with the false assurance that these medicines will
make the child better. No-one tells the mother that the immediate threat to her
baby's life is not diarrhoea, but dehydration, which she can prevent with a homemade solution of water, salt and sugar.
Drug sellers through their ignorance, encourage mothers to believe that
antidiarrhoeals will make the babies better. Manufacturers apear to have been
doing very little to warn of the dangers.(29) A mother's false sense of security can
lead to her baby's death.
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