Bitter Pills:Medicines & The Third World Poor | Page 107

of diarrhoea and is not recommended for use in children under two years of age provided
these changes are acceptable to local regulatory bodies". (40)
Lomotil is a useful drug of convenience for the rich. But it can cost "up to 25
times more than other widely used symptomatic treatments for diarrhoea". ( 4 "
In response to the concern we have expressed that Lomotil is unlikely to represent
'value for money' for the poor, Searle have sent us the results of various clinical
trials, but the reliability of some of these has been seriously called into question
by Social Audit. <42) The hazards remain. How will illiterate drug sellers
understand that Lomotil is only an "adjunctive treatment" without pictograms
backed by an active health education campaign? (43)
CLIOQUINOL
Ciba-Geigy's antidiarrhoeals, Entero-Vioform and Mexaform, both containing
clioquinol, are freely available over the counter in many developing countries.
In most cases we found them on sale in foil strips, without instructions or warnings.
Sales assistants in Bangladesh, India and North Yemen were obviously completely
in the dark about the controversy that has surrounded the use of clioquinol since
an 'epidemic' of drug-induced illness broke out in Japan in the 1960s. More than
10,000 peop le in Japan were victims of what came to be known as 'SMON' (subacute myelo-optic neuropathy). As a result of using clioquinol, they suffered
numbness, weakness in the legs and eye damage. Some of the people who had taken
prolonged high doses ended up in wheelchairs, others completely blind.(44) It has
since been established that clioquinol can cause "toxic effects on the central nervous
system". (45) The manufacturers of the most-widely sold clioquinol products,
Ciba-Geigy and others, have paid compensation to victims in Japan and
Europe.' 46 '
Entero-Vioform which was once sold over the counter in Britain "for the
prevention and treatment of holiday diarrhoea" was effectively removed from
the British market when all its licensed indications were withdrawn. (471 One
antidiarrhoeal containing clioquinol was still listed in 1981 as available on a
doctor's prescription, but doctors are warned: "Special precaution: avoid
prolonged administration". (48) It has been withdrawn in other developed
countries and the expert committee that decided on the WHO selection of essential
drugs excluded clioquinol because they decided that the risks outweighed the
benefits.(49) But some developing countries have included clioquinol specifically
for use in amoebic dysentry as a three to four day course can be cheaper than
treatment with antibiotics. (50)
Ciba-Geigy's UK-based Head of International Medical Liaison has assured us
that the company is "making genuine attempts to ensure adequate literature and
warnings are given about taking long courses or too many courses which could
give rise to neurological symptoms. The problem is ensuring that this information
reaches the patient." (5I) From our research we know it clearly does not. Salesmen
in North Yemen, India and Bangladesh whom we questioned about the safety
of Entero-Vioform and Mexaform assured us that these drugs were' 'completely
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