Bitter Pills:Medicines & The Third World Poor | Page 108

safe", as they urged us to buy handfuls of foil strips to treat "all" diarrhoea.
They gave us vague and contradictory advice about the dosage we should take,
and in many cases, no maximum dosage appeared on the packaging we received.
Ciba-Geigy is by no means the only manufacturer of antidiarrhoeals containing
clioquinol which has not succeeded in ensuring that Third World patients and,
in some cases, even doctors receive any warnings about prolonged use. In
Bangladesh, for example, Fisons' local subsidiary is marketing Fistrep, a product
containing 250mg of "iodochlorhydroxyquinoline" (ie clioquinol under its less
well-known chemical name) and lOOmg of streptomycin sulphate. The dose
recommended for adults in the Bangladesh Presenter's Guide 79 (current in
September 1980) was 1.5g daily. This means that even if they resisted the temptation
to take more, within a week Bengali patients would have taken as much clioquinol
as some of the Japanese SMON victims.<52) Fisons are not of course responsible
for the entry in the Guide, but Fistrep has been selling in foil strips without warnings
of the maximum dose.
At the moment there is no evidence to suggest that Bengalis are particularly
susceptible to SMON. But nor is there any conclusive evidence to prove that they
are any less susceptible than people in Japan, Sweden, or Britain. In the
circumstances there is little room for complacency. (53) A remark recently
attributed to the Managing Director of Fisons (Bangladesh) - if correctly reported
- is particularly disturbing. He is reported to have expressed the view that "We
are businessmen first. First of all we want profits... we are oversensitive about
reports from WHO. Restrictions on drugs and pesticides imposed in the US and
Canada should not be applied in our country because our people are ethnically
and biologically different from others." (54)

BAD INFORMATION MEANS DANGEROUS DRUG USE
It is inevitable that drug use will be even less safe in the Third World if
manufacturers do not make sure that the people dispensing their products
understand how they should be used. Getting the key information across to
'preservers' with no medical training obviously presents major problems,
particularly when so many are illiterate. A Swiss professor of pharmacology
stresses that it is very difficult to balance the conflicting needs of Third World
doctors, untrained drug sellers and illiterate patients, with the added complication
of very limited space. Too much information can be as dangerous as too little.
People may find it all too daunting and ignore all the warnings. (55)
In some cases, even with the best of intentions, manufacturers can end up detracting
from the safe use of their products. In Third World countries it has become
increasingly common to sell drugs in foil strips without cardboard packs or package
inserts. This has the advantage of keeping down prices whilst still protecting drugs
from humidity in tropical climates. But foil strips have the major disadvantage
of allowing almost no space for vital information on dosage, and precautions
for use.
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