Bitter Pills:Medicines & The Third World Poor | Page 109

The marketing manager of Fisons (Bangladesh) explained to us that manufacturers
can come up against opposition when they attempt to make drug information
more readily available. When Fisons consulted local doctors on whether they would
like drug information to be in the local language, many were fiercely against the
idea. The doctors' stated objection to the proposal was that it would encourage
dangerous self-medication. (56) Clearly they take a dim view of any move that
might make patients less dependent on them.
Similarly, in Central America some major foreign manufacturers are reported
to have "eliminated the package inserts they used to include with their prescription
products, purportedly in an effort to reduce the over-the-co unter sale of these
medications". (57) But this suppression of information had little impact on selfmedication. If anything it made the situation worse.' 'The lack of package inserts
describing indications for use, contra-indications, warnings and doses of
medications led people to misuse products. For example one of the pharmacy
owners was hospitalised as a result of an overdose of a product she took to treat
a headache. The package contained no information regarding dose, very general
indications for use and a label saying 'to be sold only with a physician's
prescription'." (58)
In most developing countries a label that reads "to be dispensed on Doctor's
prescription only" can be little more than decorative. Moreover, because drugs
are so often prescribed by untrained people, the fact that package inserts are
invariably written in technical jargon that is intelligible only to doctors and
pharmacists drastically limits their usefulness. Warnings given in simple, direct
language, or in picture form, could help encourage the safe use of drugs. At the
moment, manufacturers in many cases are failing to put across information
essential to the safe use of their products. In some cases the information given
to Third World prescribers has been dangerously misleading.
The problems are illustrated by the way in which anabolic steroids have recently
been promoted in poor countries. Their use is controversial and limited in
developed countries, not least because they can cause serious toxic side-effects.

ANABOLIC STEROIDS
These drugs have not turned out to be as useful as was once hoped. (59) Their
recommended uses have been shrinking so that in Britain and other developed
countries they are now used for relatively few serious conditons including
osteoporosis (bone disease), blood diseases such as aplastic anaemia, and chronic
kidney failure "with varying degrees of success". (60) They are also given to
women with breast cancer (though less so with modern surgery), people with
chronic debilitating diseases, especially the elderly, and patients after major surgery
to help build up body protein. (6I) But a professor of clinical pharmacy stresses
that it is "much more important to ensure that the patient takes a nourishing diet
(high in protein)" than anabolic steroids. (62)
Anabolic steroids became popularly known as body-builders because of the
publicity over their use by athletes. But the British National Formulary is adamant
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